1. The surgeon marks the anteromedial and anterolateral joint lines and portal positions with a skin marker. 2. The skin areas for portal placement are infiltrated with local epinephrine. If the knee has an effusion, the surgeon aspirates it with a 16-gauge needle on a 60ml syringe, followed by injection of a small amount of distending fluid. 3. After a small stab incision with a #11 or #15 knife blade, the surgeon inserts the irrigation cannula and trocar into the lateral suprapatellar pouch near the superior pole of the patella. Lactated Ringer’s or normal saline solution is connected to the cannula and the joint is distended using gravity or a pressure-sensitive arthroscopy pump. 4. A stab incision is then made laterally or medially 2-3 mm above the tibial plateau or patellar tendon at the joint line. A sharp trocar and sheath are inserted through the stab wound and just through the capsule. 5. A blunt trocar is used to pass the sheath into the knee joint. The surgeon removes the trocar and inserts a 30 or 70 degree scope into the sheath. The light source and video camera are connected to the scope. 6. The inflow may remain in the suprapatellar area, and the tubing is connected to the arthroscope, or the position may be reversed. 7. A spinal needle can be introduced under direct vision to determine the best angle for an opposite portal for insertion of probes and operative instruments. The cruciates and menisci are probed to determine integrity and tears. 8. The scope is moved to the opposite portal to facilitate complete examination. 9. The joint is irrigated periodically and at the end of the procedure to maintain good visualization and clear the joint of blood and tissue fragments. 10. Necessary repairs are made using special arthroscopic instruments, drills, shavers, or implants. 11. The surgeon closes the portals with nylon or undyed polyglactin suture and ½ inch wound closure strips. 12. Local of surgeon’s choice...
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