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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