Keyhani Sohrab, Movahedinia Mohammad, Sherafat Vaziri Arash, Soleymanha Mehran, Vosoughi Fardis, Tahami Mohammad, LaPrade Robert F
Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Center of Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran.
EFORT Open Rev. 2023 Apr 25;8(4):189-198. doi: 10.1530/EOR-22-0133.
Various uses of posterior knee arthroscopy have been shown, including all-inside repair of posterior meniscal lesions, posterior cruciate ligament (PCL) reconstruction or PCL avulsion fixation, extensile posterior knee synovectomy for pigmented villonodular synovitis or synovial chondromatosis, posterior capsular release in the setting of knee flexion contractures, and loose bodies removal. Posterior arthroscopy provides direct access to the posterior meniscal borders for adequate abrasion and fibrous tissue removal. This direct view of the knee posterior structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures. During PCL reconstruction, posterior arthroscopy gives the surgeon proper double access to the tibial insertion site, which can result in less acute curve angles and the creation of a more anatomic tibial tunnel. Moreover, it gives the best opportunity to preserve the PCL remnant. Arthroscopic PCL avulsion fixation is more time-consuming with a larger cost burden compared to open approaches, but in the case of other concomitant intra-articular injuries, it may lead to a better chance of a return to pre-injury activities. The high learning curve and overcaution of neuromuscular injury have discouraged surgeons from practicing posterior knee arthroscopy using posterior portals. Evidence for using posterior portals by experienced surgeons suggests fewer complications. The evidence suggests toward learning posterior knee arthroscopy, and this technique must be part of the education about arthroscopy. In today's professional sports world, where the quick and complete return of athletes to their professional activities is irreplaceable, the use of posterior knee arthroscopy is necessary.
后入路膝关节镜检查已显示出多种用途，包括后半月板损伤的全关节内修复、后交叉韧带（PCL）重建或PCL撕脱固定、用于色素沉着绒毛结节性滑膜炎或滑膜软骨瘤病的扩展性后膝关节滑膜切除术、膝关节屈曲挛缩情况下的后关节囊松解以及游离体摘除。后入路关节镜检查可直接进入后半月板边缘，以进行充分的磨损和纤维组织清除。对膝关节后部结构的这种直接观察使外科医生能够使用垂直褥式缝合创建更强的生物力学修复。在PCL重建过程中，后入路关节镜检查为外科医生提供了进入胫骨插入部位的合适双通路，这可减少锐角并创建更符合解剖学的胫骨隧道。此外，它提供了保留PCL残端的最佳机会。与开放手术相比，关节镜下PCL撕脱固定更耗时且成本负担更大，但在存在其他合并关节内损伤的情况下，它可能会增加恢复到伤前活动的机会。高学习曲线和对神经肌肉损伤的过度谨慎使外科医生不愿使用后入路进行后膝关节镜检查。有经验的外科医生使用后入路的证据表明并发症较少。有证据表明应学习后膝关节镜检查，并且该技术必须成为关节镜检查教育的一部分。在当今的职业体育界，运动员快速且完全恢复其职业活动是不可替代的，因此使用后膝关节镜检查是必要的。
