Posterior Knee Arthroscopy: Anatomy, Technique, Application

Abstract

The frequency of knee arthroscopy involving the posterior compartments has increased with recent advances in arthroscopic technique and instrumentation. Total arthroscopic synovectomy, arthroscopic repair or reconstruction of the posterior cruciate ligament, all-inside repair of the posterior horn of the meniscus, and removal of loose bodies or tumors posterior to the posterior cruciate ligament all involve arthroscopic visualization of posterior aspects of the knee. Posterior knee arthroscopy is technically complex and requires a detailed knowledge of posterior knee anatomy relevant to the arthroscopist. With pertinent anatomic knowledge and meticulous technique, posterior knee arthroscopy can be safely implemented to provide a broad field of view and increased maneuverability of instruments. The popliteal artery is the most anterior structure of the popliteal neurovascular bundle. It courses anteriorly toward the insertion of the posterior cruciate ligament on the tibia and then moves posteriorly. The popliteal artery is closest to the knee joint at the insertion of the posterior cruciate ligament, where it is held near the proximal part of the tibia by the fibrous arch of the soleus. At the joint line, the popliteal artery lies posterior and lateral to the posterior cruciate ligament, adjacent to the posterior septum (Figs. 1-A and 1-B). Figs. 1-A and 1-B Magnetic resonance images of the knee, depicting the posterior cruciate ligament (PCL), posterior septum, and popliteal artery. Fig. 1-A Axial T2-weighted image with fat saturation. Fig. 1-B Sagittal T1-weighted image. Anatomic studies pertinent to an arthroscopist's assessment of posterior knee anatomy at the joint line—i.e., studies done under simulated arthroscopic conditions, including knee flexion and joint distention—are unfortunately rare. Cadaver and radiographic anatomic studies of the posterior aspect of the knee are usually done with the knee in full extension. Anatomic studies done with the knee in flexion have previously focused on posterior knee anatomy pertinent for high tibial osteotomy …