Proximity of the Popliteal Artery to the PCL During Simulated Knee Arthroscopy – <i>Implications for Establishing the Posterior Trans-Septal Portal</i>

Cosgarea, Andrew J.; Kramer, Dennis E.; Bahk, Michael S.; Totty, William G.; Matava, Matthew J.

doi:10.1055/s-0030-1248103

Cited by 52 publications

(27 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One of the critical issues of concern regarding the posteromedial aspect is injury to the saphenous nerve and vessels. 14 In this study we propose an inside-out technique to create a direct posterior portal in the knee. The benefit of this technique is the avoidance of injury to the saphenous nerve, as well as the popliteal vessel, using transillumination.…”

mentioning

confidence: 99%

Arthroscopic Treatment of Popliteal Cyst: A Direct Posterior Portal by Inside-Out Technique for Intracystic Debridement

Kongmalai

C้hernchujit

2015

Arthroscopy Techniques

View full text Add to dashboard Cite

Popliteal cysts are characterized by enlargement of the gastrocnemius-semimembranosus bursa. The pathogenesis includes a valvular opening between the knee joint and the bursa, and associated intra-articular pathology may give rise to knee effusion. The mainstay of treatment is conservative. If popliteal cysts are symptomatic, analgesia, aspiration, and steroid injection therapy may be considered, but most recur rapidly. In the past, open excision was an option if they remained symptomatic, but the associated recurrence rate was high. One important reason was that the intraarticular pathology causing the knee effusion was not treated. We present an alternative minimally invasive arthroscopic treatment using dye (methylene blue) directly injected into the cyst, which will leak from the cyst into the joint, to identify the valvular opening. The thickened valve is opened using a basket forceps and then enlarged using a motorized shaver to disrupt the 1-way mechanism between the joint and bursa, as well as to establish an unobstructed freeway connection between them. We also present a safe technique to create a direct posterior portal. Intracystic debridement of the fibrous membrane, nodules, and septa through this portal will decrease the recurrence rate of the popliteal cyst. P opliteal cysts (also termed "Baker cysts") were first described over a century ago by Adams 1 and later by Baker.2 They are most frequently characterized by enlargement of the gastrocnemius-semimembranosus bursa, which is one of several bursae around the knee. Studies of the pathogenesis of popliteal cysts have shown that they are connected to the knee joint by means of a valvular opening.3,4 The presence of a valve, along with the existence of an effusion, creates unidirectional flow of the synovial fluid from the articular cavity to the cyst and is one of the fundamental factors responsible for the appearance and persistence of the cyst.Treatments for popliteal cysts have included conservative approaches or open resection. [5][6][7] Because the cysts are often asymptomatic and resolve spontaneously, many are treated by observation alone. If they are symptomatic, analgesia, aspiration, and steroid injection therapy may be considered, but most recur rapidly. In the past, open excision was an option if they remained symptomatic; however, an associated recurrence rate as high as 42% to 63% has been reported. 6,7 Several studies have reported frequently associated intra-articular pathologies with the cysts and warned of a high recurrence rate if the intra-articular pathologic condition is not addressed. 8-12Arthroscopic intervention is favored over open excision because of the successful outcomes of arthroscopic treatment for conditions associated with popliteal cysts. Arthroscopy is minimally invasive, is associated with a lower amount of risk, directly addresses both intraarticular pathology and the cyst, and allows early aggressive rehabilitation. Recent advances in arthroscopic techniques have been made to effectively address the ...

show abstract

mentioning

confidence: 99%

Arthroscopic Treatment of Popliteal Cyst: A Direct Posterior Portal by Inside-Out Technique for Intracystic Debridement

