ISSN 0972-978X 

  About COAA







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
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.


Ian Barlow: Basic techniques in safe arthroscopy knee surgery; 2002; 2nd edition, The Royal College of Surgeons of England, London.

 This is a peer reviewed paper 

Please cite as :S Rajkumar, Letter to the editor: Tips For A Safe Knee Arthroscopy

J.Orthopaedics 2005;2(5)e6






Arthrocon 2011

Refresher Course in Hip Arthroplasty

13th March,  2011

At Malabar Palace,
Calicut, Kerala, India

Download Registration Form

For Details
Dr Anwar Marthya,
Ph:+91 9961303044



Powered by



© Copyright of articles belongs to the respective authors unless otherwise specified.Verbatim copying, redistribution and storage of this article permitted provided no restrictions are imposed on the access and a hyperlink to the original article in Journal of Orthopaedics maintained. All opinion stated are exclusively that of the author(s).
Journal of Orthopaedics upholds the policy of Open Access to Scientific literature.