A Modified Arthroscopic Trans-Septal Approach via the Figure-to-4 Position of the Knee

Standard anterior and posterior portals offer limited access to pathologies in the posterior compartment of the knee. The trans-septal portal facilitates comprehensive visualization and instrumentation in the posterolateral and posteromedial compartments. Existing techniques often necessitate a posterolateral portal or multiple anterior portals. Precise portal placement is essential to mitigate risks associated with the common peroneal nerve and popliteal artery. This technical note describes a modified arthroscopic trans-septal approach performed in the figure-of-4 position under direct visualization. The method employs a motorized shaver to perforate the posterior septum using 2 anterior portals and a posteromedial portal. The shaver is directed toward the posterior margin of the lateral femoral condyle through the posteromedial portal, with the arthroscope positioned in the anterolateral portal and saline distension in the posterior compartment.