Rarely life threatening: <>stream al., 2009). endobj Injury 2013; 44: 14981501. Knee Medial Parapatellar Approach - Approaches - Orthobullets METHODS: Fifty-six consecutive patients scheduled for knee arthroscopy were enrolled. located just lateral to peroneus tertius and superficial peroneal nerve and medial to lateral malleolus can trace out superficial peroneal nerve prior to incision Anterocentral function anterior viewing portal location and technique not commonly utilized due to danger to dorsal pedis artery medial to EDL and lateral to EHL Posterolateral function Unable to load your collection due to an error, Unable to load your delegates due to an error. Generally, primary closure of the wound is contraindicated. First described in the orthopedic literature in 1978, this test involves challenging the knee joint by injecting a significant amount of sterile saline into the joint space and observing for extrusion of saline from the wound(s). The injection of normal saline solution at a rate of 5 mL/sec through an 18-gauge needle was continued while the knee was moved through a range of motion until fluid extravasated from the iatrogenic laceration. Browning BB et al. Methods: Forty-two patients undergoing elective ankle arthroscopy were prospectively enrolled. 13.2 -2.00001 Td Feathers T et al. CT scan of the joint may have even greater sensitivity for small volumes of intra-articular air. Hip Arthroscopy - Knee & Sports - Orthobullets 2020 Mar 2;5(1):2473011420905610. doi: 10.1177/2473011420905610. endobj Saline Load Test for Detecting Traumatic Arthrotomy in the Wrist. Healthcare. <> 0 1.00001 TD . ( )Tj ET 2023 Lineage Medical, Inc. All rights reserved, Approaches | Knee Medial Parapatellar Approach, most structures of the anterior aspect of knee, support heel when knee is flexed to 90 degrees, spinal, epidural, sciatic and/or femoral blocks, tape sandbag under hip to internally rotate leg, divide subcutaneous tissues below skin incision, take care not to damage the anterior insertion of the medial meniscus (irrelevant for TKA), if difficult to flip patella then extend incision between rectus femoris and vastus medialis proximally, if contractures continue to prevent dislocation of the patella then can detach tibial tuberosity bone block and reattach afterwards with a screw, flex knee to 90 degrees to gain exposure to entire knee joint, incise between rectus femoris and vastus medialis, split underlying vastus intermedius to expose femur, proximal portion of the arthrotomy extends into the muscle belly of the vastus medialis, patella can be difficult to evert and is subluxated laterally instead, muscle belly of the vastus medialis is lifted off the intermuscular septum, preserving the blood supply to the patella, preserving the anatomy of the quadriceps tendon (maintains stability of knee), at risk during lateral retinacular release, may be last remaining blood supply after medial parapatellar approach and fat pad excision, saphenous nerve becomes subcutaneous on medial aspect of knee after piercing the fascia between the sartorius and gracilis, saphenous nerve then gives of infrapatellar branch that provides sensory to the anteromedial aspect of the knee, if cut during surgery, resect and bury end to decrease chance of painful neurom, cutaneous blood supply may be tenuous in cases of previous surgery (revision TKA) or poor host (rheumatoid etc. 0.68236 0.1098 0.1647 RG 0000003779 00000 n Injury 2013; 44: 14981501. /T1_2 1 Tf Open fractures are fractures with direct communication to the external environment. Cavus Deformities. Does the saline load test still have a role in the orthopaedic world? [1] Understanding the basic anatomy and pathophysiology of knee effusions is essential to make an accurate diagnosis. Background: A systematic review of the literature. /T1_1 1 Tf PMID: 23490316. Different countries in which training hospitals use our PASS Enterprise analytics platform. -8.971 0 Td PMID: 25150328, Makhni MC. Are you sure you want to trigger topic in your Anconeus AI algorithm? PMC Effectiveness of the saline load test in diagnosis of traumatic elbow arthrotomies. A standard inferolateral arthroscopic portal was made with a single stab incision with use of a number-11 blade. 100 0 obj 2022 Jan 30;14(1):31909. doi: 10.52965/001c.31909. 15 0 0 15 72 513.99997 Tm Detection of a traumatic arthrotomy in the pediatric knee using the saline solution load test. 97 0 obj BT Orthobullets - www.orthobullets.com Federal government websites often end in .gov or .mil. FOIA In order to detect 95% of 1-cm inferolateral arthrotomies of the knee with use of the saline solution load test, 155 mL must be injected. Place the knee in gentle flexion, which can be maintained with a towel roll. J Orthop Trauma. 