We reviewed 400 consecutive knee arthroscopy cases in a predominantly
sports medicine practice to determine (1) the frequency of posteromedi
al portal usage under a prospectively established set of indications,
and (2) the impact of posteromedial portal access on patient diagnosis
and management. Diagnostic posteromedial portals were used in 22% of
anterior cruciate ligament (ACL)-deficient knees, and in 11% of stable
knees with nonpatellar (usually meniscal) lesions. When used, postero
medial portal visualization showed treatable lesions 64% of the time,
the majority of which were repairable peripheral meniscus tears. In 63
% of these cases, no definite lesion had been identified by initial ro
utine anterior portal viewing and probing. Of the 22 patients with pos
teromedial meniscus tears that were discovered only via posteromedial
portal access, 9 had recently undergone anterior portal arthroscopy by
other surgeons, during which none of these tears were detected. Poste
romedial surgical portals (19 cases) were most useful for synovectomy,
posterior cruciate stump resection before arthroscopic reconstruction
, and posterior horn medial meniscectomy in exceptionally tight knees.
Posteromedial portal access is often useful diagnostically in cases w
here (1) posteromedial meniscal lesions are frequent (i.e., ACL-defici
ent knees) and/or suspected on the basis of preoperative symptoms or i
maging studies, and (2) full, direct visualization of the entire super
ior meniscosynovial junction is not possible via standard anterior por
tals. The option of a surgical posteromedial portal should be entertai
ned whenever frontal approaches for posteromedial instrument work prov
e inefficient or unsuccessful.