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Purpose Various methods have been described for the treatment of anterior shoulder instability with glenoid bone loss. The incidence of recurrent dislocations following surgical intervention is high and, therefore, necessitates a reliable and replicable revision procedure. The purpose of this Technical Note is to describe a method of arthroscopic anatomic glenoid reconstruction using a distal tibial allograft and screw fixation in the setting of a failed Latarjet procedure with significant glenoid bone loss. Methods We describe in detail patient positioning, portal placement, steps of the diagnostic arthroscopy, and graft preparation using imaging and a detailed intraoperative arthroscopic technique. Level of Evidence Level 1, Shoulder; Level 2, Instability., Technique Video Video 1 Technical video illustrating the arthroscopic anatomic glenoid reconstruction using screw fixation in the setting of a failed Latarjet procedure with hardware removal. The patient is placed in the lateral decubitus position, and the right arm is prepped and draped in the usual fashion. The posterior portal is used as the viewing portal for diagnostic arthroscopy, and the anterosuperior portal is used as the viewing portal for the rest of the surgical steps.

Introducción: Los desarreglos internos de la Articulación Temporomandibular son los más comunes. La artroscopia es de gran utilidad en Cirugía Maxilofacial como alternativa para el diagnóstico y tratamiento de los desarreglos internos de la Articulación Temporomandibular. Objetivo: El objetivo de la presente revisión es describir la artroscopia diagnóstica de la Articulación Temporomandibular. Me?todos: Se realizó una revisión narrativa de la literatura y búsqueda en las bases de datos Pubmed, Proquest, Scielo, Mendeley y Elsevier, en idioma ingle?s y espan?ol empleando los descriptores (Artroscopia diagnóstica, Articulacion Temporomandibular) en español e ingles. Se seleccionaron arti?culos publicados en un periodo de 40 an?os (1980-2020), incluyendo en el estudio un total de 26 arti?culos y 6 libros de 702 documentos revisados. Discusión: En la artroscopia de la Articulación Temporomandibular se puede observar la posición, calidad, textura del cartílago articular, la vascularización y la redundancia de la membrana sinovial, y se pude realizar procedimientos como técnicas de artroscopia avanzada. Conclusiones: La artroscopia diagnóstica facilita el diagnóstico y manejo de las patologías intraarticulares. Siendo necesario e imprescindible el conocimiento de esta técnica.

Purpose To determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified. Methods From 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together. Results In total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) (P < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% (P < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% (P < .001 and .001). Conclusions Anterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus. Level of Evidence Level III, diagnostic study.

Knee joint is the largest and complex joint of the body and also most frequently injured joint in sportsmen due to the lack of bony support. The stability of the joint is highly dependent on its supporting ligamentous structures; therefore, injuries of ligaments and menisci are extremely common. MRI has virtually replaced conventional arthrography and other modalities for the evaluation of menisci and cruciate ligaments [3]. Compared with CT scans, MRI provides superior anatomic and pathological status of soft tissues, ligaments, fibro cartilage and articular cartilage. Since the 1980’s, diagnostic arthroscopy has been used frequently to show intra-articular abnormalities with more than 95% accuracy depending on the expertise of the arthroscopist [6]. During arthroscopy, all the internal structures are visualized, the abnormality detected and treated as well. MRI has enormous impact on musculoskeletal imaging and knee is the most frequently imaged joint. It is non- invasive and does not require ionizing radiation. Advantages of MRI include excellent inherent soft tissue contrast, multiplanar imaging capability, lack of patient exposure to radiation, ability to visualize ligaments, tendons, articular cartilages, menisci, para-articular soft tissues and the bone marrow.

