All-Inside Arthroscopic Meniscal Stacked Suture Repair for Hypermobile Lateral Meniscus With FASTFIX 360.
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ABSTRACT:
SUBMITTER: Takahashi T
PROVIDER: S-EPMC8322567 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:MRI did not detect any abnormality in the medial meniscus besides high-intensity changes at the meniscofemoral portion of the deep medial collateral ligament. Although pure valgus stress test proved no medial joint widening at 0° and 30°, when an examiner applied knee valgus and tibial external rotation force, the patient experienced pain in the anteromedial knee joint that coincided with their refractory symptoms in individual specific activity. Arthroscopy investigation confirmed that the anterior to middle segment of the medial meniscus had excessively slid into the central direction by a probe-drawing manoeuvre; synchronous meniscal movement in the valgus and external rotation test was also observed. After arthroscopic meniscal suture to the lesion had suppressed the abnormal meniscal movement, the patients' refractory anteromedial symptoms disappeared immediately. From their common history of medial collateral injury and the high intensity at the deep medial collateral ligament, we assumed that chronic deep medial collateral ligament impairment sustained the hypermobility of the medial meniscus. Arthroscopic confirmation of hypermobility led to definitive treatment of a simple meniscal suture. Painful deep MCL injuries with hypermobile medial arthroscopic findings are not a rare phenomenon as previously assumed; however, surgeons often fail to recognize its latent clinical features.
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Project description:Parrot beak tear is a white-white meniscal injury that often occurs in isolated injuries. Partial meniscectomy for parrot beak tears is often recommended, owing to the avascular zone; however, partial meniscectomy, especially with the lateral meniscus, has a high failure rate for return to sports, leading to residual meniscus extrusion and lateral compartment osteoarthritis. Thus, we have developed a repair technique to preserve the parrot beak tear of the avascular zone. This is a modification of the inside-out repair with additional reduction sutures. We recommend this procedure as a technique for repairing avascular parrot beak tears of the lateral meniscus.
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Project description:Meniscus root tear leads to circumferential hoop tension loss and increases femorotibial contact force, which causes irreversible cartilage degeneration. Biomechanical studies have shown that meniscus root repair provides better femorotibial contact force than meniscectomy. Many techniques for meniscus root repair have been published in recent years. The soft suture anchor is widely used in the glenoid labral repair. It is a small low-profile soft anchor. This article presents a new and simple technique of lateral meniscus root repair using the small soft anchor, which results in an anatomic and more vertical anchor position. It avoids instrument-related complications, such as cartilage delamination, material reaction, metal retention, and hard suture anchor pullout.
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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.
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Project description:The number of commercially available all-arthroscopic meniscal repair devices has increased in recent years. Although inside-out vertical mattress sutures have been considered the gold standard in the past, recent biomechanical studies have shown that some all-arthroscopic repair devices provide comparable strength. To successfully use these devices, surgeons must understand proper insertion technique. The purpose of this article is to demonstrate this technique for the Meniscal Cinch (Arthrex, Naples, FL).
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Project description:Preservation of the meniscus has been shown to influence the progression of degenerative changes of the knee. As more meniscus is preserved, the propensity for development of osteoarthritis is lessened. Surgical treatment of a torn discoid meniscus has typically been a subtotal meniscectomy or partial meniscectomy. Similar to tears of a normal meniscus, partial meniscectomy compared with subtotal meniscectomy of the discoid meniscus confers better long-term results. With the abnormal morphology predisposing the discoid meniscus to tearing, several characteristic tear patterns can be observed-the horizontal tear being commonly encountered. We present a technique that not only creates a more normal morphology of a discoid meniscus but also preserves the tissue by using an all-inside, intrameniscal repair technique. This technique restores the central rim of the meniscus in the setting of a horizontal cleavage plane, thus restoring a more normal meniscus morphology.
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Project description:Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique. Technique Video Video 1 The arthroscopic view from the anterolateral portal shows a decreased volume of the lateral meniscus due to a previous surgical resection. The posterior lateral meniscus (LM) is pulled anteriorly over the center of the lateral compartment by probing. The posterior LM is repaired under the guidance of the ultrasound by having the assistant surgeon place the ultrasound probe, covered with a sterile sleeve, horizontally on the popliteal fossa to allow confirmation of the posterior portion of the LM and the popliteal artery. An all-inside suture device, the JuggerStitch, is introduced from an anterolateral portal, and the tip of the needle is observed in the ultrasound image. While penetrating the posterior LM, the direction of the needle is confirmed not to injure the neurovascular structures. The anchor of the JuggerStich is introduced at the posterior side of the LM and can be observed as a high echoic region. After introduction of two anchors, the sutures are pulled anteriorly through the anterolateral portal, and the knot is tightened. The ultrasound image shows that the two anchors are positioned on the capsule behind the posterior LM. The same procedures are then repeated. The location of the popliteal artery and the direction of the needle are confirmed by ultrasound every time. If the needle is directed toward the artery, it should be extracted and inserted again. A total of 4 sutures are performed to obtain stability of the LM under the assistance of ultrasound. The final arthroscopic examination shows the properly secured repair and the stabilized posterior LM by probing.
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Project description:Anterior cruciate ligament ruptures are commonly associated with ramp lesions of the medial meniscus. These posterior longitudinal peripheral tears induce medial meniscus instability and increase the anteroposterior and rotational knee laxity. We divided ramp lesions in 3 types: meniscocapsular ligament tears, meniscotibial ligament tears, and a combination of both lesions. The conventional surgical technique for treating meniscal ramp lesions is to use a suture hook device through a posteromedial approach, which is a complex process requiring a learning curve and extensive surgical time. An anterior approach often is criticized as underestimating the true incidence of ramp lesion and to offer insufficient operating space. The purpose of this technical note is to describe our arthroscopic repair technique in cases of isolated meniscotibial ligament tears. The suture is performed by an under-meniscus anterior approach with a percutaneous medial collateral ligament release to create an additional opening of the medial compartment. This simple procedure allows for accurate diagnoses of the meniscotibial lesions and enables repair of the lesions with an all-inside suture device without the usual drawbacks of a posteromedial approach.
| S-EPMC8252850 | biostudies-literature
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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