Malinowski Konrad, Kim Dong Woon, Kennedy Nicholas I, Pękala Przemysław A, LaPrade Robert F, Mostowy Marcin
Department of Anatomy, Jagiellonian University Medical College, International Evidence-Based Anatomy Working Group, Kraków, Poland.
Artromedical Orthopedic Clinic, Bełchatów, Poland.
Arthrosc Tech. 2023 Nov 27;12(12):e2369-e2374. doi: 10.1016/j.eats.2023.08.007. eCollection 2023 Dec.
Arthroscopic visualization and access of the posterior knee are limited when using standard anterior and posterior portals. The creation of a trans-septal portal allows for complete access to the posterior compartment as arthroscopic instruments are able to be passed back and forth between the posteromedial and posterolateral compartments. Due to the close proximity of the popliteal artery and its branches, precise portal placement and safe orientation of arthroscopic instruments are critical to avoid iatrogenic injury. The conventional technique of trans-septal portal creation, involving a posterolateral portal, can be difficult in some cases. To overcome these obstacles, a posteromedial technique of trans-septal portal creation is presented. By using the medial parapatellar portal as the viewing portal, our technique allows for direct visualization of the posterior septum on each step of creation of the trans-septal portal, eliminating the need for "blind" maneuvers. What is more, no posterolateral portal is needed, decreasing the risk of potential complications. Using the posterior cruciate ligament fibers as a main landmark for trans-septal portal placement, preservation of the posterior part of the septum is achieved. This ensures optimal safe-margin distance away from the popliteal neurovascular bundle and making the technique safe and reproducible.
使用标准的前侧和后侧入路时，膝关节后方的关节镜可视化和进入受限。经间隔入路的建立可实现对后关节腔的完全进入，因为关节镜器械能够在膝后内侧和膝后外侧关节腔之间来回通过。由于腘动脉及其分支位置临近，精确的入路定位和关节镜器械的安全定向对于避免医源性损伤至关重要。传统的经间隔入路建立技术，涉及后侧入路，在某些情况下可能会很困难。为克服这些障碍，本文介绍一种经间隔入路建立的膝后内侧技术。通过使用髌旁内侧入路作为观察入路，我们的技术在经间隔入路建立的每一步都能直接观察到后间隔，无需“盲目”操作。此外，无需后侧入路，降低了潜在并发症的风险。以交叉韧带纤维作为经间隔入路定位的主要标志，可保留间隔的后部。这确保了与腘神经血管束有最佳的安全边缘距离，使该技术安全且可重复。