0000071109 00000 n None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Brubacher, Dr. Grote, and Dr. Tilley. 0 0 1 rg Bull Hosp Jt Dis (2013). 2023 Lineage Medical, Inc. All rights reserved. Orthop Rev (Pavia). A23-year-old male presents after a bicycle accident. Current treatment of traumatic arthrotomy includes intravenous antibiotics and surgical irrigation and dbridement. Each diagnostic pathway provides useful information when evaluating for traumatic arthrotomy, and when available, the studies in conjunction may add to diagnostic yield. Most orthopedic authors conclude that saline loading test alone is either insufficiently sensitive to rule out joint violation when used alone or that a significant amount of fluid must be injected to achieve adequate sensitivity. Open Knee Joint Injuriesan evidence-based approach to management. J Orthop Traum 2012; 26: 3479. Views on the site, app, or social media channels. Traumatic Arthrotomy. They reported that the overall cost associated with isolated low-energy GSWs to the extremity is high. recognizing a penetrating injury (i.e., a traumatic arthrotomy) that contaminates the joint by making it contiguous with the skin. Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study. TECHNIQUE STEPS. 96 0 obj Split Anterior Tibial Tendon Transfer. Tornetta and Collins 1 (1996) reported 25 patients in whom a partial medial parapatellar arthrotomy was performed with the knee in a semi-extended position (15-degree bend of the knee joint), with two-thirds of the the retinaculum split. Hip Arthroscopy - Knee & Sports - Orthobullets Knee Evaluation in the Athlete Meniscal injuries Ligament injury Knee Overuse injuries Knee Extensor Mechanism Knee Cartilage Lesions Pediatric Knee Team physician Head & Neck Sports Injuries Updated: Mar 24 2023 Hip Arthroscopy } Matthew J. Steffes MD Experts 66 Bullets 198 Cards 21 Questions 9 Cases <> The site is secure. J Ortho Trauma 2012]. proximal portion of the arthrotomy extends into the muscle belly of the vastus . Open knee joint injuries--an evidence-based approach to management evaluation for traumatic arthrotomy of the knee Treatment Nonoperative urgent IV antibiotics, tetanus prophylaxis, and extremity stabilization and dressing indications initial treatment for all open fractures a soft tissue wound in proximity to a fracture should be treated as an open fracture until proven otherwise 454 0 l 2020 Apr;51(4):1114-1117. doi: 10.1016/j.injury.2020.02.087. /T1_2 1 Tf Sterilize the skin of the lower extremity from distal quadriceps to proximal calf with betadine or chlorhexidine. The https:// ensures that you are connecting to the Principles of arthrotomy & arthrocentesis. I feel like inserting a needle and injecting into a joint space would track air into that space and then your CT would not be properly interpretable. Open Fractures Management - Trauma - Orthobullets Distal Femur Fracture ORIF with Single Lateral Plate. The saline solution load test helps to determine if a wound extends into the knee joint. arthrotomy, the valgus deformity sufficiently facilitates general expo-sure so that access to the posterolat-eral corner of the knee joint is not difficult, even in patients with ex-treme obesity. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); How To Confidently Rule Out Traumatic Arthrotomy of the Knee. PMID: Konda SR et al. retrospectively reviewed the overall treatment costs associated with isolated low-energy GSWs to the extremity and the estimate cost savings associated with a single-dose IV antibiotic strategy administered in the emergency room for patients with simple GSWs. (This is an enhanced PDF from The Journal of Bone and Joint Surgery)Tj 0000003962 00000 n 0000001528 00000 n National Library of Medicine 8 0 0 8 200.45184 578.99994 Tm There is little data in the literature about what constitutes a high-risk injury aside from deeply penetrating trauma such as gunshot and stab wounds. 2023 Lineage Medical, Inc. All rights reserved, TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique. /T1_2 1 Tf 2015 May 20;97(10):846-9. doi: 10.2106/JBJS.N.01327. (Click here to )Tj -5.721 0 Td startxref PMID: 27979366. Fifty-six consecutive patients scheduled for knee arthroscopy were enrolled. Exam is notable for a deep laceration slightly inferior and lateral to his left patella. q 1 0 0 1 72 557 cm 14. 