To gain regulatory approval for the clinical use of knee biologics and devices in humans, translational large-animal studies are typically required. Animal models that permit second-look arthroscopy are valuable because they allow for longitudinal assessment of the treated tissue without needing to sacrifice the animal. The minipig is an ideal preclinical animal model for the investigation of therapies for the knee, in part because arthroscopy can be performed in its stifle (knee) joint with the use of standard surgical equipment used in humans. The purpose of this Technical Note is to describe a reproducible technique for diagnostic arthroscopy of the minipig stifle (knee) joint., Technique Video Video 1 Diagnostic arthroscopy of the right minipig stifle (knee) joint. An anterolateral portal is established, the arthroscope is introduced through the anterolateral portal and into the medial compartment, and an anteromedial portal is established under spinal needle localization. The medial compartment, intercondylar notch, lateral compartment, and distal trochlea can be visualized. Visualization of the lateral compartment can be enhanced by placing the arthroscope through the anteromedial portal. The proximal portion of the patellofemoral joint can be difficult to visualize through the anterior portals because of its elongated morphology and inability to fully extend the minipig knee. Visualization of the proximal patellofemoral joint can be performed through a separate superior portal if necessary.

As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. Smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased use of arthroscopic fluid. Differences in the technology, such as a 0° optic and less rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy as well as modified approaches to therapeutic procedures. This article introduces our preferred approach to diagnostic arthroscopy of the glenohumeral joint and subacromial space with needle arthroscopy and small-bore instruments. This technique could increase efficiency and decrease operative time with certain arthroscopic procedures, and it may improve patient outcomes.

The practice of arthroscopy in India had started as early as 1978; and during the same year, the Indian chapter of the International Arthroscopy Association was drafted alongside other countries such as Australia and Brazil. The subspecialty of arthroscopy has been a boon to both; the orthopedic surgeon and the patient. The advent of arthroscopy has enabled the orthopedic surgeon to clearly visualize and delineate the extent of disease, with minimal invasion. Moreover, the patient is benefited with rapid recovery and an early return to activities. The present-day arthroscopic surgeries include diagnostic arthroscopy, ligament reconstruction, cartilage repair, and labral repairs and have undoubtedly evolved into a glamorous subspecialty in orthopedics. However, before the technological advancements, the technique of arthroscopy had modest origins. This review traverses through the history of arthroscopy with special emphasis on the advances of arthroscopy in India.

Background The benefits of the various therapeutic options for the treatment of subacromial impingement syndrome are a topic of ongoing debate. Several studies on the subject are insufficiently evidence-based, with many other studies being considered controversial by members of the field. Nevertheless, a general opinion against surgical interventions is developing in the media in reference to these systematic reviews and meta-analyses based on insufficiently differentiated literature. Aim of the study This article provides an overview of the literature and examines the outcome after arthroscopic subacromial decompression compared with conservative therapy or diagnostic arthroscopy and bursectomy. Conclusion The outcome for patients treated with conservative therapy or subacromial decompression who explicitly suffered from mechanical outlet impingement (MOI) or mechanical non-outlet impingement (MNOI) has not yet been studied. The main problem concerning almost all published studies is that they are based on a mixture of pathologies. It seems likely that especially patients with a mechanical, and therefore structural, narrowing of the subacromial space can profit more from surgical management than patients with unspecific subacromial pain. Differentiation between the pathologies is crucial for the correct treatment decision, not only for the reduction of symptoms, but most importantly for the preservation of the supraspinatus tendon.

Background The diagnosis and treatment of scapholunate interosseous ligament (SLIL) pathology is debated and notably variable. This study assessed the influence of diagnostic arthroscopy on treatment recommendations and the interobserver reliability of the arthroscopic classification of SLIL pathology. Methods The influence of diagnostic arthroscopy on treatment recommendations and the reliability of the arthroscopic classification of SLIL pathology were tested in a survey-based experiment. Seventy-seven surgeons evaluated 16 scenarios of people with wrist pain with variation in symptoms, scaphoid shift, time of symptom onset, and MRI appearance of the SLIL. Participants were randomized to view or not to view diagnostic wrist arthroscopy. Factors associated with recommendation for repair, capsulodesis, or tenodesis were analyzed. Results Viewing arthroscopic videos was associated with both offering surgery and a more reconstructive option. Other factors independently associated with recommendation for surgery included greater pain intensity and activity intolerance, women surgeons, an asymmetric scaphoid shift, and a recent onset of symptoms. The interobserver reliability of SLIL classification was slight. Conclusions Diagnostic arthroscopy leads to more surgery, and more invasive surgery, in spite of unreliable assessment of pathology. Clinical Relevance This points to the need to measure the potential benefits and harms of diagnostic wrist arthroscopy among people with wrist pain and no clear diagnosis on interview, examination, and radiographs. Level of Evidence Not applicable.

