Arthroscopy-assisted minimally invasive removal of a plate in the distal femur.

We developed an arthroscopy-assisted minimally invasive procedure for removal of a plate in the distal femur. Under arthroscopic assistance, we made an arthrotomy in the middle of the screws attached to the plate in the knee joint; all screws were removed, except for those placed proximally that were too difficult to remove. An approximately 5-cm skin incision (the distal one half to one third of it was near the proximal end of the knee cavity) was made through the old incision scar under arthroscopic assistance, and visible screws were removed. Proximal screws that were not visible through this incision were removed percutaneously through new small stab incisions placed midway between every 2 screws under the control of an image intensifier. Then, a small arthrotomy was made through the distal portion of the approximately 5-cm incision, at the place where the plate entered the knee joint. Through this arthrotomy, any screws still attached to the plate within the knee joint were removed. Then, the plate was stripped from the distal femur, was pulled proximally, and was removed without difficulty. With the use of this procedure, we can concomitantly assess the condition of the intra-articular region.