Arthroscopic Pullout Repair of a Complete Radial Tear of the Tibial Attachment Site of the Medial Meniscus Posterior Horn (original) (raw)
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Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
We introduce a suture technique to repair a peripheral tear near the posterior tibial attachment of the posterior horn. A suture hook was inserted through the posteromedial portal, and the peripheral capsular rim was penetrated from superior to inferior by the sharp hook. Both relay limbs were brought out through the posteromedial portal. The outer limb of the superior peripheral capsular rim was identified with a hemostat. An 18-gauge spinal needle loaded with a No. 0 polydioxanone suture (PDS) was introduced into the joint from the anteromedial portal; it was passed through the joint space until it penetrated the inner torn meniscus. The PDS suture loaded within the needle was pushed into the joint and picked up through the posteromedial portal. The needle was pulled out of the torn meniscus and readvanced over it while the suture was kept loaded. The other limb of the suture from the tip of the spinal needle was retrieved through the posteromedial portal. The initial PDS suture limb was hooked to the shuttle-relay system; it then was passed through the inner torn meniscus and the peripheral capsular rim. The suture limb exiting from the peripheral capsular rim was used as a post and was joined to the other suture limb to form a sliding knot.
The Knee, 2020
using the FasT-Fix all-inside suture device combined with Ultrabraid for stronger repair (FasT-Fix 36 modified Mason-Allen technique, F-MMA) [4]. Furumatsu et al. reported that F-MMA suture 37 configuration obtained better meniscal healing and superior clinical outcomes than single FasT-Fix 38 repairs in patients with MMPRTs [5]. Recently, a new simple fixation technique using two simple stitches (TSS) under an expected initial tension was reported [6]. Other studies on transtibial pullout repair using TSS report that it is one of the major repair techniques of MMPRT treatment [7, 8]. The biomechanical study revealed the superiority of F-MMA in the ultimate failure load compared to TSS suture configuration using porcine 43 models [4, 9]. On the other hand, favourable clinical outcomes and high clinical survival rate were 44 reported using TSS technique [8, 10]． 45 In the past, there have been no studies to compare the clinical efficacy between F-MMA and TSS 46 technique in the pullout repair of MMPRT. It was hypothesized that the clinical outcomes of TSS were comparable to those of the F-MMA suture configuration. This study aimed to compare the clinical of the MM posterior horn >10 mm from the torn area (Figure. 2). The first Ultrabraid was tensioned 87 throughout an anterolateral portal during placement of the second suture for easy access. After the 88 degree of knee flexion (20°) and the expected tension (30 N) were checked, tibial fixation was 89 performed using a bioabsorbable interference screw with a spring tensioner. 90 91 Postoperative rehabilitation protocols 92 The patient was not permitted to perform weight-bearing on the knee immobilizer for 2 weeks after 93 surgery. Knee flexion exercise was limited to 90° for the first 4 weeks. The patient was allowed full 94 weight-bearing and 120° knee flexion after 6 weeks. Deep knee flexion was permitted 3 months 95 postoperatively. 2.2. Clinical scores
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014
Complete radial meniscus tears have been reported to result in deleterious effects in the knee joint if left unrepaired. An emphasis on meniscal preservation is important in order to restore native meniscal function. In this case report, a complete radial tear of the medial meniscus midbody was repaired using a novel crisscross suture transtibial technique. This technique secured the anterior and posterior meniscal horns, which were released from their extruded and scarred position along the capsule, using crisscrossing sutures passed through two transtibial tunnels and secured over a bone bridge on the anterolateral tibia. In addition, the repair was supplemented with the injection of platelet-rich plasma and bone marrow aspirate concentrate to promote the healing of the meniscal tissue. Complete healing on second-look arthroscopy is presented, including in the previously unreported white-white meniscal zone. Case Report, Level IV.
