The Hip: Preservation, Replacement and Revision

Medial Portals

- Anteromedial Portal:
    - for visualization of the lateral compartment, and instrumentation of the the medial compartment;
    - this portal is located in a manner similar to the anterolateral portal, that is, 1 cm above the medial joint line and 1 cm medial to the edge of the patellar tendon;
           - if the portal is to be made adjancent to the patellar tendon, consider placement slightly higher than usual to avoid the fat pad;
    - mark out the posterior joint line to ensure that instruments will have adequate access to the posterior meniscus (should meniscal repair be needed);
           - generally instruments should not be placed more than 15 deg off of the tibial articular surface;
    - use spinal needle to pin point proper entry point
    - entry is at intersection of inferior and medial edges of patella;
    - direct needle slightly more inferiorly than the arthroscope and direct needle towards posterior horn of medial meniscus;
    - medial meniscus is vulnerable  during suprameniscal portal placement;
          - when using knife, blade should be directed upward when the skin and capsule is incised;


- Posteromedial portal:
    - portal is located in small, triangular soft spot formed by postero-medial edge of the femoral condyle & posteromedial edge of tibia;
    - location of the portal should be about 1 cm above posteromedial joint line and precisely at posteromedial margin of the femoral condyle;
    - w/ angled lens, may visualize PCL & posterior horn of medial meniscus;
    - ref:
            - Arthroscopic posteromedial visualization of the knee.

- Misc:
    - fat pad:
           - when fat pad appears prominent and is obstructing visualization, resist the urge to shave away the fat pad;
           - instead, attempt to "push and pull" the scope either into the notch or the supra-condylar pouch in order to pull the fat pad anteriorly out of the field of vision

The posteromedial portal in knee arthroscopy: an analysis of diagnostic and surgical utility.  

Posterior portals for arthroscopic surgery of the knee.                   

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 13, 2012 3:36 pm