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Two- versus Three-Portal Technique for Routine Knee Arthroscopy

William B. Stetson, MD^*,, and Kevin Templin, ATC

^* Arthritis, Orthopedic, and Sports Medicine Center, Glendale, California, Department of Orthopedics, University of Southern California, Los Angeles, California, Missouri Bone and Joint Center, St. Louis, Missouri

Address correspondence and reprint requests to William B. Stetson, MD, Arthritis, Orthopedic, Sports Medical Center, 1505 Wilson Terrace, Suite 200, Glendale, CA 91206

The purpose of this study was to compare the results of a two-portal versus a three-portal technique for knee arthroscopy and to determine differences in patient and muscle recovery time and postoperative pain. We prospectively evaluated 16 patients undergoing routine knee arthroscopy in a randomized, double-blinded study. Six patients underwent arthroscopy with the standard three-portal technique, with the superomedial portal established through the vastus medialis obliquus muscle. Ten patients underwent the procedure with only two portals, the anteromedial and anterolateral. A third incision was created in the area of the vastus medialis obliquus muscle, but a portal was not created and the muscle was not violated. The same surgeon performed all procedures. Quadriceps muscle strength, total strength, and Lysholm scores were consistently greater for patients in the two-portal group than for patients in the three-portal group. Patients in the three-portal group returned to work and normal activities at a mean of 19 days after surgery, compared with 9 days for patients in the two-portal group. Standard knee arthroscopy with a two-portal technique does not violate the vastus medialis obliquus muscle and allows an earlier return of quadriceps muscle function and strength, earlier rehabilitation, and a faster return to activity.