Justin S. Chang, M. B. B. S. , James P. Higgins, M. D. , Jonathan D

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Systematic Arthroscopic Treatment of Diffuse Pigmented Villonodular Synovitis in the Knee Justin S. Chang, M.B.B.S., James P. Higgins, M.D., Jonathan D. Kosy, M.Sc., F.R.C.S., John Theodoropoulos, M.D., M.Sc., F.R.C.S.C. Arthroscopy Techniques Volume 6, Issue 5, Pages e1547-e1551 (October 2017) DOI: 10.1016/j.eats.2017.06.029 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Patient positioning and setup. The patient is supine with the right knee positioned with a high tourniquet and the thigh secured proximally in the leg holder to allow for maximum flexion and freedom of instruments. The contralateral left leg is positioned in a lithotomy boot. Arthroscopy Techniques 2017 6, e1547-e1551DOI: (10.1016/j.eats.2017.06.029) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Surface anatomy and portal placements. The surface anatomy and portal placements are marked out for the right knee. View from both the lateral and medial aspect of the right knee is shown. (AL, anterolateral; AM, anteromedial; APL, accessory posterolateral; APM, accessory posteromedial; BF, biceps femoris; F, fibula; PL, posterolateral; PM, posteromedial; SL, superolateral; SM, superomedial; TT, transpatellar tendon.) Arthroscopy Techniques 2017 6, e1547-e1551DOI: (10.1016/j.eats.2017.06.029) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Multiple shavers are used to ensure adequacy of debridement (1, DYONICS 4.5-mm Full Radius, Smith & Nephew; 2, DYONICS 5.5-mm INCISOR PLUS Elite, Smith & Nephew; and 3, DYONICS 4.5-mm Curved INCISOR Plus Elite, Smith & Nephew). Arthroscopy Techniques 2017 6, e1547-e1551DOI: (10.1016/j.eats.2017.06.029) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 View of the left knee posterolateral compartment through the anteromedial portal via the notch. A straight shaver is used to debride pigmented villonodular synovitis in the posterolateral compartment. Use of multiple shavers is useful to ensure adequate synovectomy. Varying the degree of flexion and extension at this stage allows the shavers to reach difficult areas and facilitates adequate debridement of the superior aspect of the posterior compartment. Arthroscopy Techniques 2017 6, e1547-e1551DOI: (10.1016/j.eats.2017.06.029) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 View from the anteromedial portal of the left knee. The posteromedial compartment is accessed by placing the arthroscope through the anteromedial portal independent from the sheath. Under direct visualization, the arthroscope sheath (with the introducing trocar) is passed through the anterolateral portal into the posteromedial compartment. (PCL, posterior cruciate ligament.) Arthroscopy Techniques 2017 6, e1547-e1551DOI: (10.1016/j.eats.2017.06.029) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions