• General with laryngeal mask airway (LMA) or sedation and local anesthesia

• 0.5% ropivacaine at the portal sites

• ±Regional block

• Weight-based dose of third-generation cephalosporin

• ±Anticoagulation: stratified by risk factors such as prior deep venous thrombosis (DVT) or clotting disorder

• The patient is positioned supine.

• A bump can be placed underneath operative hip.

• Leg support must allow the knee to achieve full range of motion including application of varus and valgus stress and should be positioned to allow circumferential access to the knee.

• Leg holder:

▪ Placed perpendicular to the femur at mid- to upper thigh to allow placement of varus and valgus forces on the knee.

▪ The leg should be internally rotated before the holder is secured so that the patella is en face.

▪ The end of the table is lowered past 90 degrees from horizontal to allow the leg to hang freely (Fig. 35-1).

• Lateral post:

▪ Placed midthigh and angled to allow a valgus force on the knee.

▪ The surgeon may leave the end of the table up or drop the end of the table.

• The contralateral leg with a sequential compression device (SCD) is placed in a padded well-leg holder of surgeon’s choosing.

• Overview

• Portals are created using no. 11 blade.

• Standard portals are the anterolateral and anteromedial portals.

• Accessory portals can be used depending on tear patterns and repair strategies (Fig. 35-2).

• Portals

• The anterolateral portal is created 5-10 mm lateral to and at the level of the inferior pole of the patella in the anatomic “soft spot.”

• The arthroscope is introduced to the notch, and the fat pad is swept anteriorly.

• The anteromedial portal is established under direct vision by localizing the entry point with a spinal needle.

▪ If the lateral meniscus is to be repaired, then the portal should be 3-5 mm superior to the anteromedial horn of the meniscus so that the suture passage device can be advanced over the tibial eminence and underneath the femoral condyle (Fig. 35-3).