**6. Discussion**

Hanger lifting procedures have been developed for abdominal operations during laparoscopic surgery, to avoid the risks inherent in conventional pneumoperitoneum (Hashimoto et al., 1993, 1995, Nagai et al., 1995). The hanger we used was designed for

The patient began range-of-motion exercises from postoperative day 1, and was able to walk from postoperative day 2. Symptom resolved within 1 month, and radiography showed bone union by 2 months postoperatively in the left knee, and by 4 months in the right knee. Even the inclined bony fragment of the right knee was corrected during the course (Fig. 10).

Fig. 10. Radiography of Case 1 along with time course. A, C, E) Right knee. B, D, F) Left knee. A, B) Radiography at the time of initial complaint of pain in both knees at 11 years old. The shape of the right patella seemed normal (A), but the lateral edge of the left knee seemed deficient (B). C, D) Preoperative radiography at 12 years old. Both knees displayed bipartite patella (Saupe classification, type II). E) Right knee at 4 months postoperatively. F)

Hanger lifting procedures have been developed for abdominal operations during laparoscopic surgery, to avoid the risks inherent in conventional pneumoperitoneum (Hashimoto et al., 1993, 1995, Nagai et al., 1995). The hanger we used was designed for

Left knee at 2 months postoperatively. Bone union seemed complete.

**6. Discussion** 

abdominal operations in children (Yokomori et al., 1998), but is also suitable for knee surgery because the diameter is close to that of the patella. Instead of lifting the abdominal wall, we lifted the anterior skin of the knee to achieve extra-articular arthroscopy. The most characteristic feature of this method is the provision of an extra-articular view, which seems effective for these procedures. Views can be obtained from both inside and outside the joint arthroscopically without water. Further, with regard to vastus lateralis release, the benefit of this technique is the ability to keep the joint capsule intact, which is not possible with a conventional intra-articular arthroscopic approach. In terms of MPFL reconstruction, the creation of patellar bone tunnel and tendon passage can be made under arthroscopic view.

Both intra- and extra-articular arthroscopic views seem indispensable for precise performance of those methods.

The only substantial complication is interstitial edema and subcutaneous adhesion due to developing subcutaneous space. Thus, early mobilization with compression dressing seems necessary.

## **7. Acknowledgement**

The authors thank Drs. Yasuyuki Fukui, Makoto Nishiyama, Masayuki Ishikawa, Nobuyuki Fujita, and Soraya Nishimura, Mita Hospital, International University of Health and Welfare, for their excellent technical assistance.

#### **8. References**


**Part 5** 

**Arthroscopy of the Foot and Ankle** 

