Table 2.

Pearls and Pitfalls of Technique for Posterior Capsular Release

Pearls

Use of a bolster under the knee increases posteromedial access.

Slight valgus stress can aid in transcondylar posteromedial arthroscope placement, whereas slight varus stress can aid in posterolateral placement.

The procedure should be performed at 90° to increase the distance of the neurovascular bundle from the capsule.

If needed, use of 70° arthroscope can further improve visualization.

A smooth shaver should be used rather than a toothed shaver to lower the risk of overly aggressive shaving.

Placement of the posteromedial or posterolateral portals can be aided by visualizing the arthroscope light source through the skin (Fig 6).

Pitfalls

Knee positioning in 90° of flexion is required to access the posterior knee.

Osteophytes in patients with severe arthritis may limit posterior-compartment access.

Immediate and continued rehabilitation is important to prevent recurrence of contractures.