• LEDs.
When it comes to
light sources,
Xenon has long
been a staple, but
LEDs seem to be
the new trend.
They do seem to
provide a little
brighter illumina-
tion, along with a
more compact
interface and a
longer lifespan, with some companies now promising up to 50,000
hours.
• Portal placement. Of course no matter how good your light-
ing is, or how sophisticated your instruments are, if your portal isn't in
precisely the right place, you're going to have a heck of a time seeing
what you want to see. A technique I learned years ago and still use is
to use a spinal needle to make sure I have the exact placement I need.
If I'm doing a routine knee arthroscopy, or ACL or meniscus repair,
and I want to make sure the angle of my portal allows me to get to the
location I need, I make a little needle stick in the skin and advance the
spinal needle all the way across the joint until I can actually touch the
structure I want to repair. Let's say I want to be able to hit the back of
the medial compartment. If my portal is too high on the medial side,
I'm going to run into the femoral condyle. If it's too low, I'm going to
run into the tibial plateau. But the spinal needle makes it easy to get
just the right elevation. I can make several needle sticks, if necessary.
And once I've localized the proper location, I can remove the needle
9 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 6
• ON TARGET Optimal portal placement and the right angled scope help put arthroscopic knee repair in the right perspective.
Danny
Dierking
