THE POSTEROMEDIAL PORTAL IN KNEE ARTHROSCOPY - AN ANALYSIS OF DIAGNOSTIC AND SURGICAL UTILITY

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.