Single-Portal Arthroscopy: Report of a New Technique Daniel E. Cooper, M.D., Brian Fouts, B.S.  Arthroscopy Techniques  Volume 2, Issue 3, Pages e265-e269 (August 2013) DOI: 10.1016/j.eats.2013.02.017 Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 1 The SPA system uses a new optically enhanced 2.9-mm diameter, 20-cm long, 30° arthroscope. The PPC is assembled on the arthroscope cannula and has 2 degrees of adjustable freedom on its axis. This PPC may be adjusted by sliding and rotating it on the axis of the cannula. The SPA shaver design is different from standard arthroscopic shavers in that there is a 30° proximal bend for ideal ergonomics. This essentially allows one to move the triangulation point of the technique outside the knee joint with the arthroscope and instruments in parallel entry into the joint, thus easing the traditionally difficult aspect of arthroscopic triangulation. Arthroscopy Techniques 2013 2, e265-e269DOI: (10.1016/j.eats.2013.02.017) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) The PPC is an in-line working cannula that attaches to the arthroscope cannula. It has a smooth plastic hub that seats against the skin at the portal site, and it has a locking lever to secure it in the desired position of insertion depth and rotation. The 25- and 55-mm working cannula tubes are sealed by a slotted rubber diaphragm that prevents fluid egress. The PPC is also available in a zero-length version with no diaphragm and no tube. (B, C) The 4.4-mm-diameter PPC working cannula attaches to the arthroscope cannula. The PPC is a cannulated device that is assembled over the arthroscope cannula. It adjusts by sliding and rotating but also has a locking lever to secure it in place once the desired position is obtained. It is introduced with a plastic obturator that hugs the arthroscope cannula and has a sloped tip to match the contour of the PPC working cannula tip. Arthroscopy Techniques 2013 2, e265-e269DOI: (10.1016/j.eats.2013.02.017) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) The zero-length PPC is designed to allow a greater degree of dissociation between the working instruments and the arthroscope cannula. More freedom of manipulation is allowed, yet there is less precise control of entry into the joint. This design allows for use of a double-bend cutter that maximizes the freedom of manipulation within the joint. This is useful for patellofemoral procedures. (B) The shavers have a new inner tube laser-cut design that allows for multipoint flexibility yet smooth turning, with minimal friction yet excellent cutting torque. Shavers are available in 3.5- and 4-mm diameters and Aggressive Plus, Resector, and Tomcat window styles. Arthroscopy Techniques 2013 2, e265-e269DOI: (10.1016/j.eats.2013.02.017) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 4 A variety of manual instruments are available for the performance of surgical procedures in the knee. Redesigned handles with improved ergonomics for both palming and finger-loop use are standard. Punch styles include round Bird Beak, square big bite, and up tip square big bite versions in sizes that allow passage through the PPC. Arthroscopy Techniques 2013 2, e265-e269DOI: (10.1016/j.eats.2013.02.017) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions