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Diagnostic Knee Arthroscopy

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Dr Shekhar Srivastav Sr Consultant- Knee & Shoulder Sant Parmanand hospital,Delhi


Arthroscopic Portal

Provides access to knee joint to LOOK and FEEL


Portal Placement Two portals ďƒ‘ Arthroscopy or Viewing Portal ďƒ‘ Instrument or Working Portal Portals should be optimally positioned to permit -satisfactory inspection -adequate access to lesion


Arthroscopic Portal ďƒ‘

Common portals Anterolateral Portal- Viewing Portal Anteromedial Portal- Working Portal Other Portals Posteromedial ,Posterolateral Superolateral , Superomedial Central (Gillquist) Portal


Viewing Portal

ANTEROLATERAL PORTAL  Position of Knee  Draping


Viewing Portal

Portal site-level of patellar apex just lat. to patellar tendon -hollow spot just above lat. Tibial condyl ďƒ‘ Infiltration with LA

ďƒ‘


Viewing Portal

ďƒ‘

Skin Incision- 700 Knee Flexion


Viewing Portal Insertion of Sheath  Skin and capsule inserted at 700 knee fexion  After capsule has been inserted extend the knee completely and direct sheath towards suprapatellar pouch 


Instrument Portal Access for Probes and Surgical Instrument ďƒ‘ Optimally PositionedAccess to the lesion Without damaging cartilage Minimal instrument Always after arthroscopic inspection has been done Location varies according to the site of lesion ďƒ‘


Instrument Portal ANTEROMEDIAL PORTAL Needle Technique Needle inserted at transilluminated site  Needle advanced under visual guidance to target structure  If access less than satisfactory- reposition the needle


Instrument Portal Infiltrate LA ďƒ‘ Skin Incision -Transverse incision -Avoid damage to veins -Avoid damage to peripheral rim meniscus ďƒ‘


Instrument Portal Suprameniscal Portal - post third med.men. ďƒ‘ High Medial Portal -Lat.men. -Post horn med. Men. -PCL recnstn. ďƒ‘


Lateral Suprapatellar Portal

Synovectomy  Loose body removal  Patellar Tracking 


Lateral Portal ďƒ‘

Removal Loose Body


Posteromedial Portal Pass scope postero-medially thro’ intercondylar notch in slight flexion. 0  Then flex the knee to 90  Ext. digital palpation. Pass needle  INDICATION -Post horn med. Men. -Loose body removal -Synovectomy -PCL reconstruction 


Posteromedial Portal


Posterolateral Portal

ďƒ‘

Indications rare - Synovectomy - Loose body removal


Switching Portals

Simple,Safe,Fast  Minimal Tissue Trauma  Switching Rod 


Diagnostic Arthroscopy Supra-patellar pouch  Patellar Articular Surface  Medial Gutter  Medial Compartment- Meniscus Articular cartilage  Intercondylar Notch- ACL PCL  Lateral Compartment- Meniscus Articular Cartilage  Lateral Gutter 


Thank You


Viewing Portal Problem Extension deficit problem Adhesions in Ant. Compartment Medial Patellar Plica ďƒ‘ Instrument Portal Problem Shifting of tissue layers Skin incision large Fluid Extravasation in Subcut.tissue ďƒ‘

Problems


Knee arthroscopy in delhi by dr shekhar srivastav  

Knee arthroscopy in delhi by dr shekhar srivastav - Best Orthopaedic Surgeon In Delhi Dr. Shekhar Srivastav is an Orthopedic Surgeon attach...

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