0 g /T1_1 1 Tf Costs of Care for Low-Energy Extremity Gunshot Injuries are Reduced With Standardized Treatment. The .gov means its official. Treatment is observation, NSAIDs, tramadol and corticosteroids for minimally symptomatic patients. Operative Treatment for Resistant Clubfoot. Orthobullets Team. Correct me if Im wrong, but wouldnt performing the SLT before CT cause many false positives? /T1_1 1 Tf 0 g Answer 3: Trans-abdominal intra-articular GSWs are considered contaminated. Total knee arthroplasty - UpToDate While these injuries can occur at any <> Traumatic Arthrotomy : JAAOS - Journal of the American Academy of - LWW endobj ), skin is supplied by perforating arteries which run in the muscular fascia so any medial or lateral skin flaps (if needed) should be just below (deep to) the fascia to avoid. Browning BB, Ventimiglia AV, Dixit A, Illical E, Urban WP, Jauregui JJ. They reported that the incidence of infection after IA gunshot injuries is low with the routine use of antibiotic prophylaxis. -5.416 0 Td lower morbidity than open arthrotomy with expeditious post-operative course. hb```e``z Bl@hOOKe_ %fAG=&=t348[9KwjIa|,oQZK]btA]}~ Cards published by our editorial team or personal cards created by our users. The purpose of this study was to determine the volume of saline required to detect traumatic arthrotomy of the ankle. Would you like email updates of new search results? endobj Ponseti Technique in the Treatment of Clubfoot. Distal Radial Ulnar Joint (DRUJ) Injuries (Detection of Traumatic Arthrotomy of the Knee Using the Saline)Tj The knee is a hinge joint susceptible to injury from trauma, inflammation, infection, and degenerative changes. Surgical Treatment of Septic Arthritis Technique - Medscape technically difficult procedure due to deep location of hip joint and high congruity (as compared to knee and shoulder) significant learning curve. S Transthoracic approach to thoracic spine. 0 g Disclaimer. Quite useful for orthopaedic residents, GPs and med students. Nguyen et al. (\240 )Tj Soft tissue injury that penetrates the joint space and exposes the joint space to the environment. Injection sites were randomized to either a superomedial or inferomedial location. Your message has been successfully sent to your colleague. Journal of the American Academy of Orthopaedic Surgeons, Get new journal Tables of Contents sent right to your email inbox, Articles in PubMed by Jacob W. Brubacher, MD, Articles in Google Scholar by Jacob W. Brubacher, MD, Other articles in this journal by Jacob W. Brubacher, MD. Historically, the saline load test has been the diagnostic test of choice for assessing traumatic arthrotomy; however, CT has recently been shown to have excellent sensitivity and specificity for detecting open knee joint injuries. Answer 4: Local wound care, tetanus prophylaxis, and administration of IV antibiotics have been showed to be appropriate for low-velocity intra-articular GSWs. For each patient, a standard 4-mm anteromedial portal was established. endobj 0 0 1 rg Treatment depends on location of fracture but generally requires immediate IV antibiotics and urgent irrigation and debridement followed by surgical fixation as needed. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. There is a small body of literature indicating that computerized tomography (CT) scanning of the knee joint may have a significant role in ruling out traumatic arthrotomies. Principles of arthrotomy & arthrocentesis - SlideShare flex knee to 90 degrees to gain exposure to entire knee joint; Extension . Posterior Approach to Thoracolumbar Spine. Traumatic Arthrotomy - Core EM African American males are the least likely to receive total joint replacement when compared to whites and Hispanics, binding of proteoglycans to hyaluronic acid, moderate inflammatory changes of synovium, osteophytes form through the pathologic activation of endochondral ossification mediated by the Indian hedgehog (Ihh) signaling molecule, responsible for cartilage matrix digestion, control MMP activity preventing excessive degradation, secreted by synoviocytes and increase MMP synthesis, No joint space narrowing (JSN) or reactive changes, Possible osteophytic lipping + doubtful JSN, Moderate osteophytes + definite JSN + some sclerosis + possible bone end deformity, Large osteophytes + marked JSN + severe sclerosis + definite bone end deformity, identify age, functional activity, pattern of arthritic involvement, overall health and duration of symptoms, often an increased adductor