Comparison of Clinical and Radiological Results between Posteromedial Portal Technique and Posterior Transseptal Portal Technique in Making a Tibial Tunnel in Single Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to compare the clinical and radiological results between posteromedial portal technique and posterior transseptal portal technique in making a tibial tunnel in single bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation. MATERIALS AND METHODS: Thirty-three cases of posteromedial portal technique and 35 cases of posterior transseptal portal technique in making a tibial tunnel in single bundle PCL reconstruction with remnant preservation were evaluated retrospectively. The clinical evaluation, including function and stability, was assessed. The tibial tunnel placement was measured using computed tomography. RESULTS: At final follow-up, the clinical results showed significant improvement compared to preoperation in both groups. There were no significant differences in clinical results including function and stability in both groups. The centers of tibial tunnels by posteromedial portal technique were placed more medially and proximally than those of the posterior transseptal portal technique. CONCLUSION: Remnant preserved single bundle PCL reconstructions by posteromedial portal technique and posterior transseptal portal technique were good methods for restoring function and stability compared to preoperation. There were no significant differences in clinical results in both groups. However, the tibial tunnels by posteromedial portal technique tended to be more medial and proximal placements than those of the posterior transseptal portal technique.

Clinical Results of Direct Arthroscopic Excision of Popliteal Cyst Using a Posteromedial Portal

PURPOSE: To evaluate the efficacy of the direct arthroscopic excision of a popliteal cyst without additional skin incision using a posteromedial portal based on minimum 2 year follow-up clinical results. MATERIALS AND METHODS: From January 2003 to January 2010, 105 patients (111 cases) with popliteal cyst have been treated by a direct arthroscopic excision. Direct arthroscopic excision using a 70 degree arthroscopy and posteromedial portal can correct the valvular mechanism of capsular fold and reduce the complications with no additional skin incision at the popliteal area. In all cases, preoperative magnetic resonance imaging (MRI) was performed to detect combined intraarticular pathology. At 2 years postoperatively, a follow-up ultrasonography or MRI was performed to detect the recurrence of cysts. We used Rauschning and Lindgren criteria for clinical evaluation. RESULTS: All cases had neither recurrence nor complaints of pain, swelling, or functional impairment more than 2 years after the surgery. At ultrasonography or MRI, no recurrence was found, and 5 complications were 1 skin lesion and 4 hematoma. Postoperatively, Rauschning and Lindgren criteria were more than grade 1. CONCLUSIONS: Direct arthroscopic excision using 70 degree arthroscope and posteromedial portal is an effective method for the treatment of popliteal cyst.

Arthroscopic Decompression and Shaving of Popliteal Cyst Using Posteromedial Portal: Technical Note

PURPOSE: To present the surgical procedure of arthroscopic decompression and shaving of popliteal cyst using posteromedial portal. OPERATIVE TECHNIQUE: After diagnostic knee arthroscopic examination, if there is associated intra-articular pathology with popliteal cyst, appropriate arthroscopic procedure has to be performed to adress the associated intra-articular pathology. It is the most important procedure to find the opening of connection between joint cavity and popliteal cyst at posteromedial compartment using anterolateral or posteromedial In some cases the capsular fold overlie the opening of connection, so thorough diagnostic examnation is mandatory. When the opening of connection is visualized, it is enlarged about 8 mm by the arthroscopic decompressive procedure of popliteal cyst using arthroscopic shaver which is approached via the posteromedial portal. After then arthroscope is positioned at posteromedial portal and advanced into popliteal cyst via enlarged opening to visualize the inside of popliteal cyst. While visualizing the inside of popliteal cyst, a 18 gauge spinal needle is introduced by outside-in technique from medial side of the skin overlying popliteal cyst. And then we make trans-cystic portal at the site of spinal needle by incising the skin with # 11 blade and arthroscopic shaver is introduced within popliteal cyst via trans-cystic portal, and arthroscopic cystectomy is performed to shave the inner wall of popliteal cyst with arthroscopic shaver. DISCUSSION: The arthroscopic procedure for popliteal cyst is an alternative of traditional surgical removal of popliteal cyst and it is expected to diagnose and to manage associated intra-articular pathology and to perform arthroscopic decompression and cystectomy effectively using posteromedial portal.