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Single-portal arthroscopy: report of a new technique.

ABSTRACT: A new technique of single-portal arthroscopy using new instrumentation for arthroscopic knee surgery is reported. The procedure is intended for "targeted" surgery to address limited pathology. The arthroscope, cutters, and biters are all introduced into the joint through 1 portal. The technique is generally applicable to knee arthroscopy for isolated conditions and potentially useful in treating other joints. A 2.9-mm-diameter, light-sensitive, high-definition, 20-cm-long arthroscope is inserted through a 4.6-mm cannula. This arthroscope-cannula combination yields fluid flow mechanics similar to a standard 4-mm arthroscope in a 5.8-mm cannula. A Parallel Portal Cannula (PPC) (Stryker Endoscopy) is applied to the arthroscope cannula, producing a "double-barrel" system for entry into the joint. The PPC allows for sliding and rotational freedom along the axis of the arthroscope cannula but also locks in place once a desired position is achieved. PPC devices are available in zero-length, short (25-mm), and long (55-mm) sizes. Cutters that are bent in the mid shaft are available in 3.5- and 4-mm diameters. The instrumentation system allows both viewing with the arthroscope and passage of working cutters and biters through a single 9- to 10-mm portal. Potential advantages of single-portal arthroscopy include decreased patient morbidity and recovery time while still allowing for adequate treatment of limited knee pathology.

SUBMITTER: Cooper DE

PROVIDER: S-EPMC3834641 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal.MethodsWe retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months.ResultsLeading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm.ConclusionUsing a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve.Level of evidenceLevel III, retrospective cohort study.

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Single-portal arthroscopy: report of a new technique.

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