Safe and reproducible knee posterolateral portal development using an arthroscopic inside-out technique: A technical note and retrospective case series of current technique.

There have been many variations of knee arthroscopy posterolateral portal establishment techniques, yet few reports of associated complications. The objective of this study was to describe a standardized inside-out posterolateral portal development technique and to report data on its safety. We conducted a retrospective case series of adult patients who underwent knee posterior arthroscopy using a modified inside-out posterolateral portal development from January 1, 2019, to December 1, 2024. Neurovascular complications were defined as injury to either the popliteal artery, or popliteal vein, or fibular nerve injury with motor function deficit. Other complications were also recorded. A total of 221 patients were included. Most patients underwent knee arthroscopy surgery for posterior cruciate ligament (PCL) reconstruction (N = 141, 64 %). Other indications included meniscal ramp repair (N = 45, 20 %), posterior pigmented villonodular synovitis resection (N = 19, 9 %), and posterior capsular release for arthrofibrosis (N = 11, 5 %). There were no neurovascular complications recorded in this cohort; however, there were six other complications (N = 6, 2.7 %). The most common other complication was a superficial portal site infection (N = 4, 1.8 %). All portal superficial infections occurred at the posteromedial portal, and none occurred at the posterolateral portal. Establishment of the posterolateral portal using an inside-out technique is safe and resulted in no injury to either the popliteus artery or vein, or fibular nerve.