Technique for All-Inside Repair of Bucket-Handle Meniscus Tears.
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ABSTRACT:
SUBMITTER: Yuen WLP
PROVIDER: S-EPMC7953237 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Meniscus tears are among the most common knee injuries in the general population and often are treated arthroscopically with a meniscus repair. Of the various meniscus repair techniques available, the inside-out meniscus tear is considered the gold standard due to its versatility and good clinical outcomes. The purpose of this Technical Note and accompanying video is to describe an inside-out bucket-handle meniscus repair using a single handed, self-advancing meniscus repair device with an interchangeable zone-specific multicannula system to decrease the technical difficulty and operative time of the repair.
| S-EPMC6993263 | biostudies-literature
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
Project description:Bucket-handle tears of the meniscus comprise nearly 10% of all meniscus tears and commonly affect the young male population. Displacement of the free segment can lead to significant pain and disability, necessitating reduction and surgical treatment. General contraindications include malalignment, severe arthritis, significant comorbidities, or chronic asymptomatic tears, but otherwise repair should almost always be performed. Options for surgical treatment include partial meniscectomy and arthroscopic repair using an all-inside, outside-in, or inside-out technique. The purpose of this Technical Note is to detail our arthroscopic inside-out repair technique augmented with bone marrow aspirate concentrate.
| S-EPMC5622027 | biostudies-literature
Project description:Understanding of meniscal function through basic science, natural history, and biomechanics has highlighted the importance of preserving the meniscus to maintain normal knee biomechanics. Tears that may alter these biomechanics can contribute to the progressive nature of degenerative joint disease in the knee. Radial tears result in the disruption of the circumferential fibers causing inability of the native meniscus to resist normal hoop stresses, thereby leading to increased focal areas of pressure that cause complications such as early onset arthrosis. In this technical note, we describe our preferred operative technique to repair radial meniscal tears using an arthroscopic inside-out approach with satisfactory clinical outcomes and healing response.
| S-EPMC5040169 | biostudies-other
Project description:Arthroscopic treatment is the treatment of choice in bucket-handle meniscal tears (BHMTs). Following BHMT, however, surgery failure rates are approximately 20% in the literature. Achieving the healing of BHMT is difficult. This is worse in chronic situations because the torn meniscus is deformed, leading to nonanatomical reduction. Some authors have reported greater failure rates, especially in the early postoperative period. In isolated BHMTs, the failure rate is greater because of inadequate and incomplete repairs due to the tight medial compartment. Multiple techniques for possible reduction of failure rate have been described. We describe an arthroscopic technique for treating chronic isolated BHMT using the technique of subcutaneously releasing the posterior fibers of the medial collateral ligament to provide adequate space for arthroscopy, meniscal reduction, and repair. A combined inside-out and all-inside repair technique was used to enhance anatomic reduction, stable fixation, surface fixation (rather than the usual suture-points fixation), and biologic healing in repairable chronic BHMTs.
| S-EPMC7917027 | biostudies-literature
Project description:There is controversy about the treatment for unstable full radial posterior lateral meniscus tears, particularly that involving the posterior root. Some surgeons have advocated repairing these types of meniscus tears using various techniques, but their methods are somewhat technical. We developed the technique for an all-inside repair for full radial posterior lateral meniscus tears using the Meniscal Viper (Arthrex, Naples, FL). A doubled thread is passed through 1 edge of the radial tear by the Meniscal Viper and is kept in place without tying the knot. The Meniscal Viper is used again to set a new thread, repeating the same procedure to another edge of the tear. At this step, 2 doubled threads are passed through each stump of the tear, and both a loop end and 2 free ends of each thread are located outside of the joint. Then, 2 doubled threads pass the third thread into its own loop, pulling it out. Finally, the third thread becomes the mattress suture over the radial tear site and is fastened by sliding knot techniques. This procedure makes it easy to strictly, smoothly, and less invasively shorten the gap by drawing each stump of the meniscus in the direction of the circumference.
| S-EPMC4885911 | biostudies-literature
Project description:Introduction:Meniscal injuries are one of the most common musculoskeletal injuries around the knee affecting patients of different genders, ages and activity levels. These injuries could be acute or chronic tears that cause pain and mechanical symptoms based on the injury severity and whether it is displaced and entrapped in an abnormal location within the knee or not. Advances in magnetic resonance imaging (MRI) allowed us to have a better understanding of multiple bucket handle meniscal tear patterns with its specific MRI signs which have been reported in the literature. Case presentation:This report presents a rare case of a 16-year-old boy with atypical bucket-handle tear of lateral meniscus and MRI showed a bucket-handle tear of lateral meniscus with a fragment entrapped behind and parallel to the anterior cruciate ligament (ACL) appearing as another ACL in sagittal views. Meniscus was repaired arthroscopically. Conclusion:In our case, the unique and infrequent mechanism led to a bucket-handle tear involving lateral meniscus with a meniscal fragment entrapped in an unusual place intra-articularly behind ACL giving the appearance of a rare MRI sign "double ACL sign". However, double ACL sign secondary to lateral meniscal tear has been reported only once previously up to the authors' knowledge.
| S-EPMC7217775 | biostudies-literature
Project description:Meniscus repair over resection, when feasible, should be strongly considered in an effort to preserve meniscus integrity and function, especially in younger patients. Currently, a number of techniques and implants may be used to achieve a successful result. Although all-inside meniscus repair devices have evolved significantly since their introduction and have become the repair technique of choice for many surgeons, the classic inside-out repair technique is still very useful to have in one's armamentarium. Though less popular because of the ease of current-generation fixators, the inside-out technique can still offer advantages for those surgeons who are proficient. With the versatility to address most tear patterns, the ability to deliver sutures with smaller needle diameters, and proven long-term results, it has been considered the gold standard in meniscus repair. We review the inside-out repair technique for both a medial and lateral meniscus tear with some helpful tips when performing the technique, and we present a video demonstration of the lateral meniscus repair technique.
| S-EPMC3882713 | biostudies-literature
Project description:Meniscal repairs are preferred to meniscectomies to preserve meniscal function and mitigate the risk of degeneration. However, repair of a chronic and displaced bucket handle tear of the meniscus can be technically challenging. We introduce a systematic method for assessment, reduction, repair, or salvage in this situation with an aim of reducing operating time and improving the chance of a favorable outcome. This technique describes repair of a bucket handle tear on the medial meniscus with displacement into the intercondylar notch. An arthroscopic probe is used for reduction and suture tension (push-and-pull technique) when using an all-inside suture device (FAST-FIX 360 repair system; Smith & Nephew) on the middle and posterior part of the tear. The anterior part of the tear is repaired with an outside-in method. If reduction is not possible, then a salvage reduction and hybrid repair is carried out instead. Postoperatively, patients will be nonweight-bearing on the operated limb, and range of motion restricted from 0 to 90° for 6 weeks, with the aim of resuming running by 6 months.
| S-EPMC8322667 | biostudies-literature
Project description: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.
| S-EPMC6928371 | biostudies-literature