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. 2022 Jul 19;2(4):26350254221087290.
doi: 10.1177/26350254221087290. eCollection 2022 Jul-Aug.

Easy Arthroscopic Transseptal Approach of the Knee

Lampros Gousopoulos  1 , Graeme Hopper  1 , Yoann Levy  1 , Charles Grob  1 , Thais Dutra Vieira  1 , Bertrand Sonnery-Cottet  1
Affiliations

Easy Arthroscopic Transseptal Approach of the Knee

Lampros Gousopoulos et al. Video J Sports Med. .

Abstract

Background: 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: 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.

Technique description: 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.

Results: 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.

Conclusion: This easy arthroscopic transseptal approach allows safe access to the posterior compartment of the knee, avoiding any potential neurovascular injury.

Keywords: arthroscopic arthrolysis; multiligament knee injury; posterior cruciate ligament (PCL) reconstruction; posterolateral corner (PLC) reconstruction; transseptal approach.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.S.-C. received support from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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Graphical Abstract
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