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Introduction of
Knee
Arthroscopy

Dwikora Novembri Utomo

Orthopaedi & Traumatologi Dr Sutomo Hospital,

Surabaya
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History of Arthroscopy
+ ……History of Arthroscopy

 Hebrew Literature

 Lichtleiter (1806) : used a candle to reflect light into the bladder through a
tube while the surgeon looked through another tube

 Edison’s invention (1886): carbon filamen light bulb

 Jacobaeus (1910) : laparoscope

+ ……History of Arthroscopy

 1918 : Takagi (Japan)

 Viewed the interior cadaver’s knee joint

with Charrier number 22 cystoscope

 1921 : Eurgen Bircher (Switzerland)

Reported the first european series

 1932 : the first photograph through the

arthroscope

 1957 : First edition Atlas of arthroscopy

 1969 : Arthroscopy was first presented in

international orthopaedic meeting

Prof. Takagi
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Knee Arthroscopy

Function :

1. DIAGNOSTIC

2. “SURGERY & RECONSTRUCTIVE”

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ARTHROSCOPY SURGICAL
PROCEDURES
 REMOVE LOOSE BODIES
 REPAIR / EXCISI MENISCUS
 SYNOVECTOMY
 LATERAL RELEASE
 OSTEOCHONDRITIS DISCECANS
 OSTEOCHONDRAL AUTOGRAFT TRANSFER
 ACL /PCL RECONSTRUCTION
 DEBRIDEMANT,WASHING,MICROFRACTURE
OSTEOARTHRITIS
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Arthroscopy Basic Tools

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 Arthroscopes and camera

 Irrigation System

 Shaver System

 Hands system
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Arthroscopes and camera

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 Triple chip,HD camera head has become standart

 Camera requirement
 Resolution
 Field of view
 Small scope diameter (knee : 4mm,0, 30,70 degree)

LIGHT SOURCE
300-350 watt
Tungsten, halogen,xenon
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……Camera system
+ ……TELESCOPE/SCOPE

 The preferred telescope for

general use is the 30 degree
fore oblique.
 A 70 degree telescope provide
greater access to the
posteromedial &
posterolateral
compartment ,especially for
the experience arthroscopist
+ ……TELESCOPE/SCOPE
+ ……TELESCOPE/SCOPE
+ ……TELESCOPE/SCOPE
……TELESCOPE/SCOPE
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Irrigation System
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Irigation System

 Computerized irrigation system

 Adjustable preasure and flow
 Increase ability of “vision”
 Hemostasis control
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Distention is essential for arthroscopy viewing

 , as it pushed synovial fluid and other structures out of the way in

viewing area

 Expand internal capacity of joint

 Allowing greater manueverability of arthroscope

 Knee :60-80mmHg,shoulder 30mmHg bellow systole

PZ, RL,Glycine,manitol 5%(may prevent excessive lost of proteoglycan

from hyaline cartilage)
+ ……Irigation system
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Shaver System
+ ….Shaver System

 As surgeon hand tool

 Function:
 Blades
 Burrs
 Saw
 Drill

 Disposable

 Different size, shape, angles, blades

+ ….Shaver System
+ ….Shaver System
+ ….Shaver System
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Hands Instrument
+ …….Hands Instrument

 probe

 cutting instruments
 grasping instruments
 nibbling instruments
 special instruments for special surgery
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Probe

 Better term as extension of arthroscopist finger

 Ussually probes a right angle of 3-4mm to measure size of defect etc

 to palpate intraarticular structure

 To feel consistency

 To determine depth

 To probe fossae and recess

 To manuevere intraarticular structure

+ ……Cutting Instrument
+ ……Cutting Instrument


+ ……Grasping Instrument
……Grasping Instrument
+ ……Nibbling Instrument
……Nibbling Instrument
……Nibbling Instrument
……Nibbling Instrument
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Portal Placement
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Standard portals

1. Anterolateral
2. Anteromedial
3. Posteromedial
4. Superolateral
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Anterolateral portal
• a 4-mm-diameter
• 30-degree oblique
forelens arthroscope
• 1 cm above the lateral
joint line
• 1 cm lateral to the margin
of the patellar tendon
• 1 cm inferior to the
patella
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Anteromedial portal

• additional viewing of the

lateral compartment
• 1 cm above the medial
joint line
• 1 cm inferior to the tip
of the patella
• 1 cm medial to the edge
of the patellar tendon
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Posteromedial portal
• palpated easily with
the knee flexed to 900

• in a small triangular soft

spot formed by the
posteromedial edge of
the femoral condyle and
the posteromedial edge
of the tibia
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Superolateral portal
•
The knee flexed to 900

• at the point where a line

drawn along the posterior
margin of the femoral
shaft intersects a line
drawn along the posterior
aspect of the fibula
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Principles of Triangulation
• Involves the use of one or more instruments that are inserted through
separate portals and brought into the optical field of the arthroscope

• The tips of the instrument and arthroscope forming the apex of a triangle

• Improved visualization

• Optical angle of telescope can be varied

• Need more skillfull psychomotor

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Portals

• Standard anterolateral
portal for arthroscope
2 1
and anteromedial potal 3
for probe
• The third portal can be
added
• The telescope should be
in the middle portal
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Thanks for the attention