Hip arthroscopy (HA) is technically demanding and associated with a prolonged learning curve. Recently, arthroscopic simulators have been developed to anatomically model various joints including the knee, shoulder and hip. The purpose of this study is to validate a novel HA simulator. Twenty trainees and one sports medicine fellowship-trained orthopaedic surgeon at a single academic institution were recruited to perform a diagnostic HA procedure using the VirtaMed ArthroS hip simulator. Trainee characteristics, including level of training, general arthroscopy experience and hip specific arthroscopy experience, were gathered via questionnaire. For the purpose of this study, participants were categorized as novice (

Cartilage injuries of the knee are a complex problem for which there are many potential solutions. These injuries may be secondary to an acute traumatic event, osteochondritis dissecans, and repetitive micro-trauma or due to meniscal insufficiency or malalignment. Patients who may benefit from cartilage repair, specifically a cell-based technique such as membrane-associated autologous chondrocyte implantation (MACI), frequently have cartilage defects between 2 and 10 cm2, with normal BMI, and are less than 55 years in age. MACI is a two-staged procedure where healthy cartilage is biopsied in an initial diagnostic arthroscopy, grown in cell culture and then re-implanted in a second procedure. Post-operatively, patients are placed on a regimented post-operative protocol focused on protecting the graft while increasing strength and range of motion. Both short- and long-term studies show good to excellent results with respect to both subjective and functional outcomes.

Wrist arthroscopy is an effective technique for the diagnosis and treatment of intra-articular pathology of the wrist. Thorough knowledge of the anatomy of the wrist is important for accurate portal placement. This chapter provides detailed anatomical illustrations and cadaveric dissections that will help the wrist surgeon create appropriate portals, and step-by-step instructions are provided to help the surgeon perform a safe and successful diagnostic arthroscopy of the wrist.

The management of Kienbock’s Disease presents a challenge to the treating surgeon. Arthroscopy should be used in conjunction with a thorough clinical review and appropriate investigations. Diagnostic arthroscopy is the most effective way to assess the articular surfaces and soft tissues within the wrist. Arthroscopic treatment confers a number of benefits, allowing for a minimally invasive directed approach to the patient with KD. It should be used with an algorithm-based approach, respecting the status of the patient, the lunate, and the wrist.

Impingement of the LHB can directly lead to articular‐sided supraspinatus tears. When pain persists despite arthroscopic debridement, we recommend taking the arm out of traction intraoperatively and placing it in the 90‐90 position.

Introduction: The traumatic or internal derangement of the knee requires certain investigations for the establishment of diagnosis. With advances in technology and because of high resolution and accuracy a MRI scan is now a standard for evaluating the knee injuries before a subsequent arthroscopy. When used properly after a thorough clinical examination, an MRI can prove to be an efficient and non-invasive diagnostic tool in the management of knee injuries. On the other hand, arthroscopy is considered as the gold standard method for the diagnosis of such injuries. Methods: The prospective hospital based study was conducted on fifty one symptomatic patients with knee injuries over a period of one year. All the patients underwent MRI of the knee joint on Philips Achieva 1.5 Tesla MRI Machine in Bir Hospital, NAMS and they were evaluated and cross checked by faculty members. After proper evaluation, diagnostic arthroscopy was done, if needed therapeutic intervention was also performed. The sensitivity, the specificity, the positive predictive value and the negative predictive value of MRI for MM, LM, ACL and PCL were calculated. Results: A total of 51 patients were included with a mean age of 30.92 years. Left knee was predominantly involved in 56.1% of the cases with 43.9% involvement of right knee. Overall, MRI showed a total of 32 medial menisci tears and 8 lateral menisci tears. There were 5 false negative cases for MMT. MRI revealed tears of ACL in 44 patients and no patient with PCL tear. Arthroscopy revealed ACL tears in 44 cases and confirmed no patient with PCL tear. Conclusions: MRI is a noninvasive, useful and reliable diagnostic tool for evaluating knee injury and it can be used as a first line of investigation in patients with knee injury.

