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All-Inside Double-Sided Suture Repair for Longitudinal Meniscal Tears.

ABSTRACT: The current consensus in the literature is that the meniscus must be saved. Even though inside-out sutures are still considered as the gold standard, the need to alternate between intra- and extra-articular structures for every stitch makes it laborious. New generations of all-inside systems are now routinely used in operating rooms and enable easier, quicker, and safer techniques. However traditional all-inside repair with limited upper fixation does not provide uniform compression from top to down, essential precondition for satisfactory meniscal healing. This Technical Note describes a simple and accessible alternative technique that provides stable fixation and overall compression of vertical meniscal tears from top to down with standard all-inside instrumentation.

SUBMITTER: Foissey C

PROVIDER: S-EPMC8355532 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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All-Inside Double-Sided Suture Repair for Longitudinal Meniscal Tears.

Foissey Constant C Thaunat Mathieu M Fayard Jean-Marie JM

Arthroscopy techniques 20210721 8

The current consensus in the literature is that the meniscus must be saved. Even though inside-out sutures are still considered as the gold standard, the need to alternate between intra- and extra-articular structures for every stitch makes it laborious. New generations of all-inside systems are now routinely used in operating rooms and enable easier, quicker, and safer techniques. However traditional all-inside repair with limited upper fixation does not provide uniform compression from top to ...[more]

PMID: 34401252

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All-inside suture meniscal repair using suture passer.

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Project description:The surgical management of medial meniscus ramp lesions can be challenging. Currently, repairs are performed via a trans-notch view, combined with a single posteromedial working portal. This technique, however, does not allow for a direct and complete visualization of the structures being injured, making a precise appreciation of the injured structures, as well as an anatomical repair, difficult. To overcome this limitation, a 2-portal posteromedial approach has recently been described. It allows better visualization of the mediolateral extent of the tear and a precise identification of the injured structures. In this Technical Note, an anatomic repair technique using this approach is presented. It consists of a double-row of sutures to repair individually both the meniscotibial and meniscocapsular ligament, thus restoring the 2 main components of the posterior horn of the medial meniscus to their natural insertion site.

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Project description:Since the role of the menisci has been better understood, there is a trend toward the meniscal repair rather than meniscectomy in the management of meniscal tears. Although numerous techniques of meniscal repair have been described and many authors advocate for and against each of them, no single method is universally accepted. The all-inside repair provides several advantages, such as a lower risk of neurovascular injury, the early introduction of exercises in passive range of motion, or the high strength of the repair. However, the all-inside meniscal repair with nonabsorbable suture is considered to be a technically demanding procedure with a long learning curve needed to perform it properly. The purpose of this Technical Note is to present the technique of lateral meniscus repair with nonabsorbable sutures and to provide surgical pearls to facilitate this procedure.

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