Kongmalai

C้hernchujit

2015

Arthroscopy Techniques

View full text Add to dashboard Cite

show abstract

“…mean sagittal distance from the mid-PCL to the popliteal artery to be 29 mm (range, 18-55 mm). 11 This distance decreased to 10 mm (range, 3-16 mm) at the PCL insertion on the tibia. 11 Thus, the posterior septum can be safely divided at its center (at the level of the mid-PCL) to create a transseptal portal that permits access between the posteromedial and posterolateral compartments, as described below.…”

Section: A 4bmentioning

confidence: 88%

“…11 This distance decreased to 10 mm (range, 3-16 mm) at the PCL insertion on the tibia. 11 Thus, the posterior septum can be safely divided at its center (at the level of the mid-PCL) to create a transseptal portal that permits access between the posteromedial and posterolateral compartments, as described below. 2 The knee flexion angle also affects popliteal artery position.…”

Section: A 4bmentioning

confidence: 88%

Pigmented Villonodular Synovitis of the Knee –Diagnosis and Treatment

Kramer

Frassica²,

Frassica³

et al. 2009

J Knee Surg

Self Cite

View full text Add to dashboard Cite

Pigmented villonodular synovitis (PVNS) of the knee is a benign but locally aggressive disease of synovial proliferation that occurs in localized nodular and diffuse villous growth patterns. Although inflammatory and neoplastic causes have been hypothesized, etiology remains unknown. Presenting as unilateral knee pain and swelling, PVNS mimics other knee ailments. Radiographs are often unremarkable, whereas magnetic resonance imaging may show characteristic intra-articular masses with signal dropout on T2-weighted sequences. Pigmented villonodular synovitis is surgically treated with open or arthroscopic total or partial synovectomy. High recurrence rates are associated with all treatments of diffuse PVNS. Complications of open synovectomy include arthrofibrosis and wound breakdown. Total arthroscopic synovectomy is technically demanding but can be advantageous. Transcondylar notch views, accessory posterior portals, and the posterior transseptal portal maximize arthroscopic access to the posterior knee. Intra-articular radioisotope injection and external beam radiation may be beneficial adjuvant therapy for extensive diffuse and recurrent PVNS of the knee.

show abstract

“…Creating the tibial tunnel in PCL surgery is 1 of the most technically demanding portions of transtibial PCL recon- 1 n sports medicine update struction due to the proximity of neurovascular structures to the PCL insertion. 12,13 In a cadaveric study during simulated arthroscopic conditions, Cosgarea et al 12 found the mean sagittal distance of the politeal artery to the mid-PCL was 29.1 mm and to the proximal PCL fovea was 9.7 mm. The distance between the PCL insertion and popliteal artery varies depending on the degree of knee flexion.…”

Section: Tibial Tunnelmentioning

confidence: 99%

Pearls and Pitfalls of Single-bundle Transtibial Posterior Cruciate Ligament Reconstruction

Durbin¹,

Johnson²

2012

Orthopedics

View full text Add to dashboard Cite

Posterior cruciate ligament (PCL) injuries are rare, but they often require reconstruction, especially in the setting of combined ligamentous knee injury. Single-bundle transtibial PCL reconstruction is 1 technique for restoring this important ligament. However, this procedure is technically demanding, and complications can occur if poor techniques are used. This article analyzes the potential pitfalls of this procedure and presents the pearls that may ease the technical demands and reduce the risk of avoidable complications.

show abstract

Proximity of the Popliteal Artery to the PCL During Simulated Knee Arthroscopy – Implications for Establishing the Posterior Trans-Septal Portal

Cited by 52 publications

References 13 publications

Arthroscopic Treatment of Popliteal Cyst: A Direct Posterior Portal by Inside-Out Technique for Intracystic Debridement

Arthroscopic Treatment of Popliteal Cyst: A Direct Posterior Portal by Inside-Out Technique for Intracystic Debridement

Pigmented Villonodular Synovitis of the Knee –Diagnosis and Treatment

Pearls and Pitfalls of Single-bundle Transtibial Posterior Cruciate Ligament Reconstruction

Contact Info

Product

Resources

About