ANATOMIC FEATURES OF POSTERIOR SEPTUM OF KNEE JOINT AND ITS APPLICATION IN POSTERIOR TRANS-SEPTAL PORTAL FOR ARTHROSCOPIC SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Jinpeng , XIONG Yilin , LEI Guanghua.

Department of Orthopedics, Xiangya Hospital, Central-South University, Changsha Hunan, 410008, P.R.China. Corresponding author: LEI Guanghua, E-mail: lgh9640@sina.com;

Corresponding author：

Keywords：

Knee joint; Arthroscopic surgery; Posterior septum; Anatomic structure

DOI：

10.7507/1002-1892.20130050

Video：

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Objective To summarize the anatomic features of the posterior septum of the knee joint and its application in posterior trans-septal portal for arthroscopic surgery. Methods The literature related to posterior septum of the knee joint and arthroscopic surgery was extensively reviewed and analyzed. Results The posterior septum of the knee joint has more mechanoreceptors and blood vessels in the upper part, which are close to arteria popliteal at the tibial plateau level; the posterior compartment is divided into wider posteromedial and narrower posterolateral compartments. A safe arthroscopic trans-septal portal is established, in the knee flexion of 90°, in a lateral-to-medial direction, and with an inserting location below the middle of posterior septum. Conclusion The establishment method of posterior trans-septal portal is not uniform and all the features of posterior septum should be considered to decrease the complications.

Citation： SUN Jinpeng,XIONG Yilin,LEI Guanghua.. ANATOMIC FEATURES OF POSTERIOR SEPTUM OF KNEE JOINT AND ITS APPLICATION IN POSTERIOR TRANS-SEPTAL PORTAL FOR ARTHROSCOPIC SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(2): 233-235. doi: 10.7507/1002-1892.20130050 Copy

