Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A.
Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A..
Arthroscopy. 2018 Jul;34(7):2201-2206. doi: 10.1016/j.arthro.2018.02.006. Epub 2018 Apr 12.
This study attempted to define a reproducible "safe zone" based on extra- and intra-articular knee anatomy for placing one or 2 accessory portals in the lateral tibiofemoral compartment for posterolateral region viewing.
Standard portals were created in 10 cadaveric knees to enable posterolateral region arthroscopic lateral tibiofemoral joint compartment viewing. After identifying the lateral knee surface tissue "soft spot," an accessory posterolateral portal (A) was created using an 18-gauge spinal needle and 4-mm cannula under direct visualization of a 70° arthroscope through the anteromedial portal. A second accessory portal (B) was then created 1 cm posterior and 1 cm superior to portal A. Accessory portal locations were measured relative to capsular fold and popliteus tendon locations. Distances from the peroneal nerve, lateral collateral ligament, popliteus tendon, and the biceps tendon were determined. Statistical analysis compared portal location differences from key anatomical structures (P < .05).
Accessory portal A (mean ± 95% confidence interval) was located 8.8 ± 2.7 mm from the popliteus tendon, 11.6 ± 2.7 mm from the lateral collateral ligament (LCL), 26.8 ± 2.3 mm from the peroneal nerve, and 4.9 ± 2.5 mm from the biceps tendon. Accessory portal B was located 17.3 ± 2.8 mm from the popliteus tendon, 20 ± 2.8 mm from the LCL, 30.3 ± 3.3 mm from the peroneal nerve, and 7.0 ± 4.8 mm from the biceps tendon. Accessory portal B was located a greater distance from the LCL and the popliteus tendon than portal A (P < .0001).
Using intra- and extra-articular anatomic landmarks, both accessory portals could be safely placed in the lateral tibiofemoral joint compartment to enable posterolateral region viewing. Accessory portals used individually or in combination may enable easier posterolateral region viewing for arthroscopic repair of lateral tibiofemoral compartment structures.
Lateral tibiofemoral compartment portals can be safely created to enable improved visibility for complex arthroscopic procedures in the posterolateral viewing region.
本研究试图根据膝关节内外解剖结构，为外侧胫股关节后外侧区域的关节镜检查定义一个可重复的“安全区”，以放置一个或两个辅助入路。
在 10 具尸体膝关节中建立标准入路，以实现后外侧区域关节镜下外侧胫股关节间室的观察。在确定膝关节表面组织“软点”后，通过前内侧入路使用 70°关节镜直视下，使用 18 号脊针和 4mm 套管建立辅助后外侧入路（A 入路）。然后，在 A 入路后 1cm 和上 1cm 处创建第二个辅助入路（B 入路）。根据关节囊皱襞和腘肌腱的位置测量辅助入路的位置。测量腓总神经、外侧副韧带、腘肌腱和二头肌肌腱的距离。统计学分析比较了与关键解剖结构的入路位置差异（P<0.05）。
辅助入路 A（平均值±95%置信区间）距腘肌腱 8.8±2.7mm，距外侧副韧带（LCL）11.6±2.7mm，距腓总神经 26.8±2.3mm，距二头肌肌腱 4.9±2.5mm。辅助入路 B 距腘肌腱 17.3±2.8mm，距 LCL 20±2.8mm，距腓总神经 30.3±3.3mm，距二头肌肌腱 7.0±4.8mm。与入路 A 相比，入路 B 距 LCL 和腘肌腱的距离更远（P<0.0001）。
使用关节内和关节外解剖标志，可以安全地将两个辅助入路放置在外侧胫股关节间室中，以实现后外侧区域的观察。单独或联合使用辅助入路可能更便于关节镜下外侧胫股间室结构的后外侧区域观察。
可以安全地创建外侧胫股间室入路，以改善后外侧观察区域复杂关节镜手术的可视性。
