Knee Arthroscopy
Arthroscopic procedures are a welcome alternative to total joint replacement and, with millions of procedures performed each year, the field of knee arthroscopy is rapidly advancing as instrumentation and applications are developed and refined. Knee Arthr
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Introduction Arthroscopy of the knee is the most common orthopaedic procedure performed in the United States [1–6]. Given the frequency of this procedure, it is hard to fathom that knee arthroscopy did not enter into the mainstream of orthopaedic surgery until the 1970s. In 1969, Masaki Wantanabe and colleagues published the Atlas of Arthroscopy [7]. In their seminal publication, they described the results of their first arthroscopic procedure, the removal of an intraarticular pigmented villonodular synovitis (PVNS), and provided pictures of their first arthroscopic meniscectomy. Jackson and Abe followed up on the work of their Japanese peers with the publication of their arthroscopic technique and outcomes in 1972 [8]. Arthroscopy of the knee became an accepted practice in the 1970s. Several forward-thinking orthopaedists contributed to the early evolution of knee arthroscopy, developing the techniques and tools that are still used today [9–12]. Over the past 40 years, knee arthroscopy has evolved from a rudimentary diagnostic tool to a state-of-the-art system of fiber optics and precision equipment. Knee arthroscopy has become a standard part of orthopaedics. It is the foundation for procedures ranging from the simple meniscectomy, to the multiligamentous knee injury, to cartilage restoration. First, the techniques of knee arthroscopy and the anatomy of the knee will be examined.
Anatomy External Anatomy Most knees have palpable bony prominences that can be used to determine the topography of the knee (Fig. 1). The patella,
A. Schena () Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
Fig. 1 Anterior knee anatomy and portal placement
patella tendon, and the medial and lateral joint line are usually accessible. The medial and lateral condyles are also useful for identifying and mapping out the knee
Intraarticular Anatomy Familiarity with the basic anatomy of the knee is essential for knee arthroscopy and treatment of knee pathology. In the patellofemoral joint, the patella should sit within the natural groove of the trochlea. There is a prominent medial and lateral facet. The inferior pole is generally nonarticulating. The patella should track well through the trochlea when brought through a range of motion. There should be no evidence of an overriding plica on the medial side of the normal knee. In the medial compartment, the “C” medial meniscus is firmly attached to the joint capsule by the meniscotibial (coronary) ligament. The mid aspect of the meniscus is directly attached to the deepest fibers of the medial collateral ligament. The width of the meniscus from the capsule to the inner aspect is approximately 9–10 mm.
B.P. McKeon et al. (eds.), Knee Arthroscopy, DOI 10.1007/978-0-387-89504-8 1, © Springer Science+Business Media, LLC 2009
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The average thickness of the meniscus is 3–5 mm. The medial meniscus will bear 40% to 50% of the joint force in extension and up to 85% to 90% of the force in flexion [13]. In general, there should be less than 5 mm of translation o
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