moment to the limb during gait, antalgic gait associated with knee arthritis, lack of full extension (>5 degrees flexion contracture), lack of full flexion (flexion <110 degrees), medial and/or lateral tibiofemoral, and/or patellofemoral, cartilage destruction with eburnation of subchondral bone, first line treatment for all patients with symptomatic arthritis, Non-steroidal anti-inflammatory drugs (first choice), selection should be based on physician preference, patient acceptability and cost, duration of treatment based on effectiveness, side-effects and past medical history, treatment option for patients with symptomatic arthritis, good evidence for mid term (8-13 weeks) improvement in pain and stiffness over placebo, Prior AAOS guidelines recommended its use, but newer guidelines do NOT recommend its routine use, rehabilitation, education and wellness activity, combination of supervised exercises and home program have shown the best results, these benefits lost after 6 months if exercises are stopped, patients with symptomatic arthritis and BMI > 25, medial unloader for isolated medial compartment OA, AAOS guidelines: moderate evidence against, younger patients with medial unicompartmental OA, valgus producing proximal tibial oseotomy, TKA have lower revision rates than UKA in the setting of unicompartmental OA, cruciate retaining vs. crucitate sacrificing implants show no difference in outcomes, no difference in pain or function with or without patella resurfacing, Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. (Permissions] link. [ 38, 39] Arthrotomy is the best. If CT is still not sensitive enough, then maybe injecting a small amount of saline + contrast (would gastrografin be harmful if injected into a joint?) 0 12.19352 1 Td 2023 Lineage Medical, Inc. All rights reserved. In one series, a volume of 194 mL was required to achieve a 95% sensitivity for small injuries. Setup. Unauthorized use of these marks is strictly prohibited. Results: HHS Vulnerability Disclosure, Help 0 g endobj retrospectively reviewed the demographics, interventions, infection rates, and other complications after intra-articular (IA) gunshot wounds. (jbjs.org)Tj <>stream In the absence of intra-articular pathology, intra-articular gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection and may be treated with local wound care, tetanus, and IV antibiotics. A summarised guide on these often frequently carried out proceduresv - arthrocentesis & arthrotomy. J. Trauma 71 2011; E110113. Asi-oqua Bassey Follow. 101 0 obj Cureus. You are on your orthopedic trauma rotation at a busy Level 1 trauma center. PDF Detection of Traumatic Arthrotomy of the Knee Using the Saline Solution Evaluation of periarticular traumatic wounds for joint penetration is a common clinical concern for orthopaedic surgeons. Detection of traumatic arthrotomy of the knee using the saline - PubMed 0000003871 00000 n Answer 4: Local wound care, tetanus prophylaxis, and administration of IV antibiotics have been showed to be appropriate for low-velocity intra-articular GSWs. (The Journal of Bone and Joint Surgery)Tj You can read the full text of this article if you: You may be trying to access this site from a secured browser on the server. endobj 2014;72(1):61-9. (Russell M. Nord, Tony Quach, Michael Walsh, David Pereira and Nirmal C. \ Tejwani \240 )Tj 0000001968 00000 n Are you sure you want to trigger topic in your Anconeus AI algorithm? 0 0 m The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. J Wrist Surg. Patella Fractures are traumatic knee injuries caused by direct trauma or rapid contracture of the quadriceps with a flexed knee that can lead to loss of the extensor mechanism. Bariteau JT et al. When one considers that a typical synovial fluid volume of the knee is around 7 mL [pmid 8779258], injecting 150 mL or more into that joint is a procedure that will require logistical planning and coaching of a cooperative patient. Inoculation of the joint often results in septic arthritis. Bethesda, MD 20894, Web Policies PDF Constraint in Primary Total Knee Arthroplasty - Orthobullets Much of the above literature reveals deficiencies of sensitivity for evaluation of traumatic arthrotomy. -13.95751 1.00001 Td `1AAGGKhh(t H$*(P( Careers. /T1_1 1 Tf Springer, Cham, Metzger et al. Incorrect Answers: Answer 2: An arthrotomy is indicated for intra-articular bullet as it may lead to local inflammation, arthritis and lead intoxication (plumbism). -3.028 0 Td Scientific journals integrated with our learning platform. eCollection 2020 Jan. J Orthop Case Rep. 2021 Mar;11(3):107-112. doi: 10.13107/jocr.2021.v11.i03.2110. Different training hospitals using our PASS training platform. The knee is comprised of the structures that surround the bony articulations of the femur, tibia, fibula, and patella. 