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All-Inside Suture Repair for Isolated Radial Tears at the Midbody of the Lateral Meniscus.

ABSTRACT: In young athletes, radial tear of the midbody on the semilunar lateral meniscus in stable knees is most common. Conventionally, for this type of tear, meniscectomy has been considered as a first-line treatment. However, meniscectomy does not prevent degenerative change. Therefore, repair is another treatment option for a full radial tear, though this type of tear can be difficult to repair because of the lack of a vascular supply. Compared with conventional transcapsular suture techniques (e.g., inside-out/outside-in techniques or all-inside techniques with implants), all-inside suture (AIS) repair techniques can avoid bunching of the meniscus to the capsule. AIS is considered suitable for restoration of normal structure and movement of the meniscus after repair, which can be advantageous for meniscal healing. However, AIS repair for an isolated radial tear at the midbody of the lateral meniscus has rarely been reported. Therefore, we applied the AIS repair technique for isolated radial tear at the midbody of the semilunar lateral meniscus using a QuickPass SutureLasso with 2-0 FiberWire. This procedure is easier and less invasive, shortening the gap by drawing each stump of the meniscus in the direction of the circumference.

SUBMITTER: Uchida R

PROVIDER: S-EPMC6928371 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Meniscus root tears are increasingly being recognized and treated because of improved awareness and diagnostics. These injuries commonly occur in combination with knee ligament injuries. Untreated posterior meniscus root teats have been demonstrated to increase contact pressure and decrease contact area, ultimately leading to unfavorable joint loading and development of early osteoarthritis. Posterior lateral meniscus root tears (PLMRTs) also have been reported to increase anterior tibial translation and pivot shift in anterior cruciate ligament–deficient knees. Therefore, it is crucial to repair meniscal root tears when possible to restore knee joint loading and kinematics. Several techniques for repair of the PLMRT have been described. In this Technical Note, we describe our preferred technique for repair of PLMRT using an all-suture anchor. This technique is reproducible, does not need a tunnel, mitigates bungee effect of transtibial technique, and the anchor can easily be inserted on the footprint without a need for a guide. Technique Video Video 1 We present our arthroscopic repair of posterior root tears of the lateral meniscus with all-suture anchor. The surgical procedure is performed with the patient under epidural anesthesia in the supine position. A padded, nonsterile tourniquet is placed high on the operative thigh, and the patient is positioned with lateral support at the level of the tourniquet and a foot post to allow the knee to be maintained at 90° of flexion when required. The operative leg is prepared and draped in standard fashion. Standard anterolateral and anteromedial portals are created for routine diagnostic arthroscopy. The torn meniscal root should be probed to assess for severity and tear pattern. First with a burr and then with a curved curette, the tibial attachment site of the torn lateral meniscus root is debrided of soft tissues and overlying cartilage down to a bleeding bone bed to improve healing of the repair. Appropriate knee flexion is key to achieve a correct anchor placement. Therefore, an accessory high anteromedial portal is created with the knee hyperflexed. A curved guide is inserted through the high anteromedial portal and the guide is placed at the prepared insertion site of the footprint. A pilot hole is created at an appropriate angle using a 1.8-mm flexible drill. Afterwards, a 1.8 mm all-suture anchor loaded with a FiberWire no. 2 is placed. We recommend to set the anchor and test its stability by pulling on the sutures. The leg is then brought into the figure-of-4 position. The sutures are retrieved through the standard anteromedial portal. A direct suture passer and retriever is loaded into the bottom jaw, and it is then introduced through the standard anteromedial portal. Once the suture passer and retriever has been positioned at the desired location on the meniscus, the top jaw is closed and the back trigger is squeezed to advance suture through the tissue bottom up. With the suture captured in the top jaw, the Knee Scorpion is retracted from the tissue. The same procedure is then repeated in the posterior part of the meniscus with the second, free-end of the suture. A simple arthroscopic knot is then tightened under direct arthroscopic visualization aiming for the correct amount of tension. Finally, with a FiberTape Cutter, the FiberWire is cut and the strength of the suture fixation is tested with a probe.

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All-Inside Suture Repair for Isolated Radial Tears at the Midbody of the Lateral Meniscus.

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