Left Knee Arthroscopy - Time Out and Draping - GoPro Fusion 360

Mary Lloyd Ireland, MD
Professor
Dept. of Orthopaedic Surgery & Sports Medicine
University of Kentucky Lexington, Kentucky
www.MaryLloydIreland.com
45 Year old for Medial Meniscus Tear
0:00 left knee arthroscopy - timeout
00:24
45 year-old - medial meniscus tear by clinical exam
- catching pain
- Murray's test with pain and popping
- localized cyst medially on
00:38
MRI scan
- meniscus tear degenerative complex
00:52
palpating the bony landmarks
knee is at 30 degrees of flexion
01:11
- 30 degree flexed blunt probe obturator
- five-five canula
01:38
check for intraarticular effusion or hemarthrosis
lock the 30 degree scope into
the cannula buttons are up lateral
femoral condyles up
01:54
turn water on for view
02:03
position the leg
holding and positioning the scope
02:18
tracking of the patella flex and extend
the knee
02:34
triangulate and work through the medial portal
fat pad is the enemy
to see anterior cruciate ligament
02:52
no medial portal yet
02:53
positioning into valgus to open up that medial
compartment and establish the medial
working portal
03:11
meniscus fragment flipped up in posterior horn
consistent with MRI scan
03:21
- medial meniscus tear posterior third
- medial femoral condyle - good
03:31
establish our medial portal
- needle directly over the anterior horn of the medial meniscus
using horizontal incisions
03:56
to work posterior horn of the medial meniscus
be just above the medial meniscus hugging that medial meniscus so
you can see the fat pad
04:07
mini arthrotomy
- make a big enough incision to be able to
easily get the instruments in and out
- remove the spinal needle
04:28
put knife under direct
visualization to establish
the medial portal
04:48
probe in the medial portal
- something may be flipped under the meniscus there
05:03
the joint isn't well open so we need to
apply more valgus not to damage
articular cartilage
05:37
tight knee - putting the leg holder
down five finger breaths above the
above the patella
05:47
probing -
degenerative tibial cited medial meniscus tear
- nontypical Baker cyst
06:06
fortunately the root is intact
- curved motorized shaver in four point
five
06:23
more valgus for better opening and access to
posterior third of the medial meniscus
06:33
shaver blade is on the torn meniscus not
the articular cartilage
06:42
using shaver can better define the tear
pattern typically tibial side is unstable
06:52
after arthroscopic partial medial meniscectomy
will probe to root attachment tibial eminence
07:27
palpating cyst to see if an
open excision needed
07:41
unstable tibial sided component that needs attention
07:52
took about 30% of it out
- scope is lateral
- working portal medial
- to get to anterior third switch the scope
08:06
tibial sided unstable horizontal split in the
meniscus but poster horn looks to be intact
08:17
use motorized -handheld punch
to complete partial medial meniscectomy
-if a lot of fragments with suction directly
on the cannula
- curved shaver will clog
08:52
completing the shaving
- root is intact
- switch scope to the other side
09:07
third medial meniscus to backbite with handheld duckbill
09:17
open the joint up enough to remove part of that
medial meniscus
09:28
reverse biter
09:34
scope back in the joints through the
medial portal will
- cannula and the obturator and not put the scope in
to not ding the tip of the scope
09:58
put the scope in medial for a different access view of
medial meniscus
- shaver in the lateral portal
- easily access mid anterior third of the meniscus
to complete meniscectomy on tibial side
10:23
looking for swelling where the cyst
10:32
needle in the medial side over cyst
- Trephining
10:40
capsular rent where the fluid
would leak from the meniscus tear
into the ganglion
- use a needle to pronate ganglion cyst
10:54
scope - medial
probe lateral side - drives posterior to the fat
pad to the lateral meniscus
11:05
part looks ligamentous
11:10
MRI scan -
read of anterior horn lateral meniscus
tear which is usually not the case
- at end of the procedure use
remainder of water to suction out
fragments
11:31
sucker directly to cannula
11:34
close portals with a nylon suture mattress fashion to reduce leakage
12:04
close the medial portal
12:23
pad this well with adaptic 4 by 4 soft roll ace wrap
12:32
injected intra articularly with marcaine
12:41
after close use cannula assist
13:01
drapes off add sterile dressing
13:34
- tourniquet is still up
- Lanny Johnson leg holder
- equipment removal and process
left knee arthroscopy