Arthroscopic techniques to improve access to posterior meniscal lesions

Unsatisfactory results following partial meniscectomy and problems related to a retained posterior horn of the medial meniscus are problems often attributed to inadequate arthroscopic partial meniscectomy. Although there are multiple techniques to gain better access to the various compartments in a truly tight knee, most of the problems in obtaining maximum visualization and instrumentation to the posterior aspects of the medial or lateral meniscus can usually be solved by adhering to a strict surgical technique that attempts to control the multiple variables encountered during arthroscopic surgery. These include the use of a tourniquet, leg holder, maximum distention of the knee provided by a large inflow cannula with large-bore tubing connected to 3-L bags, and an 18-gauge needle as a predecessor to the larger arthroscopic instruments. Of utmost importance is establishing the correct portal for the arthroscope, and it is time well spent at the beginning of the surgical procedure to verify the proper location of the arthroscope and not simply insert the arthroscope "a thumb-breadth above the joint line." Once these variables have been controlled, one can usually visualize and perform arthroscopic surgery on most meniscal lesions with minimal scuffing to the articular surfaces.