Single-Portal Arthroscopy: Report of a New Technique

Abstract

A new technique of single-portal arthroscopy using new instrumentation for arthroscopic knee surgery is reported. The procedure is intended for “targeted” surgery to address limited pathology. The arthroscope, cutters, and biters are all introduced into the joint through 1 portal. The technique is generally applicable to knee arthroscopy for isolated conditions and potentially useful in treating other joints. A 2.9-mm-diameter, light-sensitive, high-definition, 20-cm-long arthroscope is inserted through a 4.6-mm cannula. This arthroscope-cannula combination yields fluid flow mechanics similar to a standard 4-mm arthroscope in a 5.8-mm cannula. A Parallel Portal Cannula (PPC) (Stryker Endoscopy) is applied to the arthroscope cannula, producing a “double-barrel” system for entry into the joint. The PPC allows for sliding and rotational freedom along the axis of the arthroscope cannula but also locks in place once a desired position is achieved. PPC devices are available in zero-length, short (25-mm), and long (55-mm) sizes. Cutters that are bent in the mid shaft are available in 3.5- and 4-mm diameters. The instrumentation system allows both viewing with the arthroscope and passage of working cutters and biters through a single 9- to 10-mm portal. Potential advantages of single-portal arthroscopy include decreased patient morbidity and recovery time while still allowing for adequate treatment of limited knee pathology.