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Knee arthroscopic Surgery in delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
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Diagnostic Knee Arthroscopy
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
Arthroscopy or Viewing Portal
Instrument or Working Portal
Portals should be optimally positioned to permit
-satisfactory inspection
-adequate access to lesion
Arthroscopic Portal 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
Infiltration with LA
Viewing Portal
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
Optimally Positioned-
Access to the lesion
Without damaging cartilage
Minimal instrument
Always after arthroscopic inspection has been done
Location varies according to the site of lesion
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
Skin Incision
-Transverse incision
-Avoid damage to veins
-Avoid damage to peripheral rim meniscus
Instrument Portal
Suprameniscal Portal - post third med.men.
High Medial Portal -Lat.men.
-Post horn med. Men.
-PCL recnstn.
Lateral Suprapatellar Portal
Synovectomy
Loose body removal
Patellar Tracking
Lateral Portal
Removal Loose Body
Posteromedial Portal
Pass scope postero-medially thro’ intercondylar notch in slight flexion.
Then flex the knee to 900
Ext. digital palpation. Pass needle
INDICATION
-Post horn med. Men.
-Loose body removal
-Synovectomy
-PCL reconstruction
Posteromedial Portal
Posterolateral Portal
Indications rare
- Synovectomy
- Loose body removal
Switching Portals
Simple,Safe,Fast
Minimal Tissue Trauma
Switching Rod
Supra-patellar pouch
Patellar Articular Surface
Medial Gutter
Medial Compartment- Meniscus
Articular cartilage
Intercondylar Notch- ACL
PCL
Lateral Compartment- Meniscus
Articular Cartilage
Lateral Gutter
Diagnostic Arthroscopy
Thank You
Problems
Viewing Portal Problem
Extension deficit problem
Adhesions in Ant. Compartment
Medial Patellar Plica
Instrument Portal Problem
Shifting of tissue layers
Skin incision large
Fluid Extravasation in Subcut.tissue