103 0 obj TECHNIQUE VIDEO. A cadaveric study showed that CT demonstrates greater sensitivity for even small volumes (0.1 mL) of air in the joint. J Bone Joint Surg Am. Confirm entry into the joint with aspiration of synovial fluid (assuming remaining synovial fluid after injury). /T1_0 1 Tf Diagnosis is made clinically by assessing the size and nature of the external wound as well as obtaining radiographs of the bone at the location of the soft tissue injury. 2019 Jun;8(3):221-225. doi: 10.1055/s-0039-1683365. Ohliger E, Ohliger Iii J, Sultan A, Miniaci-Coxhead SL. Physician votes on our clinical treatment polls. muscle belly of the vastus medialis is lifted off the intermuscular septum. Epub 2016 Dec 12. The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. The potential advantage of This patient sustained an intra-articular gunshot wound (GSW) without other intra-articular pathology. 2007 Aug;21(7):442-3. doi: 10.1097/BOT.0b013e31812e5186. Ligaments, cartilages, and tendons are key structures both around and outside the joint. <>>> 21.02501 1 Td J. Orthop. (Solution Load Test)Tj When the patella was subluxed laterally, the trochlear groove was used as a bed for the instruments and nail. This site needs JavaScript to work properly. Are you sure you want to trigger topic in your Anconeus AI algorithm? -72 -471 m A saline load test (SLT) is the most common, non-surgical approach and diagnostic test for traumatic knee injuries involving the joint. PDF Total Knee Arthroplasty in the Valgus Knee - Orthobullets /T1_1 1 Tf %PDF-1.6 % Methods: [Metzger, Carney, Booher. <>/Filter/FlateDecode/Height 390/Length 66931/Name/X/Subtype/Image/Type/XObject/Width 900>>stream 99 0 obj Question 218990 - Qbank - Orthobullets <>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> Initial evaluation of periarticular wounds includes thorough examination of the wound and plain radiographs. %%EOF Setup, Positioning, and Joint access. ?Yfy{{O0X|}!55566;giR%H?-_jm T+44TvGUUU. J. Orthop. Septic Hip Irrigation and Debridement )Tj Before A systematic review of the literature. An arthrotomy is indicated in these cases. Diagnosis can be made with plain radiographs of the knee. Are you sure you want to trigger topic in your Anconeus AI algorithm? Different Live Medical Meeting we have partnered with. to maintaining your privacy and will not share your personal information without /T1_2 1 Tf Also known as "traumatic arthrotomy". Plain radiographs are negative for fracture. Unique people that have viewed our content. 104 0 obj PMID: 21768902, Keese GR et al. Please try again soon. Exam findings suspicious for joint capsule involvement: Extravasation of joint fluid straw colored, viscous, sometimes oily in appearance, Always obtain at least two views at right angles to each other (i.e. Little is known about the volume of injected intra-articular saline solution that is needed to effectively rule in or rule out a traumatic arthrotomy of the knee. As you assemble laceration repair supplies, you begin to consider the possibility of knee joint involvement. Injury. Traumatic Arthrotomy (forums.mtbr.com) Definition: a deep laceration that extends into the joint capsule, exposing the intra-articular surface to the environment. Wolters Kluwer Health Lesser Toe MTP Joint Approach - Approaches - Orthobullets J. Trauma 71 2011; E110113. ( )Tj \240doi:10.2106/JBJS.G.01682 )Tj Nonoperative management with local wound care, tetanus prophylaxis +/- short course of oral antibiotics is indicated in low-velocity injury with no bone involvement or non-operative fractures. midvastus approach. 0.68236 0.1098 0.1647 rg dedicated hip arthroscopy instruments required. Knee Arthroscopy - Approaches - Orthobullets Shoulder Approaches Humerus Approaches Elbow Approaches Forearm & Wrist Approaches Hand Approaches Acetabulum Approaches Hip Approaches Thoracic Spine Lumbar Spine Updated: Aug 2 2018 Knee Arthroscopy } David Abbasi MD Bullets 91 Questions 2 Cases 1 Evidence 5 Video/Pods 2 4.8 ( 16 ) 2 Topic Podcast Understanding the anatomic landmarks and capsular extensions of the major joints is key to proper evaluation. Sterilize the skin of the lower extremity from distal quadriceps to proximal calf with betadine or chlorhexidine. A laceration into the joint exposes the normally sterile intra-articular contents to external contamination, Inoculation of the joint often results in septic arthritis, Laceration over joint which may be large or small, Probe to bottom of wound with hemostat or q-tip. