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Protecting patients from unintended harm is one of the most important aspects
of proper positioning. Although nerve damage or pressure injuries caused by
improper placement on the OR table is a relatively rare occurrence, it's also a
complication that positioning devices can help avoid.
The proper use of positioning devices and positioning aids that protect bony
prominences or pressure points helps to mitigate the risk of patient harm. But
A report I co-authored in the journal Arthroscopy
Techniques (osmag.net/uQ5DXp) reviews the basic
principles of positioning a knee arthroscopy patient.
The key to positioning for knee arthroscopy is allowing
for the application of varus and valgus forces, which
open up access to the knee's medial and lateral com-
partments.
First, place the prone patient's heels at the end of
the table to improve the surgeon's access to the knee.
Then make sure the pelvis is lined up with the edge of
the table to ensure the leg can be leveraged firmly
against the leg positioning device or table's post. The
surgical team then has 2 main options for positioning the knee:
• Place a circumferential leg holder around the patient's upper thigh and lower the foot off the table to
allow for the application of direct varus and valgus forces. A surgical assistant can push the leg laterally to
expose the medial compartment or medially to expose the lateral compartment.
• Place a lateral post roughly 5 cm superior to the proximal patella to allow the surgeon or assistant
to stand between the bed and the patient's ankle. Then press the patient's thigh against the post to apply
valgus force, which improves access to the medial compartment. The knee is placed in the "figure of 4"
position for access to the lateral compartment. If access to the intercondylar notch is needed, abduct the
hip, bring the patient's knee off the side of the table and lower the post.
— Benjamin D. Ward, MD
POSITIONING PEARLS
Optimizing Access During Knee Arthroscopy
z A LEG UP Proper positioning of the knee lets
staff and surgeons apply the forces needed to
open up access to the joint.
Pamela
Bevelhymer,
RN,
BSN
