The Hip book
Home » Joints » Knee » Medial Portals

Medial Portals

- Anteromedial Portal:
    - for visualization of the lateral compartment, and instrumentation of the the medial compartment;
    - this portal is located in a manner similar to the anterolateral portal, that is, 1 cm above the medial joint line and 1 cm medial to the edge of the patellar tendon;
           - if the portal is to be made adjancent to the patellar tendon, consider placement slightly higher than usual to avoid the fat pad;
    - mark out the posterior joint line to ensure that instruments will have adequate access to the posterior meniscus (should meniscal repair be needed);
           - generally instruments should not be placed more than 15 deg off of the tibial articular surface;
    - use spinal needle to pin point proper entry point
    - entry is at intersection of inferior and medial edges of patella;
    - direct needle slightly more inferiorly than the arthroscope and direct needle towards posterior horn of medial meniscus;
    - medial meniscus is vulnerable  during suprameniscal portal placement;
          - when using knife, blade should be directed upward when the skin and capsule is incised;


- Posteromedial portal:
    - portal is located in small, triangular soft spot formed by postero-medial edge of the femoral condyle & posteromedial edge of tibia;
    - location of the portal should be about 1 cm above posteromedial joint line and precisely at posteromedial margin of the femoral condyle;
    - w/ angled lens, may visualize PCL & posterior horn of medial meniscus;
    - ref:
            - Arthroscopic posteromedial visualization of the knee.

- Misc:
    - fat pad:
           - when fat pad appears prominent and is obstructing visualization, resist the urge to shave away the fat pad;
           - instead, attempt to "push and pull" the scope either into the notch or the supra-condylar pouch in order to pull the fat pad anteriorly out of the field of vision

The posteromedial portal in knee arthroscopy: an analysis of diagnostic and surgical utility.  

Posterior portals for arthroscopic surgery of the knee.