Needle assisted arthroscopic clysis of the medial collateral ligament of the knee: a simple technique to improve exposure in arthroscopic knee surgery

Abstract

During knee arthroscopy, narrowness and tightness maybe encountered in the medial compartment that does not allow sufficient visualization or instrumentation. When this occurs, our team has found it helpful to perform a percutaneous clysis of the deep portion of the medial collateral ligament with a spinal needle. With the knee positioned in 10° to 20° of flexion and a valgus stress is applied. A spinal needle (18 Gauge) is passed percutaneously through the medial collateral ligament between the tibial plateau and undersurface of the medial meniscus. Several passes are made with the spinal needle with the bevel of the needle angled to selectively divide the fibers while keeping the medial collateral ligament under tension. Then with controlled valgus force, the medial compartment will progressively open allowing improved visualization to the posteromedial corner of the knee. This increase in space gives an enhanced visual field and further allows more room for arthroscopic instrumentation.

Keywords: knee arthroscopy; ligament release; medial collateral ligament; menisectomy.

Figure 1.

Outside view of spinal needle insertion as valgus force is maintained by the surgeon. View of a right knee from its medial aspect. The knee is held in near full extension while the surgeon applies controlled valgus stress by pushing his pelvis against the medial malleolus. The arthroscope (seen at the top of the picture) is viewing from the lateral parapatellar portal. The surgeon’s right hand inserts the 18-gauge spinal needle at the medial aspect of the knee.

Figure 2.

A) Note inside view with the arthroscope in the lateral parapatellar portal showing position of spinal needle and narrowness of joint space. With the arthroscope in the lateral parapatellar portal this view is posteromedial. The orange double arrow displays joint space opening prior to clysis. Note the spinal needle entering beneath the medial meniscus pointed out by the blue arrow on the right. B) Same view showing increase in the medial joint space following the MCL clysis and controlled release. Note the increased joint space opening (double orange arrow) showing the same arthroscopic view following clysis and completed partial menisectomy.