Knee Arthroscopy: Portals, Indications, Complications & Rehab

Knee Arthroscopy

Arthroscopy ("Keyhole surgery") allows visualization and treatment of intra-articular pathology using a camera (Arthroscope) and instruments inserted through small incisions (Portals).

1. The Procedure

• Standard Portals:
  • Anterolateral (AL): Viewing portal (Camera).
  • Anteromedial (AM): Instrumentation portal (Probes, cutters).
• Fluid: Saline is pumped in to distend the joint for visibility.

2. Indications

• Meniscus: Repair or Partial Meniscectomy.
• Ligaments: ACL/PCL Reconstruction.
• Cartilage: Microfracture, Mosaicplasty, Debridement.
• Synovium: Synovectomy (RA), Plica excision, Loose body removal.

3. Contraindications

Absolute: Active Infection (unless doing washout), Severe bony ankylosis (cannot distract joint).
Relative: Severe OA (surgery may not help pain), Bleeding disorders.

25 Practice MCQs

Q1. The standard viewing portal for knee arthroscopy is:

Answer: A). Located lateral to the patellar tendon.

Q2. The standard instrumentation (working) portal is:

Answer: B). Located medial to the patellar tendon.

Q3. Which of the following is an absolute contraindication?

Answer: A). The joint space cannot be opened to see inside.

Q4. Most common complication of arthroscopy is:

Answer: A). Usually resolves but can be painful.

Q5. Diagnostic arthroscopy is useful for:

Answer: A). When MRI is inconclusive.

Q6. Which nerve is at risk during portal placement?

Answer: A). Can cause numbness below the knee.

Q7. Arthroscopic Washout (Debridement/Lavage) is proven to be:

Answer: A). Unless there are mechanical symptoms (locking).

Q8. Loose bodies in the posterior compartment require:

Answer: A). These are accessory portals.

Q9. A "Probe" is used to:

Answer: A). The "finger" of the surgeon.

Q10. Fluid extravasation (leakage) can lead to:

Answer: A). If the capsule is breached.

Q11. Synovial Plica excision is done if:

Answer: A). Pathological plica causes clicking/pain.

Q12. Microfracture technique involves:

Answer: A). Forms fibrocartilage (scar cartilage).

Q13. Tourniquet use helps to:

Answer: A). Standard practice.

Q14. Arthrolysis refers to:

Answer: A). Often needed after trauma.

Q15. Can Septic Arthritis be treated arthroscopically?

Answer: A). Less invasive than open arthrotomy.

Q16. Lateral Retinacular Release is indicated for:

Answer: A). Helps center the patella.

Q17. Which angle of the arthroscope is most common?

Answer: A). Allows "looking around the corner" by rotating the light cable.

Q18. Recovery time for simple meniscectomy is:

Answer: A). Very fast compared to repair.

Q19. "Light Cable" orientation determines:

Answer: A). Key skill in navigation.

Q20. Is arthroscopy used for Tibial Plateau Fractures?

Answer: A). Allows precise reduction without big incisions.

Q21. Superolateral portal is used for:

Answer: A). Helps flush the joint.

Q22. What is "Triangulation"?

Answer: A). Basic arthroscopic skill.

Q23. Radiofrequency (RF) ablation (Coblation) is used for:

Answer: A). "Chondroplasty".

Q24. Anesthesia for arthroscopy is usually:

Answer: A). To relax muscles for valgus/varus stressing.

Q25. Risk of DVT in arthroscopy vs TKR:

Answer: A). But not zero.