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Continuous Meniscal Suture Technique of the Knee.

ABSTRACT: The menisci are fibroelastic structures interposed between the articular surfaces of the femur and tibia. They absorb impact and transmit load. Meniscal injury may compromise function and cause rapid joint degeneration, leading to the development of secondary osteoarthritis. Surgical treatment of meniscal injury is usually performed by arthroscopy, and meniscectomy or meniscal suture may be associated with such treatment. Meniscal suture should be considered when the injury compromises the proper functioning of the meniscus to recover its anatomy and function. Different meniscal suture techniques exist; the most widely used are the inside-out, outside-in, and all-inside techniques. The gold-standard repair technique is the inside-out technique. A drawback of this technique is the need to alternate between intra- and extra-articular structures for every stitch, which makes it even more laborious. We describe the continuous meniscal suture technique, also called "meniscal stitching," for a medial meniscal bucket-handle injury. This technique is performed from the inside out and allows the surgeon to perform multiple stitches with the same thread quickly and effectively. This surgical technique is performed using a single meniscal suture device that was developed by our group, called the "Meniscus 4 A-II" device.

SUBMITTER: Rocha de Faria JL

PROVIDER: S-EPMC7301274 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Outside-in Continuous Meniscal Suture Technique of the Knee.

Project description:The meniscus is largely responsible for the health and longevity of the knee. It has diverse functions, being fundamental in load absorption and distribution and even in joint stability. To preserve meniscal functions and prevent the occurrence of osteoarthritis after meniscectomy, several meniscal repair techniques have been developed. To perform meniscal repair in anterior horn, the outside-in technique is the most used. There are few devices for performing them, with most of the surgical techniques described using needles. Our group uses a device capable of performing meniscal repair in different ways. Our objective is to describe a continuous outside-in meniscal repair technique, especially indicated for anterior horn and meniscus body tears, with the "Meniscus 4-All suture device." The continuous outside-in meniscal suture technique using this device is easy to perform, inexpensive, fast, and reproducible, minimizing the risk of soft-tissue entrapment. In addition, it allows the surgeon to perform meniscal repair in the posterior horn in extensive injuries with the same repair device, just switching to inside-out technique.

| S-EPMC7587458 | biostudies-literature

Vertical Continuous Meniscal Suture Technique.

Project description:Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device.

| S-EPMC7528575 | biostudies-literature

Continuous Meniscal Suture in Radial Meniscal Tear: The Hourglass Technique.

Project description:The key to preventing early knee osteoarthritis is meniscal preservation. The main functions of the meniscus are impact absorption, mechanical load transmission, lubrication, joint stability, and proprioception. Radial lesions that extend to the joint capsule are called complete radial tears. This type of injury compromises 2 of the main meniscal functions, which are impact absorption and load distribution, which is equivalent, from a biomechanical perspective, to a total meniscectomy. In the recent past, the treatment of choice for this type of injury was partial meniscectomy. However, several studies have observed progressive joint degeneration after this type of treatment. Recently, different types of meniscal sutures involving radial lesions of the meniscus have been developed. It is believed that such repairs may bring a decrease in future osteoarthritis in this patient profile. The purpose of this article is to describe the steps of continuous meniscal suture for the treatment of radial tears of the medial and lateral menisci.

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Anterior Horn Meniscal Repair Using an Outside-In Suture Technique.

Project description:The menisci are important structures within the knee that play a critical role in maintaining proper stability, load distribution, and joint lubrication. Injury to the menisci has been found to significantly alter the complex biomechanics of the knee, and thus affect the health and longevity of the native joint. Tears involving the anterior horn are increasingly recognized as an important pathology. Although early treatment of meniscal tears focused primarily on removal of the injured tissue, recent attention on the long-term consequences of partial or total meniscectomy has led to increased attempts at meniscus repair whenever possible. Because of the location of anterior horn tears and the technical difficulty in accessing this location arthroscopically, an outside-in repair technique is ideal for treatment of these lesions. This technical note details our surgical technique of outside-in repair of anterior horn meniscal tears.

| S-EPMC5310193 | biostudies-literature

Peripheral Stabilization Suture to Address Meniscal Extrusion in a Revision Meniscal Root Repair: Surgical Technique and Rehabilitation Protocol.

Project description:Meniscal root tears are an increasingly recognized condition. These tears can cause the meniscus to become extruded outside the joint, which can diminish the biomechanical functionality of the meniscus. Anatomic repair of the meniscal root has previously been described, but this surgical procedure may not adequately address severe extrusion of the meniscal tissue. Additionally, when a primary anatomic repair fails, meniscal extrusion can increase, which can possibly accelerate joint degeneration if untreated. Therefore, the purpose of this Technical Note is to describe our surgical technique for revision medial meniscal root repair with a peripheral stabilization suture to address medial meniscal root tears with severe meniscal extrusion.

| S-EPMC7451443 | biostudies-literature

All-inside suture meniscal repair using suture passer.

Project description:In recent years, to save the meniscus and prevent the progression of knee osteoarthritis, the indications for meniscus repair have been expanding instead of partial menisectomy. Accordingly, various repair techniques for meniscus tears have been developed. The conventional inside-out and outside-in meniscus repair techniques and all-inside repair technique with an implant/anchor can be classified as trans-capsular (TC) repair from the perspective of suture with penetrating capsule. Recently, new suture passers for all-inside meniscus repair have been developed. To distinguish from conventional all-inside repair with implant/anchors, all-inside repair with only suture using these suture passers was described as all-inside suture (AIS) repair. This AIS repair could achieve meniscus-to-meniscus suture across the tear without interposition of soft tissues including the capsule between suture and meniscus, leading direct gap closing of torn edges. In this respect, AIS repair is considered to be "anatomical meniscus repair". Actually, some reports showed biomechanical and clinical advantages of AIS repair. However, there is still limited evidence in clinical practice. Moreover, there are some disadvantages for AIS repair. Not only further studies but also development of new devices and surgical techniques for AIS should be required. This review describes the current status of AIS repair for each type of tear.

| S-EPMC11304093 | biostudies-literature

Posterior Meniscal Root Repair Using a Meniscal Suture Device.

Project description:A greater understanding of the deleterious consequences that a meniscal root tear brings to the knee joint and how its surgical repair can be advantageous over the previously used treatment strategies brings the need for the development of surgical techniques that make the procedure less complex and more reproducible. When meniscal root rupture occurs, a mechanical overload occurs in the affected compartment similar to a total meniscectomy. Several authors have concluded that meniscal root reinsertion significantly improves postoperative outcomes and patient satisfaction, regardless of age or laterality of the meniscal injury. The Meniscus 4 A-II device (Rio de Janeiro, Brazil) allows stitching at the root of the medial and lateral menisci. In this article, we describe the surgical repair technique for posterior-medial and -lateral meniscal root tears using this meniscal suture device. This technique is fast and effective.

| S-EPMC7372309 | biostudies-literature

Full-Thickness Radial Medial Meniscal Tear: Fixation With Inside-Out Technique With Tibial Knotless Suture Anchors.

Project description: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.

| S-EPMC7953262 | biostudies-literature

Continuous Suture Technique for Aortic Valve Replacement Shortens Cross-Clamp and Bypass Times.

Project description:The interrupted noneverting mattress suture technique is typically used in conventional surgical aortic valve replacement. The continuous suture technique, although faster, has been associated with a higher incidence of paravalvular leak. Using a slightly modified technique to minimize this risk, we investigated whether continuous suturing would shorten aortic cross-clamp time in aortic valve replacement in comparison with interrupted suturing. We reviewed the cases and compared the perioperative data of 60 consecutive patients in Japan and Australia (35 men and 25 women; median age, 70 yr) who had undergone aortic valve replacement with or without septal myectomy. The continuous suture technique had been used in 41 patients (Group CS) and the standard interrupted suture technique in 19 (Group IS). The groups were similar in age, sex, pathologic valvular conditions, and operative urgency. In Group CS, aortic cross-clamp time (47 vs 63 min; P=0.0001) and cardiopulmonary bypass time (76 vs 89 min; P=0.04) were significantly shorter. Neither group had early paravalvular leak. Using our continuous suture technique safely shortened aortic cross-clamp time during surgical aortic valve replacement.

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A suture technique for easier reduction and repair of bucket-handle meniscal tears while using the all-inside devices.

Project description:Arthroscopic repair of bucket-handle meniscal tears is difficult due to their complex pathology. Many meniscal repair techniques such as all-inside, inside-out, and outside-in have been described for the treatment of these tears. Loss of reduction is a likely complication with the use of new-generation, all-inside suture instruments, as the tip of the needle is extracted following advancement of the first implant behind the capsule. The complication may be encountered quite often and renders the use of the meniscus repair instrument unusable and causes an irreparable iatrogenic injury in the meniscus. The application of a simpler and more efficient technique is necessary until surgical experience is gained. The aim of this study was to define a new, simpler, and more efficient combination of suturing method in the treatment of bucket-handle meniscal repairs and minimize the rate of complications which may be caused by this technique.

| S-EPMC5125161 | biostudies-literature

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