Objective: To assess the diagnostic accuracy of direct wrist MR arthrography (MRA) compared to conventional MRI in diagnosis of different pathologic entities causing chronic wrist pain. Materials and methods: 37 consecutive patients 22 males and 15 females, with age range from 16 to 49 years ''mean age 28 years'' complaining of unexplained chronic wrist pain were prospectively examined by using MRI and MRA with arthroscopic correlation in 25 of them. Findings were divided into 5 main groups of lesions including triangular fibrocartilage complex (TFCC) lesions, ligamentous injuries, osseous lesions, tendon pathology and ganglion. Results: MRA picked up more ligamentous injuries and triangular fibrocartilage complex (TFCC) lesions that couldn`t be detected on MRI study while both were equal in detection of other types of lesions. TFCC lesions were the most common pathologic findings in both MRI and MRA. Arthroscopic correlation in 25 suspected TFCC lesions (clinically, radiologically or both) revealed that the sensitivity / specificity / accuracy of MRI and MRA were 87.5% / 100% / 96% and 100% / 100% / 100% respectively for central lesions while were 71.4% / 81.3% / 76% and 100% / 90.9% / 96% respectively For peripheral lesions. Extra-capsular lesions, like tenosynovitis and fracture hook of hamate couldn`t be confirmed arthroscopically. Conclusion: MRA can replace both MRI and diagnostic arthroscopy in detecting causes of chronic wrist pain. Keywords: Chronic wrist pain, MRI, MRA, Arthroscope

Shoulder arthroscopy is the second most common orthopaedic procedure. Diagnostic arthroscopy of the shoulder requires an efficient and reproducible technique. In this Technical Note, we describe a step-wise approach to diagnostic arthroscopy of the shoulder. This technique is performed using a posterior viewing portal. It can be performed from the beach chair or the lateral decubitus position. This technique uses a 2-circle approach: the surgeon first evaluates the glenoid aspect of the joint space, followed by the humeral aspect of the joint space. This method ensures a complete and consistent evaluation of the glenohumeral joint.

Background There is currently a lack of consensus regarding the most effective diagnostic algorithm for cases of supposed low-grade infection after total hip arthoplasty (THA). Objective The aim of this study was to assess reliability in the use of biopsies, obtained by hip arthroscopy, to detect a periprosthetic hip joint infection (PJI). Methods From 2012 to 2016, diagnostic arthroscopy of the hip joint was performed in 20 patients with a supposed PJI following THA. In 10 of these patients, the THA was revised for various reasons after diagnostic arthroscopy. The microbiological and histological findings of the biopsies obtained by arthroscopy were compared to findings from intraoperative samples of the revision arthroplasty. Results For arthroscopic biopsies, we detected a sensitivity of 1.00 (95% confidence interval [CI] 0.40-1.00), a specificity of 0.83 (95% CI 0.36-1.00), a positive predictive value of 0.80 (95% CI 0.28-1.00), and a negative predictive value of 1.00 (95% CI 0.48-1.00). The accuracy was 0.90. Conclusions The analysis of arthroscopic biopsies represents a helpful tool to verify or rule out a PJI in selected patients. Nevertheless, minimally invasive diagnostic tools (e.g., laboratory analysis and aspiration) should be utilized beforehand.

