A Modified Arthroscopic Approach for Localized Pigmented Villonodular Synovitis in the Posterior Knee Compartment

Localized pigmented villonodular synovitis of the posterior knee compartment presents a surgical challenge due to limited arthroscopic access and the complex anatomy of the posterior knee. We describe a modified arthroscopic approach that enhances visualization and facilitates efficient resection by enlarging the posteromedial portal. This technique allows simultaneous use of the arthroscope and surgical instruments within the same portal, optimizing maneuverability and precision. The procedure involves careful portal placement, strategic use of a 70° arthroscope, and a combination of curettage, shaving, and radiofrequency ablation to achieve complete resection while minimizing iatrogenic injury. Compared to traditional approaches using both posteromedial and posterolateral portals, our method is less invasive yet provides adequate exposure for thorough lesion removal. Additionally, resection performed solely from anterior portals has been reported, but it frequently results in incomplete excision due to restricted access. This technique offers distinct advantages, including improved visualization, efficient instrument handling, and reduced operative time, making it particularly suitable for novice surgeons. By refining arthroscopic accessibility to the posterior knee compartment, this approach represents a safe, effective, and reproducible method for managing localized pigmented villonodular synovitis with minimal morbidity.