Surgical and Radiologic Anatomy

, Volume 41, Issue 12, pp 1455–1459 | Cite as

Y sign: new landmark for anteromedial portal placement in knee arthroscopy

  • Gordan Gulan
  • Antun ŠumanovacEmail author
  • Hari Jurdana
  • Leo Gulan
Anatomic Bases of Medical, Radiological and Surgical Techniques



During arthroscopy training process, determination of anteromedial portal is more difficult in contrast with anterolateral portal and frequently results in suboptimal position, and longer operating times. The aim of our study was to identify an anatomical landmark which could facilitate anteromedial portal placement.


The relationship of the cutaneous veins at the anteromedial side of the knee was analysed regarding the optimally placed anteromedial portal and anatomical landmarks of the anteromedial part of the knee in 70 patients undergoing knee arthroscopy. The study was designed as case series.


In 70% of the patients, the joining of the cutaneous veins was seen after transillumination resembling Y letter. In the remaining 30% of patients, a solitary vein with a curve which corresponds to the joining point was observed. The curve and the joining was located adjacent to optimally placed anteromedial portal measured 2 cm ± 0.3 from the medial patellar tendon border, and 1.1 cm ± 0.1 from the palpable edge of the medial tibial plateau.


The “Y sign” can assist knee arthroscopy trainees in anteromedial portal placement, with the resulting avoidance of multiple puncturing of the skin with the needle, shorter operating room times to find the optimal portal placement, and potential reduction of damage to intraarticular structures.


Arthroscopy Knee Anteromedial portal Landmarks 


Author contributions

GG—project development, data collection, manuscript editing. AŠ—project development, data collection and management, data analysis, manuscript writing and editing. HJ—project development, manuscript editing, data analysis. LG—manuscript writing, data analysis, data collection.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bennett WF, Sisto D (1995) Arthroscopic lateral portals revisited. A cadaveric study of the safe zones. Am J Orthop (Belle Mead NJ) 24:546–551Google Scholar
  2. 2.
    DeHaven KE (1982) Principles of triangulation for arthroscopic surgery. Orthop Clin N Am 13:329–336Google Scholar
  3. 3.
    Kim TK, Savino RM, McFarland EG, Cosgarea AJ (2002) Neurovascular complications of knee arthroscopy. Am J Sports Med 30:619–629. CrossRefPubMedGoogle Scholar
  4. 4.
    Philips BB, Mihalko MJ (2017) Arthroscopy of the lower extremity. In: Azar FM, Canale TS, Beaty JH (eds) Campbell’s operative orthopaedics, 13th edn. Elsevier, Philadelphia, pp 2488–2489Google Scholar
  5. 5.
    Pujol N, Beaufils P (2016) Knee arthroscopy: general setup, portal options, and how to manage a complete arthroscopic investigation. In: Randelli P, Dejour D, van Dijk CN et al (eds) Arthroscopy: basic to advanced, 1st edn. Springer, Berlin, pp 69–74Google Scholar
  6. 6.
    Tay C, Khajuria A, Gupte C (2014) Simulation training: a systematic review of simulation in arthroscopy and proposal of a new competency-based training framework. Int J Surg 12:626–633. CrossRefPubMedGoogle Scholar
  7. 7.
    Ward BD, Lubowitz JH (2013) Basic knee arthroscopy part 1: patient positioning. Arthrosc Tech 2:497–499. CrossRefGoogle Scholar
  8. 8.
    Ward BD, Lubowitz JH (2013) Basic knee arthroscopy Part 2: surface anatomy and portal placement. Arthrosc Tech 2:501–502. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinic for Orthopaedic Surgery Lovran, Medical FacultyUniversity of RijekaLovranCroatia
  2. 2.Department of Anatomy and Neuroscience, Faculty of MedicineJosip Juraj Strossmayer University of OsijekOsijekCroatia
  3. 3.Department of Orthopaedics and TraumatologyCounty General Hospital VinkovciVinkovciCroatia
  4. 4.University Hospital Rijeka, Medical FacultyUniversity of RijekaRijekaCroatia

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