Diagnostic Needle Arthroscopy and Partial Medial Meniscectomy Using Small Bore Needle Arthroscopy

Abstract

As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. The smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased arthroscopic fluid use. Differences in the technology, such as a 0-degree optic and less rigid instrumentation necessitate a novel technique to accommodate thorough diagnostic arthroscopy as well as new approaches to therapeutic procedures. This manuscript introduces our preferred approach to diagnostic arthroscopy and partial medial meniscectomy with NA and small-bore instruments. The minimally invasive nature of this technology may decrease postoperative pain and improve return of comfort and function.

Fig 1

(A) The NA set (Nanoscope, Arthrex Inc) includes a 0° arthroscope with power cord, monitor, sharp and blunt trochars with corresponding sheaths including inflow portals and assorted instruments including a retractable probe, meniscal biters, and a 2.0 mm shaver. (B) Arthroscopic portals are indicated from a lateral external view of a right knee: 1, superior lateral portal; 2, superior medial portal (not visible); 3, medial portal; 4, lateral portal; 5, far lateral portal; 6, medial portal; and 7, far lateral (not visible).

Fig 2

(A) Arthroscopic view, right knee, superior lateral portal, articular surface of the patella, and trochlea. (B) External view depicting camera sheath inserted into superior lateral portal.

Fig 3

(A) Arthroscopic view, right knee, central portal, depicting intercondylar notch including anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). (B) External view, right knee, depicting needle arthroscope in central (transpatellar) portal while visualizing the intercondylar notch.

Fig 4

(A) Arthroscopic view, right knee, central portal of the lateral compartment including, lateral femoral condyle (LFC), lateral meniscus (LM), and lateral tibial plateau (LTP). (B) External view, right knee, demonstrating the needle arthroscope in the central portal while visualizing the lateral compartment.

Fig 5

Arthroscopic view, right knee, far lateral portal, visualizing the lateral meniscal root (LMR), lateral femoral condyle (LFC), and lateral tibial plateau (LTP). Because of the 0-degree optic, the far lateral approach provides the best visualization of the lateral meniscal root while allowing the lateral portal to remain available for instrumentation. Externally, the far lateral portal is 3 to 4 mm lateral to the standard anterior lateral portal to obtain this view. The knee is in a figure of four position (knee flexed to 90° and the hip externally rotated).

Fig 6

(A) Arthroscopic view, right knee, central portal visualizing the medial compartment including the medial femoral condyle (MFC), medial tibial plateau (MTP), and medial meniscus (MM). (B) External view, right knee, depicting the needle arthroscope in central portal and cannula in the medial portal for visualization of the medial compartment. The camera is directed medially in the central portal sheath and a valgus force is applied from the physician’s hip against the lateral post with 30° to 45° of knee flexion to open up the medial knee compartment. A blunt trochar is demonstrated in the medial portal.