Arthroscopic Identification of the Knee Posterolateral Corner Structures and Anatomic Arthroscopic Posterolateral Corner Reconstruction: Technical Note - Part 1

Abstract

Arthroscopic assessment of posterior compartments of the knee and the posterior aspect of the proximal tibial and fibula is challenging because of the relative proximity of the neurovascular bundle. This Technical Note describes a reproducible arthroscopic surgical approach in a cadaveric model that aims to identify and expose the popliteus tendon, posterior fibular head, fibular collateral ligament popliteal fibular ligament, biceps femoris tendon, and peroneal nerve.

Fig 1

Left knee in 90 degrees of flexion. Superolateral portal. Left: Arthroscopic view through anterolateral portal. Right: Extra-articular view, needle positioning in a transillumination technique.

Fig 2

Left knee in 90 degrees of flexion. 30 arthroscope through the anterolateral portal into the posteromedial compartment. Posteromedial portal. Left: Arthroscopic view though anterolateral portal with needle through posteromedial capsule. Right: Extra-articular view, needle positioning in a transillumination technique. Abbreviations: MFC, medial femoral condyle; MMPH, medial meniscus posterior horn.

Fig 3

Left knee in 90 degrees of flexion. 30 arthroscope through the anteromedial portal to access the posteromedial compartment. Transeptal approach (inside and outside views). (A) Access to the posteromedial compartment. (B) Central-inferior septum debridement. (C) Release of the septum from medial to lateral to reach the posterolateral compartment. (D) Shaver debridement from the medial to the lateral compartment under direct observation. (E) Window between the compartments.

Fig 4

Left knee in 90 degrees of flexion. Posterolateral portal (inside view from transeptal approach and outside views).

Fig 5

Left knee in 90 degrees of flexion. Posterolateral capsule of the knee joint is carefully separated from the synovial edge of the posterior horn of the lateral meniscus. (A) Aspect before capsulotomy. (B) Radiofrequency debridement separating the posterior capsule from the posterior horn of lateral meniscus, and the space between popliteus and gastrocnemius is opened. (C) Identification of the musculotendinous junction after capsulotomy. Symbols: –, popliteus tendon; †, lateral meniscus; α, femoral condyle; ∝, posterior capsule.

Fig 6

Left knee in 90 degrees of flexion. Posterolateral structures. Symbols: ▪, biceps femoris; •, fibular head; ◊, popliteofibular ligament; x, fibular collateral ligament; –, popliteus tendon.

Fig 7

Peroneal nerve dissection. Symbols: ▪, biceps femoris; •, fibular head; ∗, peroneus longus; +, peroneal nerve.

Fig 8

Left knee in 90 degrees of flexion. Fibular collateral ligament (FCL) and popliteus tendon dissection on femoral side. Symbols: x, fibular collateral ligament; –, popliteus tendon; †, lateral meniscus; α, femoral condyle.