Calvisi Vittorio, Lupparelli Stefano, Giuliani Pierandrea
Department of Surgery, Università degli Studi dell'Aquila, L'Aquila, Italy.
Arthroscopy. 2007 Mar;23(3):324.e1-5. doi: 10.1016/j.arthro.2006.07.040. Epub 2006 Nov 27.
The use of flexible positions based on the surgeon's need to address specific pathology has been advocated in arthroscopic surgery. In this report we reappraise the midpatellar portals popularized by Patel and present a technique modification of the medial midpatellar portal (mMPP) focusing on its use in anterior cruciate ligament primary and revision arthroscopic surgery. The modified mMPP is established under arthroscopic control from a high anterolateral portal. Its location is more proximal than the original Patel's mMPP. The nearly vertical orientation of the arthroscope and its proximity to the midline offer a wider and almost face-to-face visualization of the intercondylar notch in the coronal plane, which would provide advantages over standard portals. The anteromedial and anterolateral portals may both be used as working portals without crowding because the arthroscope is cranially located. The need to perform notchplasty is reduced, minimizing bleeding from trabecular bone. Aggressive soft-tissue processing in the intercondylar notch to improve visualization is seldom required. The recipient site is less devascularized, which may promote autograft healing. The modified mMPP may also facilitate femoral tunnel placement and setting of an interference screw. It is safe and reproducible and may add to the diagnostic and working capabilities of the knee arthroscopist.
在关节镜手术中，基于外科医生处理特定病理情况的需要，提倡使用灵活的体位。在本报告中，我们重新评估了由帕特尔推广的髌中入路，并提出了内侧髌中入路（mMPP）的技术改进，重点介绍其在初次和翻修关节镜下前交叉韧带手术中的应用。改良后的mMPP是在关节镜控制下通过高位前外侧入路建立的。其位置比原来的帕特尔内侧髌中入路更靠近近端。关节镜几乎垂直的方向及其与中线的接近程度，在冠状面上提供了更宽且几乎面对面的髁间窝视野，这比标准入路更具优势。由于关节镜位于头侧，前内侧和前外侧入路均可作为操作入路而不会造成拥挤。进行髁间窝成形术的需求减少，从而使小梁骨出血最小化。很少需要在髁间窝进行积极的软组织处理以改善视野。受区血管破坏较少，这可能促进自体移植物愈合。改良后的mMPP还可能便于股骨隧道的置入和干涉螺钉的安置。它安全且可重复，可能会增强膝关节镜医生的诊断和操作能力。
