Basic Knee Arthroscopy Part 4: Chondroplasty, Meniscectomy,

and Cruciate Ligament Evaluation

Benjamin D. Ward, M.D., and James H. Lubowitz, M.D.

Abstract: Knee arthroscopy is an important diagnostic and therapeutic tool in the management of disorders of the knee.
In a series of 4 articles, the basics of knee arthroscopy are reviewed. In this article (part 4), the basics of operative knee
arthroscopy are reviewed including chondroplasty and meniscectomy. Evaluation of the cruciate ligaments is also
reviewed. Mastery of these techniques is critical for the treatment of the most common pathology encountered during
knee arthroscopy.

K nee arthroscopy is the most commonly performed

orthopaedic procedure. Indications include diag-
nostic arthroscopy, meniscectomy, loose body removal,
Surgical Technique
The 2 most frequent operative procedures in knee
arthroscopy are meniscectomy and chondroplasty
chondroplasty, microfracture, irrigation and debride- (Video 1). A critical skill to be mastered for both
ment, and ligament reconstruction. In this series of arti- procedures is triangulation. This refers to the triangle
cles, we present a comprehensive review of the complete that is formed by the instrument and the arthroscopic
surgical technique for basic knee arthroscopy.1,2 camera. The ability to insert instruments into the knee
Two of the most commonly found pathologies on so that they appear within the camera’s field of view is
arthroscopy are chondromalacia and meniscal tears. critical to master so as not to damage cartilage. Areas of
Chondroplasty refers to the smoothing of degenerative cartilage degeneration or damage can be treated with
cartilage and trimming of unstable cartilage flaps to chondroplasty. Rough and unstable cartilage lesions are
stabilize and treat chondral lesions. Partial meniscec- treated with the use of an oscillating shaver, curettes,
tomy involves trimming unstable flaps of a torn and other debridement tools. A curved shaver can
meniscus to establish a stable remnant meniscus. These reach more places within the knee and can be very
2 techniques are critical for performing basic operative useful for treating lesions of the patella. A small amount
knee arthroscopy. Cruciate ligament evaluation is also of suction is used on the shaver to remove the debris
covered in this article. Examination of the integrity without decreasing the intra-articular pressure from
and attachments of the posterior cruciate ligament over-sucking, resulting in bleeding. Curved shavers clog
(PCL) and anterior cruciate ligament (ACL) is part of more frequently, and a technical pearl is to maintain
a complete diagnostic knee arthroscopy.3,4 strong suction with the use of a pressure- and flow-
controlled pump to maintain joint distension while
preventing clogging. Unstable cartilage is removed,
From Taos Orthopaedic Institute, Taos, New Mexico, U.S.A.
with care taken neither to damage healthy cartilage nor
The authors report the following potential conflict of interest or source of to expose bare bone. Advanced techniques for treating
funding: B.D.W. receives support from Arthrex Fellows Forum Travel and cartilage damage include microfracture, abrasion
Hotel; J.H.L. receives support from SNE, Arthrex, Ivivi, AANA, law firms not arthroplasty, and osteochondral autograft or allografts
related to orthopaedic industry (i.e., medical malpractice defense, ski industry and adjuvants.
defense), Breg, Donjoy, Smith & Nephew, MTF, DCI, Taos Orthopaedic
Institute, Taos Center for Sportsmedicine and Rehabilitation, and Taos MRI.
Meniscal tears are the most frequently encountered
Received June 29, 2013; accepted July 25, 2013. pathology on knee arthroscopy. These are most
Address correspondence to James H. Lubowitz, M.D., Taos Orthopaedic commonly treated with partial meniscectomy when they
Institute, 1219-A Gusdorf Rd, Taos, NM 87571, U.S.A. E-mail: jlubowitz@ occur in the inner avascular region. There are different
kitcarson.net techniques to remove the torn portion of the meniscus, or
Ó 2013 by the Arthroscopy Association of North America. Open access
under CC BY-NC-ND license.
“partial meniscectomy.” Often, the most effective method
2212-6287/13441 to start the meniscectomy is to use a biter and then use
http://dx.doi.org/10.1016/j.eats.2013.07.011 a shaver to remove the morsels (Fig 1). As described

Arthroscopy Techniques, Vol 2, No 4 (November), 2013: pp e507-e508 e507

e508 B. D. WARD AND J. H. LUBOWITZ

but spare healthy meniscus as long as the surgeon

controls the technique. Morselization is a technique that
combines the biter with the shaver to remove pathologic
tissue. The morsels are little pieces that are created when
the biter is used to remove meniscus. After the biter is
used, the surgeon lets go of the biter, resting it gently on
the back of the knee, and turns the fluid off to prevent the
pieces from floating away and creating a loose body. The
biter is gently removed, and the shaver is immediately
inserted and the suction turned on to remove the morsels
and smooth the rim. The biter and shaver are used to
remove the tear and create a smooth transition zone back
to normal meniscus.
An important part of diagnostic arthroscopy is eval-
uating the cruciate ligaments. With the arthroscope
viewing the intercondylar notch, the ACL and PCL can
be seen forming a triangle. The ligaments should be
probed to check for laxity. Often, a torn ACL will scar to
Fig 1. Lateral compartment of a left knee viewed from the the PCL and will lose its normal attachment to the
anterolateral portal. An arthroscopic biter (A) is seen lateral wall. Patients with a torn ACL will have an
removing pathologic torn meniscus tissue from the lateral empty lateral wall.
meniscus (B). The biter can be used to sharply remove torn
meniscus tissue to leave a stable rim of residual tissue. The
biter produces free-floating morsels that must be removed Discussion
with the shaver to prevent them from becoming loose bodies. Knee arthroscopy is a valuable diagnostic and thera-
peutic procedure for the treatment of various knee
earlier, the shaver has suction that will remove loose disorders. Chondroplasty is a basic treatment option for
pieces (Fig 2). The suction also pulls the torn tissue into articular cartilage pathology found on diagnostic
the shaver so that the shaver blade can remove the arthroscopy. Key points include removing rough and
damaged tissue. It tends to remove damaged meniscus unstable cartilage with the shaver and curettes to
establish a stable lesion without exposing subchondral
bone. Meniscal tears are the most common reason for
knee arthroscopy. Treatment with partial meniscectomy
is appropriate when the tears occur in the avascular
inner two-thirds of the meniscus. Key points include
morselization with the biter and prevention of loose
bodies by quickly inserting the shaver to remove the
morsels. The shaver is also used to create a smooth
transition to normal meniscus tissue. Mastery of chon-
droplasty and meniscectomy will allow the surgeon to
effectively treat 2 of the most common pathologies
encountered on knee arthroscopy.

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