Fig 18.

Shown is the correct position of the anteromedial portal, the already-placed superomedial inflow portal, and the visual assistance of the arthroscope from the anterolateral portal. The surgeon has placed the patient’s extremity on his hip to allow for increased valgus moment arm on the knee. Slight flexion and external rotation are preferred. The surgeon palpates the proposed anteromedial portal placement, then places an 18-gauge spinal needle using triangulation. If visualization is limited, an 18-gauge spinal needle can be used to pie-crust the medial collateral ligament to increase the medial joint space. (Caud., caudal; Ceph., cephalad; L, left; R, right.)