Andrew J. Hotchen, M.R.C.S., Joel T.K. Melton, F.R.C.S.(Tr & Orth)

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Presentation transcript:

Radiofrequency Ablation for Mucoid Degeneration of the Anterior Cruciate Ligament Andrew J. Hotchen, M.R.C.S., Joel T.K. Melton, F.R.C.S.(Tr & Orth) Arthroscopy Techniques Volume 7, Issue 5, Pages e459-e463 (May 2018) DOI: 10.1016/j.eats.2017.11.006 Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 1 Setup as for standard arthroscopy using a side support and foot bolster. Tourniquet should be applied and inflated to 250 mm Hg. Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 2 The port placement. This should be a standard anteriomedial and anteriolateral port either side of the patella tendon. Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 3 Prepare and drape the patient as for standard arthroscopy. Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopy still as viewed by the anterolateral portal showing mucinous deposits and characteristic “stranding” of the mucoid degenerate ACL fibers, which confirms the diagnosis of MD-ACL. (ACL, anterior cruciate ligament; LFC, lateral femoral condyle; MD, mucoid degeneration; MFC, medial femoral condyle.) Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 5 The radiofrequency probe should be inserted via the anteriomedial port. The camera should be inserted through the anteriolateral port. Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 6 Arthroscopy still as viewed by the anterolateral portal showing the debridement of the medial wall of the ACL using a radiofrequency probe. This should continue to the peripheries until all ACL tissue that causes impingement has been debrided. (ACL, anterior cruciate ligament; LFC, lateral femoral condyle; MFC, medial femoral condyle.) Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 7 Arthroscopy still as viewed by the anterolateral portal showing the hemostasis that can be achieved using the radiofrequency probe. Hemostasis of any bleeding synovial vessels covering the ACL should be stopped by using the radiofrequency probe. There can be significant bleeding from the synovial vessels. (ACL, anterior cruciate ligament; LFC, lateral femoral condyle.) Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 8 Arthroscopy still as viewed by the anterolateral portal showing that the debrided ACL can now freely move within the femoral notch without impingement. The ACL has reduced in bulk compared with the start of the operation and now does not impinge on either the PCL or within the notch. (ACL, anterior cruciate ligament; LFC, lateral femoral condyle; MFC, medial femoral condyle; PCL, posterior cruciate ligament.) Arthroscopy Techniques 2018 7, e459-e463DOI: (10.1016/j.eats.2017.11.006) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions