Gousopoulos Lampros, Hopper Graeme, Levy Yoann, Grob Charles, Vieira Thais Dutra, Sonnery-Cottet Bertrand
Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Lyon, France.
Video J Sports Med. 2022 Jul 19;2(4):26350254221087290. doi: 10.1177/26350254221087290. eCollection 2022 Jul-Aug.
The arthroscopic approach to the posterior compartment of the knee is always challenging. This easy arthroscopic transseptal approach allows safe access to the posterior compartment of the knee, avoiding any potential neurovascular injury.
Indications include arthroscopic posterior cruciate ligament (PCL) reconstruction, fixation of avulsion fractures of the tibial attachment of the PCL, arthroscopic posterolateral corner reconstruction, removal of loose bodies from the posterior compartment, PCL cyst removal, ramp repair, and arthroscopic arthrolysis of the posterior compartment.
Using a posteromedial portal, a shaver is introduced with the tip in direct contact with the medial side of the septum facing anteriorly, away from the popliteal neurovascular bundle. The scope is then inserted into the posterolateral compartment to visualize the lateral side of the septum while the shaver remains in the posteromedial compartment. The septum is then released until the tip of the shaver is visible. The shaver is then removed and the scope can now be inserted from the posteromedial portal to the posterolateral compartment through the released septum.
The transseptal approach can be performed without any additional risk if the shaver remains centrally on the inferior aspect of the septum. Therefore, the risk of iatrogenic injury of the middle genicular artery is minimized. Likewise, with the knee flexed to 90°, there is no risk of damaging the popliteal neurovascular bundle. Having a precise knowledge of the anatomy of the posterior compartment of the knee minimizes any risks of the transseptal approach, avoiding any additional surgical time whilst facilitating the indicated operation.
This easy arthroscopic transseptal approach allows safe access to the posterior compartment of the knee, avoiding any potential neurovascular injury.
膝关节后室的关节镜入路一直具有挑战性。这种简单的关节镜经隔入路可安全进入膝关节后室，避免任何潜在的神经血管损伤。
适应证包括关节镜下后交叉韧带（PCL）重建、PCL胫骨附着处撕脱骨折固定、关节镜下后外侧角重建、后室游离体取出、PCL囊肿切除、斜坡修复以及后室关节镜下粘连松解。
通过后内侧入路，将刨削器插入，使其尖端直接接触隔的内侧，面向前方，远离腘神经血管束。然后将关节镜插入后外侧室以观察隔的外侧，同时刨削器留在后内侧室。接着松解隔，直到能看到刨削器的尖端。然后取出刨削器，此时关节镜可通过已松解的隔从后内侧入路插入后外侧室。
如果刨削器始终位于隔下方的中央位置，则可在无任何额外风险的情况下进行经隔入路。因此，膝中动脉医源性损伤的风险降至最低。同样，当膝关节屈曲至90°时，不存在损伤腘神经血管束的风险。精确了解膝关节后室的解剖结构可将经隔入路的风险降至最低，避免额外的手术时间，同时便于进行指定的手术。
这种简单的关节镜经隔入路可安全进入膝关节后室，避免任何潜在的神经血管损伤。