Arthroscopy Techniques, 2021
Complete radial tears of the meniscus render the entirety of the meniscus functionally incompetent (known as an ameniscal state); therefore, attempts at repair are essential. Although various techniques have been described, repair failures continue to frequently occur, especially with the medial meniscus. Inside-out repair and anchoring of the preserved meniscus to both the capsule and tibia may offer the advantage of a more robust repair. The objective of this Technical Note is to describe a method of repair for complete radial tears of the medial meniscus using a combination of inside-out sutures and secondary reinforcement to the tibia using all-suture knotless anchors.
Medial Meniscus Radial Tear: A Transtibial 2-Tunnel Technique
Arthroscopy Techniques, 2016
Complete radial tears of the medial meniscus significantly decrease the meniscal tissue's ability to dissipate tibiofemoral loads and have been described as functionally similar to a total meniscectomy, predisposing patients to early osteoarthritis. At present, no consensus exists regarding the optimal surgical treatment of a radial meniscal tear. Current repair techniques have led to a reportedly high rate of incomplete healing or healing of the meniscus in a nonanatomic, gapped position, which compromises its ability to withstand hoop stresses. Improvement regarding the ability to repair and heal medial meniscus radial tears has the potential to result in enhanced preservation of the articular cartilage in the medial compartment of the knee. This technical description details a method for repairing radial tears of the medial meniscus using a transtibial 2-tunnel technique.
Outside-In Repair of Longitudinal Tear of Medial Meniscus: Suture Shuttle Technique
Arthroscopy Techniques, 2020
Meniscal tears are commonly encountered conditions of the knee. In the past, torn menisci were treated by excision of the loose flap. A better understanding of the meniscus anatomy and its biomechanical characteristics has led to the concept of meniscus preservation in eligible cases. Several suture-based repair techniques have been described in literature, including the outside-in technique. Although the outside-in technique of meniscus repair is commonly indicated for the anterior two-thirds of the meniscus, it can be used to repair the posterior part of the meniscus as well. Several modifications of this technique have been described in the literature. We hereby describe our modification of the outside-in technique of meniscus repair with the help of an epidural needle and highstrength sutures that is readily available in operating rooms. The advantages of our technique are that no large incision is required around knee joint, it's inexpensive, it can be performed with basic instruments, and even the tear of meniscus extending up to the posterior horn can be repaired. A supplemental video demonstration of the technique is included with this article.
The Knee, 2008
The purpose of this prospective study is to report the outcome of arthroscopic repair of radial lateral menicus tears at the junction of the anterior horn and body. Five patients with an average age of 27 years were treated. The repair was performed with double horizontal sutures by inside-out technique, using zone-specific, curved cannulae with no enhancement technique. A mean of 2.4 superior and 2.8 inferior stitches were performed. Reduction was obtained in all cases. Patients were evaluated using Lysholm functional knee scores. All patients were clinically and radiologically examined using MRI to assess meniscus integrity at the repair site, over an average follow-up period of 31 months. All patients were able to return to their former level of activity. In all cases, MRI showed a fully healed meniscus at the repair sites, with no further disruption of the debrided area. The mean Lysholm scores improved from 62 preoperatively to 94 postoperatively. The difference between preoperative and postoperative values was found to be statistically significant (p = 0.029). No cases of postoperative extra or intra-articular complications were encountered. We found that repairing rather than resecting radial lateral menicus tears that extend into capsular zone, improves activity level.
Arthroscopy Techniques, 2013
The importance of the lateral meniscus in weight bearing, distribution of force, shock absorption, articular cartilage protection, proprioception, stabilization of the joint, and joint lubrication is well known. Surgeons currently agree on the importance of preserving the menisci. Different suture techniques have been standardized. These include outsidein, inside-out, and all-inside techniques. The all-inside technique can be used to repair lesions of the posterior horn of the lateral meniscus. However, this technique presents important disadvantages, such as the necessity for an accessory portal and a high risk of neurovascular damage. For these reasons, we have developed a technique in which a suture hook and a shuttle relay are used to pass the suture wire through the meniscal lesion of the posterior horn of the lateral meniscus with an all-inside technique, without the use of accessory portals and cannulas, with a standard 30 arthroscopic camera.