basics of knee arthroscopy, clinical anatomy, interpretation of MRI, INSTRUMENTS AND THEIR USE, diagnostic steps, troubleshooting, PICTORIAL DEPICTION

1. BASICS OF KNEE ARTHROSCOPY
DR. D. P. SWAMI
DPS " ONLY FOR EDUCATIONAL PURPOSES"

2. CLINICAL ANATOMY…IN BRIEF
DPS " ONLY FOR EDUCATIONAL PURPOSES"

3. CLINICAL ANATOMY…IN BRIEF
DPS " ONLY FOR EDUCATIONAL PURPOSES"

4. CLINICAL ANATOMY…IN BRIEF
DPS " ONLY FOR EDUCATIONAL PURPOSES"

5. HOW TO READ MRI…T1 WEIGHTED
CORONAL VIEW
1. VASTUS
MEDIALIS
2. FEMUR
3. VASTUS
LATERALIS
4. PCL
5. ACL
6. TIBIAL
COLLATERAL LIG.
7. FUBULAR
COLLATERAL LIG.
8. MEDIAL
MENISCUS
9. LATERALDPS " ONLY FOR EDUCATIONAL PURPOSES"

6. HOW TO READ MRI…T2 WEIGHTED
CORONAL VIEW
1. VASTUS
MEDIALIS
2. FEMUR
3. VASTUS
LATERALIS
4. PCL
5. ACL
6. TIBIAL
COLLATERAL
LIG.
7. FUBULAR
COLLATERAL
LIG.
8. MEDIALDPS " ONLY FOR EDUCATIONAL PURPOSES"

7. HOW TO READ MRI…T2 WEIGHTED
SAGITTAL VIEW
1.VASTUS MEDIALIS
2.FEMUR
3.MEDIAL MENISCUS
ANTERIOR HORN
4.TIBIA
5.GASTROCNEMIUS
6.MEDIAL MENISCUS
POTERIOR HORN
7.SEMITENDINOSUS
8.SEMIMEMBRINOSUS
DPS " ONLY FOR EDUCATIONAL PURPOSES"

8. HOW TO READ MRI…T2 WEIGHTED
SAGITTAL VIEW
1.VASTUS MEDIALIS
2.QUADRICEPS TEN
3.PATELLA
4.PATELLAR TENDO
5.ACL
6.TIBIA
7.GASTROCNEMIUS
8.PCL
DPS " ONLY FOR EDUCATIONAL PURPOSES"

9. BE FAMILIAR WITH ARMORY…AND
UNDERSTAND HOW TO USE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

10. BE FAMILIAR WITH ARMORY…AND
UNDERSTAND HOW TO USE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

11. BE FAMILIAR WITH ARMORY…AND
UNDERSTAND HOW TO USE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

12. BE FAMILIAR WITH ARMORY…AND
UNDERSTAND HOW TO USE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

13. BE FAMILIAR WITH ARMORY…AND
UNDERSTAND HOW TO USE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

14. BE FAMILIAR WITH ARMORY…AND
UNDERSTAND HOW TO USE
CAUTERY
DPS " ONLY FOR EDUCATIONAL PURPOSES"

15. LANDMARKS…
DPS " ONLY FOR EDUCATIONAL PURPOSES"

16. LANDMARKS…
DPS " ONLY FOR EDUCATIONAL PURPOSES"

17. LANDMARKS…
DPS " ONLY FOR EDUCATIONAL PURPOSES"

18. PROCEDE: STEP BY STEP
DPS " ONLY FOR EDUCATIONAL PURPOSES"

19. PROCEDE: STEP BY STEP
CL
PCL
PATELLA
TROCHLEA
FEMUR
TIBIA
MEDIAL MENISCUS
FEMUR
TIBIA
SUPRAPATELLAR POUCH
MEDIAL GUTTER
LATERAL GUTTER
INTERCONDYLAR NOTCH
DPS " ONLY FOR EDUCATIONAL PURPOSES"

20. PRESTEP: KNOW WHAT ARE YOU
GOING TO HANDLE….
DPS " ONLY FOR EDUCATIONAL PURPOSES"

21. PRESTEP: KNOW WHAT ARE YOU GOING TO HANDLE….
•BOTH CAMERA AND LIGHT SOURCE CAN MOVE AROUND:
USEFUL BUT CONFUSING
•CAMERA CONTROLLS YOUR HORIZON
•LIGHT SOURCE WORKS ON INCLINATION ANGLE AND VIEW
TOWRDS OPPOSITE SIDE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

22. PRESTEP: KNOW WHAT ARE YOU
GOING TO HANDLE….
JUST OBSERVE PICTURES SEQUENTIALY
AND OBSERVE THE TIP OF SCOPE AND
POSITION OF CAMERA AND LIGHT SOURCE:
WILL HELP IN ORIENTATION AND VISUALISATION
OF ALL ANATOMICAL DETAILS
DPS " ONLY FOR EDUCATIONAL PURPOSES"

23. PRESTEP: HOW TO HOLD…
BY HOLDING TROCHAR AND LIGHT
SOURCE WITH EXTENDED FINGERS
BY HOLDING CAMERA ONLY
DEPENDS ON EXPERIENCE AND CHOICE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

24. STEP 1: PATIENT POSITION
•TOURNIQUET WITH ADEQUATE PADDING
•SIDE SUPPORT: AT JUNCTION OF PROXIMAL AND MIDDLE THIRD OF THIGH!
•CHECK: SURGEON MUST BE ABLE TO ABDUCT LIMB, APPLY VALGUS/VARUS FORCE AND
MAKE FIGURE OF 4 POSITIONDPS " ONLY FOR EDUCATIONAL PURPOSES"

