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Tips For
A Safe Knee
Arthroscopy
S Rajkumar D.Orth, FRCS, M.Ch-Orth
Senior Clinical Fellow-Orthopaedics,
Wexham Park Hospital, Slough SL2 4HL, U.K.
Basic Standards
1. Safety is of paramount importance.
2. Always ask for senior help if in doubt.
3. Make sure the indications for arthroscopy is correct before
placing the patient in the list.
4. Obtain full informed written consent
including risks involved and mark the limb.
5. Ask about peripheral vascular disease and sickle cell status
before applying the tourniquet.
6. Avoid placing tourniquet if planning
for synovial biopsy.
7. Place the tourniquet high so as not to
interfere with superior portals placement.
8. EUA must always precede the operative
procedure.
9. Be familiar with all the instruments,
sizes and assembly.
10. Do not use sharp trocar as it may
damage the articular cartilage.
11. Obtain a white balance before
proceeding to insert the scope.
12. Ensure that the scope and instruments
can be passed effortlessly into the knee if this not possible due to flexion
of knee, resite the
portals.
13. Ensure the orientation of camera is
anatomically constant at all times.
14. Maximise the viewing window by
rotating the scope.
15. Familiarise with the magnifying
changes seen on ‘pistoning’ the scope.
16. Keep a routine for your examination;
remembering the gutters, trochlea grove and to examine the ACL and PCL with the
hook.
17. Do not forget the blunt hook is
important for performing diagnostic arthroscopy.
18. Do not send synovial samples taken
from shaver as this cannot be processed.
19. Never allow the tip of scope to touch
the patient or the drape as it is hot and can cause burns.
20. Don’t forget to check for tracking of
patella.
Do not forget
1. The most common portal error is low
placement.
2. The lateral compartment is best viewed
with leg in figure of 4 position.
3. Access difficulty to lateral
compartment can be solved by switching portals or resecting ligamentum mucosum.
4. To view a tight posterior-medial
corner:
- Ensure maximum external rotation of
tibia and valgus
- Try varying the flexion angle of the
knee
- Ensure the light cable entry port on
the scope is parallel to joint line.
5. Always send a synovial fluid sample for
histopathology and culture but should not replace a biopsy specimen.
6. The commonest cause for poor picture
quality is inadequate light owing to damaged light leader or scope.
7. A sensation of metal striking metal
invariably means that the angle between the scope and instrument is excessive;
close the angle by bringing the hands together and advance the scope.
8. Save the hard copies of pictures and
label it with name, date of birth.
9. Always document clearly and legibly;
EUA findings, tourniquet time and pressure, operative findings, procedure
performed, post-op instructions including physiotherapy and follow-up.
10. Don’t forget post-op pain relief;
analgesics, intraarticular injections etc.
Do not panic
If a complication does occur, explain and
reassure the patient, consult your senior and treat accordingly and promptly.
References:
Ian Barlow: Basic
techniques in safe arthroscopy knee surgery; 2002; 2nd edition, The Royal College of Surgeons of England,
London.
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