The purpose of this study was to define the diagnostic value of magnetic resonance imaging (MRI) and plain radiographs (X-ray [XR]) in identifying an osteochondral defect or loose body in patients undergoing operative treatment for patellar instability. A total of 87 patients treated operatively for patellar instability with medial patellofemoral ligament (MPFL) reconstruction between 2015 and 2019 were identified. Inclusion criteria were evidence of clinical patellar instability, preoperative XR and MRI studies, and concomitant diagnostic knee arthroscopy and MPFL reconstruction performed to address patellar instability. Patients were excluded if they had a history of prior procedure for patellar instability on the surgical knee, underwent MPFL reconstruction without concomitant diagnostic knee arthroscopy, or had an anterior cruciate ligament or posterior cruciate ligament deficient knee. Operative notes and arthroscopic images were reviewed to identify osteochondral or chondral injuries and loose bodies noted during diagnostic arthroscopy. The primary outcome was the identification of intra-articular loose bodies, chondral injury, or osteochondral defect on preoperative plain radiographs and MRI in patients with patellar instability. All MRIs were performed on a 3T MRI. The sensitivity and specificity of identifying loose bodies on MRI were 0.52 and 0.92 and on XR were 0.23 and 0.98, respectively. The sensitivity and specificity of identifying osteochondral lesions on MRI were 0.43 and 0.81 and on XR were 0.08 and 0.97, respectively. Of the 87 available reports, 45 (51%) described performing chondroplasty for Outerbridge grade II/III chondral lesions on diagnostic arthroscopy. In conclusion, MRI and XR are poorly sensitive at identifying loose bodies or osteochondral defects after patellar dislocations. The poor sensitivity of imaging studies must be considered when determining whether or not to recommend operative management to a patient with patellar instability. This is a Level IV, diagnostic study.

Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called “scapholunate complex” has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).

Superior capsule reconstruction (SCR) creates a humeral head depressor in the setting of a massive, irreparable rotator cuff tear. Recently, a 6-mm-thick acellular dermal allograft (ACD) has been shown to be noninferior to the standard fascia lata autograft in recreating native shoulder biomechanics. This paper outlines a reproducible means by which to perform an arthroscopic SCR using a 6-mm ACD. A standard diagnostic arthroscopy first assesses the integrity of the subscapularis and infraspinatus tendons. The glenoid anchors are then placed. Accessory anterior and posterolateral portals are made as well as a lateral portal by which to shuttle the graft. Suture management is paramount. Ideally allograft preparation occurs on the back table simultaneously to maintain efficiency. Suture passage through premade holes in the graft, and when the sutures have passed through and been tensioned, the graft is shuttled into place and tied down with medial and lateral row anchors in SpeedBridge fashion. The thickness of ACD has been shown to influence the ability of the reconstructed superior capsule to perform its role as a humeral head depressor. This technique describes the use of a 6-mm-thick ACD to perform an arthroscopic SCR that minimizes both donor-site morbidity and operative time., Technique Video Video 1 The patient is prepped and draped in the beach chair position in usual sterile fashion with the operative shoulder exposed. A diagnostic arthroscopy is begun and the remaining rotator cuff is debrided as appropriate, including the footprint on the tuberosity. Accessory portals are made anteriorly and posterolaterally for suture management. Three sutures are placed through the remaining subscapularis tendon anteriorly and brought out of the accessory anterior portal. Similarly, 3 sutures are placed through the remaining infraspinatus tendon posteriorly and placed through the accessory posterolateral portal. While the diagnostic arthroscopy is taking place, the graft preparation begins on the back table while the shoulder is prepared for insertion of the acellular dermal allograft (ACD). The graft is folded in half, with the crease facing posteriorly. Four corner sutures are placed with #2 FiberWire (Arthrex, Naples, FL). Holes are then created at the medial border for the glenoid side, through which knotless SutureTak sutures are passed in mattress fashion. Holes on the anterior and posterior sides are created for side-to-side repair to the remaining subscapularis and infraspinatus, respectively. Medial sided holes are created one centimeter from the graft’s lateral edge and will incorporate SutureTapes from the humeral-sided medial row SwiveLock anchors (Arthrex). These holes are created with a fresh 11-blade scalpel to ensure a single pass through the 6-mm thick ACD. Passing sutures may be employed, or a Hewson suture passer may alternatively be used. While the graft preparation takes place, the shoulder is debrided as appropriate, a bony bed is created on the humerus, and anchor placement begins on the glenoid with three knotless Bio-SutureTak anchors (Arthrex). In addition, side-to-side sutures are passed through the remaining subscapularis anteriorly and infraspinatus posteriorly. Medial row anchors are placed on the humerus just lateral to the articular margin with tape-loaded SwiveLock anchors. The graft is then brought to the shoulder and the appropriate sutures are placed through each respective hole with either shuttle sutures or a Hewson suture passer. The graft is shown outside the PassPort cannula with all sutures passed through. For demonstration purposes, only 2 anterior and posterior sutures have been placed. The technique recommended includes three sutures. The graft is then cigar-rolled around a KingFisher clamp and placed into the joint. Subsequently it is shuttled to its final location using the medial glenoid anchor pull-sutures. The anterior and posterior side-to-side sutures are tied. Finally, the medial row humeral tapes are brought further laterally to lateral row SwiveLock anchors. The final images demonstrate the final resting position of the graft.