25. STEP 2: CLEAN-DRAP AND MARKING
PALPATE AND MARK
FEEL: SOFT SPOT
DPS " ONLY FOR EDUCATIONAL PURPOSES"

26. STEP 3: PORTAL PLACEMENT…ANTEROLATERAL
•HORIZONTAL/ VERTICAL
•HORIZONTAL: COSMATICALY BETTER BUT DIFFICULT TO MANAGE IF
PORTAL IS VERY HIGH/LOW
•KEEP CUTTING EDGE OF BLADE OPPOSITE TO PATTELLAR TENDON
•AVOID DEMAGE TO MENISCUS OR ARTICULAR CARTILAGE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

27. STEP 3: PORTAL PLACEMENT…ANTEROLATERAL
CHECK WHITE BALANCE
INSERT SCOPE
CAMERA
HAND PIECE
ARTHROSCOPE
INSERT TROCAR IN SAME DIRECTION
EXTEND KNEE AND DIRECT TROCHAR BETWEEN
TROCHLEA AND PATELA
DPS " ONLY FOR EDUCATIONAL PURPOSES"

28. STEP 4: IRRIGATE KNEE
IT ‘LL IMPROVE VISUAL CLEARITY
OBSERVED DRAP IN PIC??- CHECK
IT BEFORE HAND AND AVOID
SPILAGE OF FLUID
DPS " ONLY FOR EDUCATIONAL PURPOSES"

29. STEP 5: VISUALIZE: UNDER SURFACE
OF PATELLA
KEEP KNEE: EXTENDED
CAMERA: HORIZONTAL
LIGHT SOURCE: DOWNWARD
LOOK FOR DAMAGE TO ARTICULAR CARTILAGE AND MEDIAL AND LATERAL FACET OF PATELA
DPS " ONLY FOR EDUCATIONAL PURPOSES"

30. STEP 6:MAKE ANTERO-MEDIAL
PORTAL
KEEP KNEE: FLEXION
CAMERA: HORIZONTAL
LIGHT SOURCE: FACING LATERALY
USE WIDE BORE CANNULA FOR DIRECTION FOLLOWED BY SKIN INCISION AND PREPARATION OF
PORTAL WITH TROCAR
AVOID DAMAGE TO MENISCUS
MUST BE MADE UNDER VISION AND PROPER ORIENTATION
DPS " ONLY FOR EDUCATIONAL PURPOSES"

31. STEP 7:MEDIAL COMPARTMENT
FEMORAL CONDYLE
TIBIA
KEEP KNEE: FLEXION; VALGUS FORCE TO OPEN UP MEDIAL COMPARTMENT
CAMERA: HORIZONTAL
LIGHT SOURCE: FACING LATERALY
LOOK FOR: MENISCAL TEAR, OSTEOCHONDRAL DEFECT
DPS " ONLY FOR EDUCATIONAL PURPOSES"

32. STEP 8: NOTCH
KEEP KNEE: FLEXION
CAMERA: HORIZONTAL
LIGHT SOURCE: FACING DOWNWARD
SHAVE SYNOVIUM: KEEP IN MIND DIRECTION OF CUTTING EDGE (JUST POINTS OPPOSITE TO
SHAVER BUTTON)
AVOID SHAVING TOO POSTERIOR (DEMAGE TO ACL) AND TOO ANTERIOUR (PATELLAR TENDON)
Look for: ACL AND USE PROBE TO CHECK INTEGRITY
BE FAMILIAR WITH LIGAMENTUM MUCOSUM
ACL
NOTCH
DPS " ONLY FOR EDUCATIONAL PURPOSES"

33. STEP 9: LATERAL COMPARTMENT
KEEP KNEE: FIGURE OF 4 (PARK PROBE BETWEEN ACL AND LATERAL FEMORAL CONDYLE TO
AVOID LOSS OF ORIENTATION )
CAMERA: PERPENDICULAR TO TIBIAL PLATEAU
LIGHT SOURCE: FACING INFERO MEDIALLY
LOOK FOR: LATERAL MENISCUS, OSTEOCHONDRAL DEFECT, OSTEOPHYTES
LATERAL MENISCUS
DPS " ONLY FOR EDUCATIONAL PURPOSES"

34. TROUBLESHOOTING….PORTAL
PLACEMENT
HIGH LOW
APPROPRIATE
DIFFICULT TO VISUALIZE POSTERIOR
HORN OF MEDIAL MENISCUS
YOU MAY INJURE MENISCUS AND
MAY FACE STUCK IN TO MOVE SCOPE
DPS " ONLY FOR EDUCATIONAL PURPOSES"

35. TROUBLESHOOTING….DIFFICULTY IN
VISUALIZATION OF INSTRUMENTS
•FOLLOW RULE OF TRIANGULATION
•CHECK: IN WHICH DIERECTION SCOPE IS LOOKING!!
•TRY TO TOUCH INSTRUMENT TO SCOPE ANYWHERE AND MOVE INSTRUMENT UNTIL IT COMES
IN VISION
•REDUCE ANGLE BETWEEN INSTRUMENT AND SCOPEDPS " ONLY FOR EDUCATIONAL PURPOSES"

36. TROUBLESHOOTING….KEEP SCOPE AND LIMB POSITION
APROPRIATE FOR AREA TO VIEW
DPS " ONLY FOR EDUCATIONAL PURPOSES"