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“Arthroscraping”

      The term “arthroscrape” was coined back in the early 1980s when I first began doing knee arthroscopy, and I can honestly say, having performed over 15,000 knee arthroscopies over the past 38 years, that I have “arthrosrcaped” a significant number of femoral condyles during my career. The articles by Compton et al.
      • Compton J.
      • Slattery M.
      • Coleman M.
      • Westermann R.
      Iatrogenic cartilage injury during arthroscopic hip and knee procedures: A common occurrence that results in cartilage ell death.
      and Harris et al. confirm
      • Harris J.D.
      • Brand J.C.
      • Rossi M.J.
      • Leland J.M.
      • Lubowitz J.H.
      Iatrogenic arthroscopic cartilage injury: arthroscrapes result from iatrogenesis imperfecta.
      that this is a common occurrence and results in permanent damage to the articular surface. This occurs when we encounter a very “tight” medial compartment incapable of housing a 4- to 4.5-mm arthroscope and/or using relatively large tools to access the “far reaches” of the posterior compartment to complete a satisfactory meniscectomy despite valgus stress on the knee during the case. In the mid 1980s, I was involved in the manufacturing of an “electrocautery loop probe” that was developed in order to avoid damage to the articular surface by affording a flexible base with an exposed “cutting” wire that had to be used in a nonconductive fluid medium. I had watched one of my urology colleagues “looping out” a small bladder tumor using water as the nonconductive fluid medium and for this reason began using a similar device as a way of avoiding articular cartilage surface damage and published the results in Arthroscopy in 1992.
      • Bert J.M.
      Usage of an electrocautery loop probe for arthroscopic meniscectomy: a five-year experience with results, indications and complications.
      This tool is no longer available and thus it is important to liberally release the medial collateral ligament to avoid cartilage surface injury as has been noted by multiple authors which the literature confirms does not result in any long-term instability.
      • Jung K.W.
      • Youm Y.S.
      • Cho S.D.
      • Jin W.Y.
      • Kwon S.H.
      Iatrogenic medial collateral ligament injury by valgus stress during arthroscopic surgery of the knee.
      • Moran T.E.
      • Awowale J.T.
      • Werner B.C.
      • Fox M.A.
      • Miller M.D.
      Associated morbidity after the percutaneous release of the medial collateral ligament for knee arthroscopy.
      • Claret G.
      • Montañana J.
      • Rios J.
      • et al.
      The effect of percu-taneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome.
      • Claret-Garcia G.
      • Montañana-Burillo J.
      • Tornero-Dacasa E.
      • et al.
      Pie crust technique of the deep medial collateral ligament in knee arthroscopy: Ultrasound and anatomic study.
      First, I would urge everyone who performs knee arthroscopy to make certain that they use a knee holder placed as little as 3 cm superior to the superior pole of the patella to allow for significant leverage when putting valgus stress on the knee. Second, I have a very low tolerance for releasing the MCL whether by “pie-crusting” the proximal MCL, releasing it superior to the meniscus intra-articularly with a cautery, or releasing it inferior to the meniscus with an awl. It is critical to avoid “arthroscraping” the articular surface of the knee since it has absolutely no ability to heal.
      • Bert J.M.
      First do no harm. Protect the articular cartilage when performing arthroscopic knee surgery.
      As we know, even removing a minimal amount of the meniscus during a meniscectomy results in the development of articular cartilage degeneration. Thus, we must try to avoid hastening this progression by maintaining a “pristine” articular surface during surgery to avoid rapid advancement of degenerative arthritis. With the recent trend to put “metal and plastic” in younger and younger patients, it is up to us as arthroscopic surgeons to do our best to avoid articular cartilage damage during arthroscopic surgery.

      Supplementary Data

      References

        • Compton J.
        • Slattery M.
        • Coleman M.
        • Westermann R.
        Iatrogenic cartilage injury during arthroscopic hip and knee procedures: A common occurrence that results in cartilage ell death.
        Arthroscopy. 2020; 36: 2114-2121
        • Harris J.D.
        • Brand J.C.
        • Rossi M.J.
        • Leland J.M.
        • Lubowitz J.H.
        Iatrogenic arthroscopic cartilage injury: arthroscrapes result from iatrogenesis imperfecta.
        Arthroscopy. 2020; 36: 2041-2042
        • Bert J.M.
        Usage of an electrocautery loop probe for arthroscopic meniscectomy: a five-year experience with results, indications and complications.
        Arthroscopy. 1992; 8: 148-156
        • Jung K.W.
        • Youm Y.S.
        • Cho S.D.
        • Jin W.Y.
        • Kwon S.H.
        Iatrogenic medial collateral ligament injury by valgus stress during arthroscopic surgery of the knee.
        Arthroscopy. 2019; 35: 1520-1524
        • Moran T.E.
        • Awowale J.T.
        • Werner B.C.
        • Fox M.A.
        • Miller M.D.
        Associated morbidity after the percutaneous release of the medial collateral ligament for knee arthroscopy.
        Arthroscopy. 2020; 36: 891-900
        • Claret G.
        • Montañana J.
        • Rios J.
        • et al.
        The effect of percu-taneous release of the medial collateral ligament in arthroscopic medial meniscectomy on functional outcome.
        Knee. 2016; 23: 251-255
        • Claret-Garcia G.
        • Montañana-Burillo J.
        • Tornero-Dacasa E.
        • et al.
        Pie crust technique of the deep medial collateral ligament in knee arthroscopy: Ultrasound and anatomic study.
        J Knee Surg. 2019; 32: 764-769
        • Bert J.M.
        First do no harm. Protect the articular cartilage when performing arthroscopic knee surgery.
        Arthroscopy. 2016; 32: 2169-2174