REVIEW - Arthroscopic synovectomy of the knee joint in RA: surgical steps for complete synovectomy

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Arthroscopy. 2006 Apr;22(4):461.e1-4.

Arthroscopic synovectomy of the knee joint in rheumatoid arthritis:

surgical steps for complete synovectomy

Kim SJ, Jung KA, Kwun JD, Kim JM.

Department of Orthopaedic Surgery, Yonsei University College of

Medicine, Seodaemun-Ku, Seoul, Korea.

For successful arthroscopic total synovectomy in rheumatoid arthritis

of the knee, proper sequential steps are required. First, we resect

hypertrophied synovial villi on the intercondylar notch to make a

gateway for the posterior compartments. We also perform synovectomy at

the posterolateral chamber because of the narrower space of the

chamber than that of the posteromedial chamber and the intra-articular

crowding due to swollen synovial villi with the passage of operation

time. Special care should be taken not to overlook both posterior back

corners and roofs, which cannot be seen through the transnotch view,

even with a 70 degrees arthroscope. The posterior back corners and

roofs can be visualized by using the trans-septal approach technique.

In this approach, we prefer to perforate the posterior septum in the

posterolateral-to-posteromedial direction to avoid damaging the

neurovascular structures because the structures are located just

behind and lateral to the midline septum and the posteromedial capsule

bulges a bit more posteriorly than the posterolateral capsule.

Attention is then directed to the medial, lateral, and suprapatellar

compartments, and finally the retropatellar compartment. Our surgical

steps are safe and effective for complete synovectomy of the

rheumatoid arthritic knee joint and other synovial disorders.

PMID: 16581463

http://www.ncbi.nlm.nih.gov/pubmed/16581463

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