Knee Arthroscopy: Patient Positioning, Room Set-Up, and Equipment

Knee arthroscopy can be performed with a variety of subtle variations based on institutional differences and surgeon preferences; however, the general principles are the same. A successful procedure is predicated on appropriate planning and preparation. This includes collaboration with anesthesiologists to establish both primary and contingency plans. Knee arthroscopy is typically performed under general anesthesia with or without adjuncts of local or regional anesthetics. After appropriate identification of patient, procedure, and operative extremity, the patient is positioned supine on the operative table. The use of either a post or an arthroscopic leg holder allows for appropriate intraoperative limb positioning, including the application of valgus stress for medial compartment visualization. Bony prominences and potential areas of nerve compression are well padded. The arthroscopic tower is positioned in a manner that allows for convenient visualization by the surgeon while also allowing for passage of tubing and cords off the surgical field. The arthroscopic tower typically contains video processing units, arthroscopic pump, shaver and ablation controllers, and additional vendor-specific equipment. The most common set-up includes a 30-degree arthroscope and arthroscopic instruments including probes, biters, and graspers. The remainder of the room set-up and instrumentation can be tailored based on surgeon preferences and procedure-specific requirements. For example, an additional back table is used for extensive graft preparation or a 70-degree arthroscope is used for better visualization of the posterior aspect of the knee. Again, a successful procedure is dependent on appropriate preoperative planning, which includes identifying case-specific equipment needs and ensuring they are present prior to beginning the case.