The discoid lateral meniscus (DLM) is an infrequent anatomical variant, which usually affects the lateral compartment of the knee. Its estimated prevalence is low and higher rates have been observed in the Asian population. The identification of symptomatic DLM requires an appropriate level of clinical suspicion based upon the patient’s medical history and symptoms, the judicious use of imaging studies (including plain films and magnetic resonance imaging (MRI)), and diagnostic arthroscopy. It is the authors’ experience that a high frequency of bilaterality occurs with a high prevalence of peripheral tears that require repair. The MRI classification can aid surgeons in predicting the occurrence of peripheral tears and degree of instability as well as plan the treatment method preoperatively. Current treatment recommendations favor meniscal reshaping through partial meniscectomy with or without repair. However, arthroscopic reshaping can be challenging to an inexperienced surgeon because visualization within the lateral joint space may be limited by a thickened meniscus and the small size of the pediatric knee. It is believed that the described technical guide to arthroscopic partial meniscectomy in conjunction with the meniscal repair of the peripheral tear is an effective method.

Needle arthroscopy, miniarthroscopy, or nanoarthroscopy are terms used to identify a specific subset of arthroscopic viewing instruments. Whereas a standard arthroscope is approximately 2.7–4.0 mm in diameter with a fiberoptic cable connecting to a camera, the Nanoscope (Arthrex, Naples Fl) is a much smaller scope (1.9) that contains a microchip on the tip of a needle that transmits video to the viewing screen. This can lead to smaller incisions, decreased morbidity, and faster recovery times. Cost analysis has shown needle arthroscopy to be more cost-effective than magnetic resonance imaging for diagnostic purposes with studies showing nearly equivalent diagnostic accuracy if not improved accuracy with the arthroscope. This has led to the increasing popularity of needle arthroscopy.

Posterolateral corner of the knee is an anatomically complex region with variable formation of tendons and ligaments which provide important posterolateral stability of the knee. Injury of this region is often a high-energy multi-ligament injury that rarely happens in isolation. The three posterolateral structures that are biomechanically and surgically most important are fibular collateral ligament, popliteus tendon muscle, and popliteofibular ligament. A thorough physical examination combined with stress radiographs and magnetic resonance imaging is critical to accurately define the injured structures. Diagnostic arthroscopy further enhances our surgical decision-making in choosing the proper reconstruction technique. The most appropriate posterolateral corner surgical reconstruction should be used based on the careful grading of each injury. The aim of different surgical reconstructions is to restore the normal knee biomechanics. Surgical techniques have progressed and range from the classical wide-open approach, to minimally invasive approach with two mini-open incisions and percutaneous posterolateral corner reconstruction to arthroscopic popliteus bypass reconstruction. Posterolateral reconstruction is usually involved in complex knee reconstruction and mostly combined with posterior or anterior cruciate ligament reconstruction. High tibial osteotomy is used in chronic cases of varus malalignment in knees with posterolateral injury. Posterolateral corner reconstructions are technically demanding procedures. Complications after such procedure can arise in large part due to the complex anatomy and injury pattern of this region combined with a surgeon’s lack of experience and thus require a highly skilled and experienced surgeon to perform them.

Background:Although medial patellofemoral ligament (MPFL) reconstruction is well described for patellar instability, the utility of arthroscopy at the time of stabilization has not been fully defined.Purpose:To determine whether diagnostic arthroscopy in conjunction with MPFL reconstruction is associated with improvement in functional outcome, pain, and stability or a decrease in perioperative complications.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent primary MPFL reconstruction without tibial tubercle osteotomy were reviewed (96 patients, 101 knees). Knees were divided into MPFL reconstruction without arthroscopy (n = 37), MPFL reconstruction with diagnostic arthroscopy (n = 41), and MPFL reconstruction with a targeted arthroscopic procedure (n = 23). Postoperative pain, motion, imaging, operative findings, perioperative complications, need for revision procedure, and postoperative Kujala scores were recorded.Results:Pain at 2 weeks and 3 months postoperatively was similar between groups. Significantly improved knee flexion at 2 weeks was seen after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and reconstruction with targeted arthroscopic procedures (58° vs 42° and 48°, respectively; P = .02). Significantly longer tourniquet times were seen for targeted arthroscopic procedures versus the diagnostic and no arthroscopic procedures (73 vs 57 and 58 min, respectively; P = .0002), and significantly higher Kujala scores at follow-up were recorded after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and targeted arthroscopic procedures (87.8 vs 80.2 and 70.1, respectively; P = .05; 42% response rate). There was no difference between groups in knee flexion, recurrent instability, or perioperative complications at 3 months. Diagnostic arthroscopy yielded findings not previously appreciated on magnetic resonance imaging (MRI) in 35% of patients, usually resulting in partial meniscectomy.Conclusion:Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. Postoperative pain, range of motion, and risk of complications were equal at 3 months postoperatively with or without arthroscopy. Despite higher Kujala scores in MPFL reconstruction without arthroscopy, the relationship between arthroscopy and patient-reported outcomes remains unclear. Surgeons can consider diagnostic arthroscopy but should be aware of no clear benefits in patient outcomes.

As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. The smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased arthroscopic fluid use. Differences in the technology, such as a 0-degree optic and less rigid instrumentation necessitate a novel technique to accommodate thorough diagnostic arthroscopy as well as new approaches to therapeutic procedures. This manuscript introduces our preferred approach to diagnostic arthroscopy and partial medial meniscectomy with NA and small-bore instruments. The minimally invasive nature of this technology may decrease postoperative pain and improve return of comfort and function.

Needle arthroscopy may provide several potential advantages over standard arthroscopy. The smaller camera size and weight allows for a minimally invasive and percutaneous approach with decreased fluid use. As resolution and image quality improve, the potential to expand clinical use for therapeutic applications becomes possible. One promising use is in elbow arthroscopy. Difference in the technology, such as a zero-degree optic and less-rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy and therapeutic procedures. This manuscript introduces the authors' approach to diagnostic needle arthroscopy of the anterior and posterior elbow compartments and placement of therapeutic instrumentation. This technique could theoretically decrease the risk of iatrogenic neurovascular injuries, reduce postoperative swelling and pain due to decreased fluid use, and potentially lead to faster recovery.