Anterior Knee Endoscopy

Abstract

Anterior knee endoscopy can access the quadriceps ten- don, patellar tendon, Hoffa fat pad, and various bursae. Prepatellar bursa, infrapatellar bursa, and Morel-Lavallée lesion are superficial lesions that are easily approached. However, open resection is associated with poor healing of the surgical wound, decreased sensation over scar area, contracted scar tissue, atrophic skin changes, subcutane- ous collection, and scar hypersensitivity. Endoscopic resection is a minimally invasive surgical approach that may reduce the risk of complications associated with open surgery. Acute quadriceps tendon rupture typically occurred in the distal 2 cm of the tendon. While delay in diagnosis was common, it was associated with poor out- come even after open surgical repair. An endoscopic tech- nique of acute quadriceps tendon rupture at the osteotendinous junction and the mid-substance is devel- oped. There is no early post-operation complication and the short-term results are favorable. Patellar tendon pathol- ogy typically occurs at the enthesis site; in most cases it occurs at the inferior pole of the patella, but it can occur at the tibial tuberosity. Pathology of the Hoffa pad can be intrinsic, e.g. intracapsular chondroma, localized nodular synovitis, post-surgery or post-traumatic fibrosis, or extrinsic, e.g. pigmented villonodular synovitis, meniscal cyst. Patellar tendoscopy and endoscopy of the Hoffa fat pad are useful minimally invasive approaches to deal with these pathologies with the advantages of better cosmetic result, less post-operative pain, and less surgical trauma. In this chapter, the endoscopic techniques are outlined.