Proximal approaches to arthroscopic surgery of the knee

Arthroscopic surgery of the knee has become more popular recently because of better optics and instrumentation. The currently available techniques and approaches for doing surgery as well as their drawbacks are summarized. The author's new technique is described. The anterior and lateral compartments and popliteal tunnel could not be adequately visualized with the existing techniques. Distortion of image, magnification, crowding, and collision were found in the distal approaches during surgery. Injuries to the anterior compartment of the knee as the instruments come blindly in and out can also cause damage to the fat pad and the menisci. By inserting the arthroscope proximally (midpatellar lateral, midpatellar medial) and using inferomedial and inferolateral portals for instruments, the surgery and the above problems have been minimized. The drawbacks of this technique are initial confusion in orientation and poorer placement of the arthroscope. The posterior cruciate ligament cannot been seen using this technique. The posterolateral portion of the lateral meniscus and to some extent the posteromedial portion of the medial meniscus are, in inexperienced hand, somewhat difficult to see. The technique of menisectomy is described.