BACKGROUND
Henderson described the benefits of removal of loose bodies from the knee joint in 1916 using an open technique.1 Removal of loose bodies is usually straightforward where a lesion is <1cm as it can be drawn through the arthroscopic portal.2 However, larger lesions need a further incision, accessory portals or widening of the portal for removal.3–5 In addition, the use of hand instruments to reduce the size of the fragment can result in multiple small bodies that can be disseminated throughout the knee. This increases the operative morbidity and may necessitate closure of a formal incision with sutures. We describe a technique using triple puncture for an all arthroscopic removal of any loose body within the knee.
TECHNIQUE
Three arthroscopy portals are made: one for viewing, one for grasping the loose body and one for introduction of a shaver. While the scrub nurse holds the camera, the surgeon grasps the loose body and manipulates it to the shaver (Figs 1 and 2). The loose body is then reduced to a suitable size (Fig 3) to enable safe removal through a standard arthroscopic portal (Fig 4).
Figure 1.
Loose body in knee joint
Figure 2.
Loose body grasped with tool
Figure 3.
Loose body reduced with shaver
Figure 4.
Removal of loose body once reduced
DISCUSSION
The only potential danger with this technique is inadvertent damage to the grasper by the shaver. This can be avoided by good surgical technique. By using this operative technique, a large arthrotomy can be avoided.
References
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