Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques

Abstract

Various uses of posterior knee arthroscopy have been shown, including all-inside repair of posterior meniscal lesions, posterior cruciate ligament (PCL) reconstruction or PCL avulsion fixation, extensile posterior knee synovectomy for pigmented villonodular synovitis or synovial chondromatosis, posterior capsular release in the setting of knee flexion contractures, and loose bodies removal. Posterior arthroscopy provides direct access to the posterior meniscal borders for adequate abrasion and fibrous tissue removal. This direct view of the knee posterior structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures. During PCL reconstruction, posterior arthroscopy gives the surgeon proper double access to the tibial insertion site, which can result in less acute curve angles and the creation of a more anatomic tibial tunnel. Moreover, it gives the best opportunity to preserve the PCL remnant. Arthroscopic PCL avulsion fixation is more time-consuming with a larger cost burden compared to open approaches, but in the case of other concomitant intra-articular injuries, it may lead to a better chance of a return to pre-injury activities. The high learning curve and overcaution of neuromuscular injury have discouraged surgeons from practicing posterior knee arthroscopy using posterior portals. Evidence for using posterior portals by experienced surgeons suggests fewer complications. The evidence suggests toward learning posterior knee arthroscopy, and this technique must be part of the education about arthroscopy. In today's professional sports world, where the quick and complete return of athletes to their professional activities is irreplaceable, the use of posterior knee arthroscopy is necessary.

Hypermobile lateral meniscus: A systematic review of current treatment options

“…Although anteromedial and anterolateral portals were the most common portals used in diagnostic and therapeutic arthroscopy of the included studies, it has been reported that utilizing anterior portals to visualize structures in the PLC comprising the posterior horn of the LM and PMF is restrictive due to narrow anatomy of posterior section of the knee [21]. Recently, it was recommended to establish posterior arthroscopic portals as they may provide a wider view of posterior structures of the knee and facilitate functional and anatomical fixation of the LM (Figure 3) [21].…”

The pie‐crusting release of the medial collateral ligament in arthroscopic partial meniscectomy is associated with improved clinical outcomes without altering radiological measurements

“…Achieving a complete visualisation of the intra-articular anatomy, particularly focusing on the posterior horn of the medial meniscus, is crucial for making an accurate diagnosis and initiating the appropriate treatment procedure [15]. The posteromedial compartment is identified as one of the primary sources of diagnostic errors in knee arthroscopy, especially in the tight medial tibiofemoral joint [22].…”

Development of Hydroxyapatite Coatings for Orthopaedic Implants from Colloidal Solutions: Part 2—Detailed Characterisation of the Coatings and Their Growth Mechanism

“…The coating of metal titanium alloy implants (or other metals such as chromium cobalt) is key to improving the bodily response to a metal. As mentioned in Part 1 [ 1 ] of this study, hydroxyapatite (HA) coatings on orthopaedic implants mitigate fibrous build-up and promote implant fixation [ 2 , 3 ]. In this, Part 2 of the study, the evolution of HA as it grows on a substrate and the resulting film is extensively characterised.…”