Boot Camp Articles Flashcards
tourniquet level
350 mmHg
tourniquet placement for arthroscopy
3 ways to create varus and valgus force on the knee during procedure
1) leg holder
2) post + figure of 8
3) assistant
draping for arthroscopy
first drape tails up
second tails down
angled drape for arm board
arthroscopic drape over foot with rubber seal up past knee
stockinette on foot
hip positioning for arthroscopy
ipsilateral hip on edge of bed
which joint line is more superior?
lateral
surface landmarks for arthroscopy
patella
tibial tubercle
patella tendon
medial joint line
lateral joint line
head of fibula
which incision orientation is more cosmetic?
horizontal
which optional port can you use for fluid outflow?
superomedial
where do you place ports?
anterolateral 1 cm above joint line just next to patellar ligament
anteromedial 1 cm above joint and 1 cm medial to patellar ligament
what is the first step after marking surface anatomy for ports?
local anaesthetic
how do you make the incision for ports?
4-5 mm horizontal with blade facing away from patella ligament
stay away from ligament, cartilage and meniscus
how do you insert ports?
index finger along port
anterolateral first
angle parallel to tibial plateau directed between the condyles
push into the intercondylar notch
pull back so the canulla is just out of the notch
straighten knee
advance canulla into suprapatellar pouch
remove obturator
put in camera
start fluid flow
with the camera in place and fluid flowing, what is the anteromedial port for?
working with instruments
create under direct vision from the already inserted camera using a spinal needle
make sure the needle can reach the posterio horn of the medial meniscus or your angle is off
then remove needle and make a similar incision - watch for fluid eruption
place instruments via canulla
which is turned on first, light or irrigation?
irrigation - this avoids thermal damage
order of places to scope
suprapatellar pouch
patellar surface
trochlear groove
medial gutter down to the tibia
straighten the knee and apply valgus force
medial compartment
inspect medial meniscus
cartilage on medial condyle and medial tibial plateau
bend knee to 90°
intercondylar notch
ACL, PCL
into the triangle formed by ACL, lateral meniscus, lateral femur
varus force with figure 4 or assistance or leg holder
lateral meniscus and femoral and tibial cartilage
popliteal hiatus and popliteal tendon
lateral gutter
reposition the medial canulla through the notch then reinsert the camera
view posteromedial compartment
access posterolateral compartment via the triangle
A
ACL
B
PCL
what might you find in the suprapatellar pouch?
plica
loose bodies
patellar chondromalacia
trochlear chondromalacia
what might you find in the lateral gutter?
loose bodies
femoral osteophytes
what might you find in the medial gutter?
loose bodies
femoral osteophytes
what might you find in the intercondylar notch?
loose bodies
trochlear chondromalacia
ACL tear
PCL tear
where do root tears occur?
in the posterior compartments
quick order of spots to check in arthroscopy
suprapatellar pouch
lateral gutter
medial gutter
medial compartment
intercondylar notch
lateral compartment
posterior medial compartment
posterior lateral compartment
4 advanced techniques for treating cartilage damage
microfracture
abrasion arthroplasty
osteochondral autograft
osteochondral allograft
most frequently encountered pathology in knee arthroscopy
meniscal tear
treatments for meniscal tears
partial meniscectomy if inner avascular part using biter, then shaver
how do you stop a biter from creating a loose body?
let go of the biter and rest it on the back of the knee
turn of the fluid
remove biter
insert shaver
turn suction back on
how can you tell if an ACL is torn if it has scarred to the PCL?
empty lateral wall of the intercondylar notch
what is the main treatment for cartilage damage during arthroscopy?
chondroplasty
where rough and loose areas are shaved and smoothed
