Knee Arthroscopy
synonyms: Knee scope, knee arthroscopy, KATS
Knee Scope CPT
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29866(with osteochondral autografts)
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29880(with med & lat meniscetomy)
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29867(with osteochondral allografts)
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29881(with med or lat meniscectomy)
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29868(with meniscal transplant)
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29882(with med or lat meniscus repair)
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29870(diagnostic / biopsy)
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29883(med & lat meniscus repair)
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29871(with lavage/drainage)
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29884(with lysis of adhesions/MUA)
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29873(with lateral release)
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29885(with OCD bone grafting)
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29874(with loose body removal)
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29886(with OCD drilling)
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29875(with limited synovectomy)
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29887(with OCD drilling & fixation)
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29876(with major synovectomy)
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29888(with ACL recon)
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29877(with chondroplasty)
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29889(with PCL recon)
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29879(with microfracture)
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Knee Scope Indications
Knee Scope Contraindications
- Infection
- Advanced arthritis
- Inadequate trial on non-operative treatment
Knee Scope Alternatives
- Non-operative management
- Open surgery
Knee Scope Pre-op Planning / Special Considerations
- Standard portals: inferomedial and inferolateral portals
- Posteromedial portal: 1cm above the joint line, behind the MCL; risks Saphenous nerve; allows view of posteior horns of menisci and PCL.
- Posterolateral portal: 1cm above the joint line, between LCL and biceps tendon; risks common peroneal nerve; allows view of posteior horns of menisci and PCL.
Knee Scope Technique
- Pre-operative antibiotics, +/- regional block
- Supine position. All bony prominences well padded.
- General endotracheal anesthesia vs MAC.
- Examination under anesthesia: ROM 0-130; varus laxity ext/30; valgus laxity ext/30; anterior drawer ER/IR, posterior drawer; lachman; pivot shift; ->10 degree increase in ER at 30 degrees flexion, but not at 90 degrees.
- Tourniquet high on thigh, but not inflated, popliteal post & lateral post or arthroscopic knee holder.
- Prep and drape in standard sterile fashion.
- Inferior lateral arthroscope portal made with 11 blade, blunt obturator and cannula.
- Evaluate suprapatellar pouch (synovitis).
- Patellofemoral joint: trochlear groove, medial and lateral facets of patella, assess patellar tracking.
- Lateral gutter, medial gutter.
- Inferior medial arthroscopy portal: 18 gauge spinal needle, 11 blade, blunt obturator, probe/etc.
- Medial compartment: MFC, MTP, medial meniscus.
- Notch: ACL, PCL
- Lateral compartment: LFC, LTP, lateral meniscus, popliteus.
- See also: Meniscal tear classification, chondral injury classification,
- Accessory portals: Posteromedial=1cm above the joint line, posterior to the MCL, risks saphenous nerve/vein, aids visualization of PHMM, PCL. Posterolateral=1 cm above the joint line, between the LCL and the biceps tendon, risks common peroneal nerve.
- Close portal sites.
Knee Scope Complications
- Overall complication rate = 1.85% (Small NC, Arthroscopy 1988;3:215)
- Iatrogenic chondral injury (most common complication)
- Hemarthrosis / hematoma
- DVT: 9.9%, proximal DVT rate = 2.1% (Ilahi OA, Arthroscopy, 2005;21:727)
- Stiffness / Arthrofibrosis
- Arthritis
- Infection
- NVI (saphenous neuralgia)
- Fluid Extravastion / Compartment Syndrome
- Complex Regional Pain Syndrome: rare
- Synovial fistula
- Instrument Failure
Knee Scope Follow-up care
- Dependent on diagnosis and treatment.
- Partial medial meniscectomy: WBAT with crutches as needed. Home ROM and strengthening program.
- Knee Arthroscopy Rehab Protocol.
Knee Scope Outcomes
Knee Scope Review References
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