A View From Above: A Modified Patel’s Medial Midpatellar Portal for Anterior Cruciate Ligament Arthroscopic Surgery

Calvisi, Vittorio; Lupparelli, Stefano; Giuliani, Pierandrea

doi:10.1016/j.arthro.2006.07.040

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…( 4 , 24 ) Obtaining anatomic femoral tunnel placement and subsequent tunnel length measurement relies on adequate visualization of the native ACL footprint. Numerous techniques have been proposed for gaining better visualization of the lateral femoral condylar wall within the notch, including a modified mid-patellar portal ( 25 ) and a central accessory medial portal. ( 26 ) By using a 70° arthroscope through the standard anterolateral portal, the “top-down” view described in this study provides the surgeon with an unobstructed view of the far side of the femoral tunnel aperture without the need for extra portals.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Viewing Position Affects Anterior Cruciate Ligament Reconstruction Femoral Tunnel Length Measurements

et al. 2018

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PurposeTo purpose of this study was to compare arthroscopic anterior cruciate ligament (ACL) reconstruction femoral tunnel length measurements from the anterolateral portal between the standard notch view using a 30° arthroscope versus a “top-down” view utilizing a 70° arthroscope to visual the far side of the femoral tunnel aperture.MethodsArthroscopic femoral tunnel length measurements using calibrated reamers from the standard notch versus the “top-down” view were obtained and reviewed in 54 skeletally mature patients undergoing ACL reconstruction with no prior bony knee surgery. Patient age, height, weight, sex, and surgery laterality were also recorded. Measurements of femoral tunnel length were repeated using both views for inter-observer and intra-observer correlation.ResultsInter-observer and intra-observer intra-class correlation coefficients for the standard notch view and “top-down” views were excellent, with higher reliability values appreciated using the “top down” view. Mean overall femoral tunnel length measurements obtained using the standard notch view were significantly longer than measurements from the “top-down” view (p < 0.001).ConclusionsThe standard notch view provides significantly longer femoral tunnel length measurements in comparison to the “top-down” view.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Viewing Position Affects Anterior Cruciate Ligament Reconstruction Femoral Tunnel Length Measurements

et al. 2018

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“…Standard anteromedial, anterolateral, and superolateral arthroscopic portals allow for full access to knee visualization, favoring a complete and direct visualization of the tibial eminence avulsion. We prefer to avoid the trans-tendinous Gillquist central portal [34], but we systematically use a modified Patel's medial mid-patellar (superomedial) portal [35] or more patient-specific accessory ones if necessary to address associated intraarticular lesions. A thorough hematoma and blood clot washing and a selective Hoffa's pat debridement are performed to achieve clear visualization of the joint.…”

Section: Approach and Fracture Fixationmentioning

confidence: 99%

“…Cannulated aimers are also useful in performing a moderate compression of the fracture fragments while inserting the Kirschner wires. Two K wires are inserted through the superolateral portal to reduce the tibial intercondylar eminence (and mimic the orientation and the force lines of ACL fibers), and 1 K wire is inserted through the superomedial portal [35]. According to our experience, the Kirschner wires should ideally reach the opposite tibial cortical surface to strengthen the osteosynthesis mechanism.…”

Section: Approach and Fracture Fixationmentioning

confidence: 99%

Technical Note: Tibial Spine Avulsion Treatment with Arthroscopic Reduction and Internal Fixation with Kirschner Wires in Skeletally Immature Patients

Calvisi,

Romanini,

Staniscia

et al. 2023

Healthcare

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Introduction: Tibial spine avulsion injury, tibial eminence injury, tibial spine fracture, and anterior cruciate ligament (ACL) avulsion are multiple terms that express the same pathological condition. It can be encountered both in the pediatric and adult population. A wide array of surgical techniques have been proposed to manage displaced tibial spine avulsions. Anyway, insufficient evidence is currently available to prefer one fixation technique over another, and a gold-standard arthroscopy-based technique is still missing. In this article, we describe a mini-invasive, safe and user-friendly technique for arthroscopic reduction and internal fixation of displaced tibial eminence fractures. Materials and methods: Standard and patient-specific accessory arthroscopic portals allow for full access to knee visualization and management of concomitant intraarticular lesions. After performing the debridement of the inflammatory tissue and the release of eventual interposed tissues in the fracture site, the tibial eminence avulsion can be reduced by using a less-invasive bone impactor. With the knee flexed to 90°, the fracture fragments are then synthesized (under fluoroscopic control) with three thin Kirschner wires inserted in a proximal–distal direction in a cross-shaped geometry. Results: This technique allows a fast surgical and hospitalization time, a punctiform arthrotomy, proximal tibial physis preservation, and an early rehabilitation program. Conclusions: This novel technique seems attractive and very promising since it is respectful of the epiphyseal growth plates and is thus suitable for children and adolescents.

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Lesion tipo Ciclops post fractura de espinas tibiales: Reporte de caso

Figueroa,

Cifuentes,

Yañez

et al. 2024

Revista Chilena de Ortopedia y Traumatología

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ResumenLa fractura de espinas tibiales es una fractura intraarticular de la inserción ósea del LCA sobre el platillo tibial, más común en niños y adolescentes entre 8 y 14 años de edad. Su incidencia se ha reportado entre 2% y 5% en la población pediátrica, pero son raras en adultos. La lesión tipo ciclops es una proliferación fibrosa de tejido de granulación, que genera un nódulo de partes blandas que limita la extensión, siendo una de las complicaciones posibles del manejo artroscópico de este tipo de fracturas. Se reporta el caso de una paciente de 25 años que cursó con fractura de espinas tibiales, donde se realizó una reducción anatómica satisfactoria de forma artroscópica y evolucionó con pérdida de extensión en el postoperatorio. Su estudio con RNM reveló una lesión tipo ciclops que requirió desbridamiento artroscópico.

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A View From Above: A Modified Patel’s Medial Midpatellar Portal for Anterior Cruciate Ligament Arthroscopic Surgery

Cited by 4 publications

References 5 publications

Arthroscopic Viewing Position Affects Anterior Cruciate Ligament Reconstruction Femoral Tunnel Length Measurements

Arthroscopic Viewing Position Affects Anterior Cruciate Ligament Reconstruction Femoral Tunnel Length Measurements

Technical Note: Tibial Spine Avulsion Treatment with Arthroscopic Reduction and Internal Fixation with Kirschner Wires in Skeletally Immature Patients

Lesion tipo Ciclops post fractura de espinas tibiales: Reporte de caso

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