1.	21 Tawes RJ Jr, Etheredge SN, Webb RL, et al. Popliteal artery injury complicating arthroscopic menisectomy. Am J Surg, 1988, 156(2): 136-138. 22 Beck DE, Robison JG, Hallett JW Jr. Popliteal artery pseudoaneurysm following arthroscopy. J Trauma, 1986, 26(1): 87-89. 23 Pace JL, Wahl CJ. Arthroscopy of the posterior knee compartments: neurovascular anatomic relationships during arthroscopic transverse capsulotomy. Arthroscopy, 2010, 26(5): 637-642. 24 Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy, 2000, 16(8): 796-804. 25 Cosgarea AJ, Kramer DE, Bahk MS, et al. Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal. J Knee Surg, 2006, 19(3): 181-185. 26 Ramos LA, de Carvalho RT, Cohen M, et al. Anatomic relation between the posterior cruciate ligament and the joint capsule. Arthroscopy, 2008, 24(12): 1367-1372. 27 Smith PN, Gelinas J, Kennedy K, et al. Popliteal vessels in knee surgery. A magnetic resonance imaging study. Clin Orthop Relat Res, 1999, (367): 158-164.
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20.	桂鉴超, 王黎明, 张昊伟, 等. 跨膝关节后纵隔入路的建立及临床应用. 中华外科杂志, 2006, 44(16): 1106-1110.
21.	Ahn JH, Ha CW. Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy, 2000, 16(7): 774-779.
22.	Louisia S, Charrois O, Beaufils P. Posterior “back and forth” approach in arthroscopic surgery on the posterior knee compartments. Arthroscopy, 2003, 19(3): 321-325.
23.	Ahn JH, Lee YS, Lee DH, et al. Intraarticular fibroma of the posterior compartment in the knee. A case report. Knee, 2008, 15(2): 155-158.
24.	Lakdawala A, El-Zebdeh M, Ireland J. Excision of a ganglion cyst from within the posterior septum of the knee—an arthroscopic technique. Knee, 2005, 12(3): 245-247.
25.	Ramos LA, Astur D, Novaretti JV, et al. An anatomic study of the posterior septum of the knee. Arthroscopy, 2012, 28(1): 100-104.
26.	Kramer DE, Bahk MS, Brett M, et al. Posterior knee arthroscopy: anatomy, technique, application. J Bone Joint Surg (Am), 2006, 88 Suppl 4: 110-121.
27.	Kim SJ, Song HT, Moon HK, et al. The safe establishment of a transseptal portal in the posterior knee. Knee Surg Sports Traumatol Arthrosc, 2011, 19(8): 1320-1325.
28.	罗浩, 余家阔. 膝关节后纵隔与后交叉韧带下止点的解剖关系及临床意义. 解剖学报, 2010, 41(4): 616-619.
29.	Kim SJ, Jung KA, Kwun JD, et al. Arthroscopic synovectomy of the knee joint in rheumatoid arthritis: surgical steps for complete synovectomy. Arthroscopy, 2006, 22(4): 461. e1-4.
30.	Kyung BS, Lee SH, Han SB, et al. Arthroscopic treatment of synovial chondromatosis at the knee posterior septum using a trans-septal approach: report of two cases. Knee, 2012, 19(5): 732-735.
31.	Ogilvie-Harris DJ, Biggs DJ, Mackay M, et al. Posterior portals for arthroscopic surgery of the knee. Arthroscopy, 1994, 10(6): 608-613.
32.	Kim JM. Direct posterior-posterior triangulation of the knee joint. Arthroscopy, 1997, 13(2): 262-264.
33.	Yoo JH, Kim EH, Min KD, et al. Arthroscopic excision of the ganglion in the posterior septum by posterior trans-septal portal: report of two cases. Arch Orthop Trauma Surg, 2009, 129(8): 1047-1051.
34.	Furie E, Yerys P, Cutcliffe D, et al. Risk factors for arthroscopic popliteal artery laceration. Arthroscopy, 1995, 11(3): 324-327.
35.	Potter D, Morris-Jones W. Popliteal artery injury complicating arthroscopic meniscectomy. Arthroscopy, 1995, 11(6): 723-726.
36.	Bernard M, Grothues-Spork M, Georgoulis A, et al. Neural and vascular complications of arthroscopic meniscal surgery. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 14-18.
37.	Ritt MJ, Te Slaa R, Koning J, et al. Popliteal pseudoaneurysm after arthroscopic meniscectomy. A report of two cases. Clin Orthop Relat Res, 1993, (295): 198-200.
38.	Jimenez F, Utrilla A, Cuesta C, et al. Popliteal artery and venous aneurysm as a complication of arthroscopic meniscectomy. J Trauma, 1988, 28(9): 1404-1405.
39.	Casscells SW. Injury to the popliteal artery as a complication of arthroscopic surgery. A report of two cases. J Bone Joint Surg (Am), 1988, 70(1): 150.