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. 0000001875 00000 n Distal Femur Fracture ORIF with Single Lateral Plate )Tj The accuracy of the saline load test in the diagnosis of traumatic knee arthrotomies. How To Confidently Rule Out Traumatic Arthrotomy of the Knee doi: 10.7759/cureus.20793. 10 0 0 10 161.70999 483.99988 Tm Goyal N, Bohl DD, Frank RM, Slikker W 3rd, Fernandez JJ, Cohen MS, Wysocki RW. A much smaller volume of 50 mL was less than 50% sensitive. Moreover, in the absence of IA pathology, IA gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. A systematic review of the literature. The Effectiveness of Saline Load Test in Detecting Simulated Traumatic Elbow Arthrotomies: A Cadaveric Investigation. The incidence of infection after IA gunshot injuries is low with the routine use of antibiotic prophylaxis. (order reprints or request permission)Tj endobj ( )Tj 18.921 -2.00001 Td 150 cc saline load into joint has high negative predictive value and 95% sensitivity in detecting small joint injuries. Are you sure you want to trigger topic in your Anconeus AI algorithm? Total Knee Arthroplasty procedure steps - Opulent Epidemiology. (Reprints and Permissions)Tj Bulletin of the Hospital for Joint Diseases 2014; 72: 61-9. Definition: a deep laceration that extends into the joint capsule, exposing the intra-articular surface to the environment, History: Mechanisms that should raise suspicion for violation of the joint capsule include penetrating trauma (knives, sharp objects, gunshot), falls, or other high energy injuries, Traumatic Arthrotomy Workup Flow (epmonthly.com), Bariteau JT et al. -3.61601 -3.8 Td endstream Data is temporarily unavailable. FN0370q080p8 QW(&0`fw9m8+#Dc5@ 2 PMID: Browning BB et al. Consider CT to assess for intraarticular air, Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients, Open joints ED evaluation and management, How to confidently rule out traumatic arthrotomy of the knee. Intra-articular gas seen on radiograph or the development of septic arthritis following a peri-articular wound are generally considered definitive signs of knee joint penetration. Ankle Arthritis - Foot & Ankle - Orthobullets Postoperative Patient Care. 0 0 1 rg /T1_2 1 Tf Arthroscopy is a surgical technique that can be applied to perform the following types of procedures: Chondral defect repair, including microfracture, controversial whether or not it provides symptomatic relief, but makes figure-four position more difficult, Place tourniquet (important for safety, but often not inflated), Make anterolateral incision over soft spot of knee, have advantage of increased superior-inferior mobility of instruments, have advantage of increased medial-lateral mobility of instruments, advance blade into capsule then follow with trochar, make with knee in flexion, adjacent to patellar tendon over soft spot on joint line, used as the primary instrumentation portal, most common site for aspiration or injection, 1 cm above joint line between LCL and biceps tendon, 1 cm distal to patella and splits the patellar tendon, do not use if performing a bone-patella-bone graft harvest, used for anterior compartment visualization, place where can be best utilized for need, Should systematically check the following locations and structures, with knee flexed to 90 move to medial compartment, with knee in figure-four position finish in lateral compartment, Shoulder Anterior (Deltopectoral) Approach, Shoulder Lateral (Deltoid Splitting) Approach, Shoulder Arthroscopy: Indications & Approach, Anterior (Brachialis Splitting) Approach to Humerus, Posterior Approach to the Acetabulum (Kocher-Langenbeck), Extensile (extended iliofemoral) Approach to Acetabulum, Hip Anterolateral Approach (Watson-Jones), Hip Direct Lateral Approach (Hardinge, Transgluteal), Hip Posterior Approach (Moore or Southern), Anteromedial Approach to Medial Malleolus and Ankle, Posteromedial Approach to Medial Malleolus, Gatellier Posterolateral Approach to Ankle, Tarsus and Ankle Kocher (Lateral) Approach, Ollier's Lateral Approach to the Hindfoot, Medial approach to MTP joint of great toe, Dorsomedial Approach to MTP Joint of Great Toe, Posterior Approach to Thoracolumbar Spine, Retroperitoneal (Anterolateral) Approach to the Lumbar Spine.
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