Posterior Knee Arthroscopy (With Portal Placement)

Recent advances in arthroscopic technique and increased understanding of the utility of posterior knee instrumentation have led to a swift increase in the prevalence of posterior knee arthroscopy. Despite the increased prevalence, posterior knee arthroscopy remains technically challenging for many surgeons due to the historical relative infrequency of its indications. However, as these indications have continued to expand, the experienced arthroscopist has begun to see posterior knee arthroscopy as a tool to be used in a wide variety of circumstances rather than a rare and unnecessary technique.Transcondylar notch visualization is the traditional and fastest way to arthroscopically examine the posterior knee. It is achieved by passing the arthroscope from an anterior entry site through the interval between the femoral condyle and the cruciate ligament on either side of the intercondylar notch into the posterior knee.The posteromedial and posterolateral accessory portals are utilized when transcondylar notch visualization is not possible or inadequate. These portals are created at the respective soft spots on either side of the posterior knee and pose minimal risk to surrounding structures with proper technique. The posterior transseptal portal allows passage of the arthroscope or other instruments from the posteromedial to the posterolateral compartment and vice versa.The use of these techniques facilitates the performance of posterior cruciate ligament reconstruction or repair, all-inside posterior horn meniscal repair and repair of ramp lesions, removal of loose bodies, excision of cysts or tumors, total arthroscopic synovectomy, and identification of far posterior cartilage lesions on the femoral condyles.