1. 21 Tawes RJ Jr, Etheredge SN, Webb RL, et al. Popliteal artery injury complicating arthroscopic menisectomy. Am J Surg, 1988, 156(2): 136-138. 22 Beck DE, Robison JG, Hallett JW Jr. Popliteal artery pseudoaneurysm following arthroscopy. J Trauma, 1986, 26(1): 87-89. 23 Pace JL, Wahl CJ. Arthroscopy of the posterior knee compartments: neurovascular anatomic relationships during arthroscopic transverse capsulotomy. Arthroscopy, 2010, 26(5): 637-642. 24 Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy, 2000, 16(8): 796-804. 25 Cosgarea AJ, Kramer DE, Bahk MS, et al. Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal. J Knee Surg, 2006, 19(3): 181-185. 26 Ramos LA, de Carvalho RT, Cohen M, et al. Anatomic relation between the posterior cruciate ligament and the joint capsule. Arthroscopy, 2008, 24(12): 1367-1372. 27 Smith PN, Gelinas J, Kennedy K, et al. Popliteal vessels in knee surgery. A magnetic resonance imaging study. Clin Orthop Relat Res, 1999, (367): 158-164.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20. 桂鉴超, 王黎明, 张昊伟, 等. 跨膝关节后纵隔入路的建立及临床应用. 中华外科杂志, 2006, 44(16): 1106-1110.
21. Ahn JH, Ha CW. Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy, 2000, 16(7): 774-779.
22. Louisia S, Charrois O, Beaufils P. Posterior “back and forth” approach in arthroscopic surgery on the posterior knee compartments. Arthroscopy, 2003, 19(3): 321-325.
23. Ahn JH, Lee YS, Lee DH, et al. Intraarticular fibroma of the posterior compartment in the knee. A case report. Knee, 2008, 15(2): 155-158.
24. Lakdawala A, El-Zebdeh M, Ireland J. Excision of a ganglion cyst from within the posterior septum of the knee—an arthroscopic technique. Knee, 2005, 12(3): 245-247.
25. Ramos LA, Astur D, Novaretti JV, et al. An anatomic study of the posterior septum of the knee. Arthroscopy, 2012, 28(1): 100-104.
26. Kramer DE, Bahk MS, Brett M, et al. Posterior knee arthroscopy: anatomy, technique, application. J Bone Joint Surg (Am), 2006, 88 Suppl 4: 110-121.
27. Kim SJ, Song HT, Moon HK, et al. The safe establishment of a transseptal portal in the posterior knee. Knee Surg Sports Traumatol Arthrosc, 2011, 19(8): 1320-1325.
28. 罗浩, 余家阔. 膝关节后纵隔与后交叉韧带下止点的解剖关系及临床意义. 解剖学报, 2010, 41(4): 616-619.
29. Kim SJ, Jung KA, Kwun JD, et al. Arthroscopic synovectomy of the knee joint in rheumatoid arthritis: surgical steps for complete synovectomy. Arthroscopy, 2006, 22(4): 461. e1-4.
30. Kyung BS, Lee SH, Han SB, et al. Arthroscopic treatment of synovial chondromatosis at the knee posterior septum using a trans-septal approach: report of two cases. Knee, 2012, 19(5): 732-735.
31. Ogilvie-Harris DJ, Biggs DJ, Mackay M, et al. Posterior portals for arthroscopic surgery of the knee. Arthroscopy, 1994, 10(6): 608-613.
32. Kim JM. Direct posterior-posterior triangulation of the knee joint. Arthroscopy, 1997, 13(2): 262-264.
33. Yoo JH, Kim EH, Min KD, et al. Arthroscopic excision of the ganglion in the posterior septum by posterior trans-septal portal: report of two cases. Arch Orthop Trauma Surg, 2009, 129(8): 1047-1051.
34. Furie E, Yerys P, Cutcliffe D, et al. Risk factors for arthroscopic popliteal artery laceration. Arthroscopy, 1995, 11(3): 324-327.
35. Potter D, Morris-Jones W. Popliteal artery injury complicating arthroscopic meniscectomy. Arthroscopy, 1995, 11(6): 723-726.
36. Bernard M, Grothues-Spork M, Georgoulis A, et al. Neural and vascular complications of arthroscopic meniscal surgery. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 14-18.
37. Ritt MJ, Te Slaa R, Koning J, et al. Popliteal pseudoaneurysm after arthroscopic meniscectomy. A report of two cases. Clin Orthop Relat Res, 1993, (295): 198-200.
38. Jimenez F, Utrilla A, Cuesta C, et al. Popliteal artery and venous aneurysm as a complication of arthroscopic meniscectomy. J Trauma, 1988, 28(9): 1404-1405.
39. Casscells SW. Injury to the popliteal artery as a complication of arthroscopic surgery. A report of two cases. J Bone Joint Surg (Am), 1988, 70(1): 150.

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Chinese Journal of Reparative and Reconstructive Surgery

ANATOMIC FEATURES OF POSTERIOR SEPTUM OF KNEE JOINT AND ITS APPLICATION IN POSTERIOR TRANS-SEPTAL PORTAL FOR ARTHROSCOPIC SURGERY

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