It is simply impossible. Both gas and fluid have their advantages and disadvantages. The gas medium also allows the practitioner the ability to distinguish between old and new lesions within the joint. One of the major disadvantages of gas is the risk of pulmonary embolism. Other disadvantages include vision obstruction from bubbles in joint fluid, synovial fluid and blood adhering to the lens and steam fogging the lens.
Gas can also leak from the portal incisions leading to joint deflation.
This means that structures appear closer and bigger than they really are. It is possible to document the menisci and their inner borders, bodies attachments, and posteromedial and posterolateral moorings. Identification of the anterior cruciate ligament and its condition both by observation and by watching the ligament under stress of a draw sign is possible. The posterior cruciate ligament can be seen through a posteromedial puncture in most patients because it is immediately beneath the synovium on the posterior septum as seen from the medial side. Observations include the popliteus tendon at its attachment, the posteromedial and posterior capsular structures and the tibial collateral ligament.