Table 1.

Surgical Pearls and Pitfalls

Pearls

The use of a leg holder increases access to various compartments by providing the ability to adjust the amount of knee flexion with control.

The establishment and use of multiple portals, including superomedial, superolateral, accessory posteromedial, and accessory posterolateral portals, are often required.

To visualize and debride difficult areas in the posteromedial and posterolateral compartments, adjusting the knee to varying degrees of flexion and extension can be beneficial.

The use of Kelly forceps, Kocher graspers, and surgical snaps provide more robust options for removal of the synovial tissue and loose bodies in comparison to standard arthroscopic graspers.

It is important to visualize the submeniscal and intercruciate regions because these are frequent areas of loose bodies and diseased tissue. However, care must be taken to avoid damage or detachment of the meniscus and cruciate ligaments.

Visualization through the posteromedial and posterolateral portals and debridement through the notch provide improved access for intercruciate disease.

The use of 3 shavers (4.5 mm, 5.5 mm, and curved) and a system that enables the easy transition from a 30° to 70° arthroscope ensures that all areas of varying difficulty are adequately visualized and debrided.

Pitfalls

Improper leg holder positioning or tourniquet placement can limit access and visualization throughout the procedure.

Inadequate visualization increases the risk of leaving symptomatic disease and recurrence.

Loose body removal and extensive debridement along the posterior condyles may be limited if the posterior portals are established too distal and close to the joint line.

The use of a single shaver risks inadequate debridement and remaining diseased synovium. Shavers often become blocked, which impacts surgical efficiency if only 1 shaver is used.