Dataset Information

Arthroscopic Saucerization With Inside-Out Repair and Anterocentral Shift of a Discoid Lateral Meniscus With Retention of Adequate Volume of Residual Meniscus

ABSTRACT:

Abstract

Preservation of the meniscus has been shown to influence the progression of osteoarthritic changes in the knee. Discoid lateral meniscus (DLM) is classified on the basis of the presence and location of instability resulting from deficient capsular attachments. Recently, meniscal stabilization after saucerization was recommended in cases of DLM to preserve the meniscus shape and avoid the progression of osteoarthritis. However, it is difficult to identify the accurate resection volume and residual meniscal width during surgery, especially when there is an anterocentral shift of the DLM. This Technical Note describes an arthroscopic technique for an anterocentral shift of the DLM in which we highlight the resection point and confirm the methods of retaining an adequate volume of residual meniscus to restore and maintain the shape and function of the meniscus.

Level of Evidence

Level 1, Knee; Level 2, Meniscus. Technique Video Video 1 We demonstrate a technique for an anterocentral (AC) shift of the discoid lateral meniscus (DLM) in which we show the resection point and preservation methods of the meniscus so as to reshape it to the same size as the normal lateral meniscus. This case is the right knee of 13-year-old boy who had an anterocentral type of DLM. The DLM is confirmed by arthroscopic viewing from the anterolateral portal in the figure-4 position, and meniscal instability was confirmed by pulling the posterolateral corner of the meniscus by using a probe. From the lateral gutter view through the anterolateral portal, absence of the superoposterior fascicle is confirmed in the extension position of the knee. Saucerization is started from the border between the anterior horn and the central area of the DLM with a 45˚ punch from the anteromedial portal parallel to the circumferential fibers of the anterior horn of the DLM as viewed from the anterolateral portal. Measurement of the resection length is performed with a ruler from the anteromedial portal. After 1 cm of resection length is confirmed by viewing from the anterolateral portal, saucerization with removal of the central area is performed with a punch from the anteromedial portal. Resection is performed until it is 10 mm from the hiatus. This type of DLM often has a horizontal tear in the residual meniscus. Meniscal instability is again confirmed by a probe, and the deep flexion position is viewed from the anteromedial portal. An arthroscopic rasp is used to freshen the sites of tears in the meniscus so as to promote healing from the anteromedial portal. The dual meniscal repair needles loaded with 2-0 braided polyester sutures are penetrated to the unstable portion of the meniscus including the horizontal tear through the cannula positioned in the anteromedial portal. The suture needles are retrieved under direct visualization through the previously prepared lateral incision. The sutures are tied over the capsule after every 4 sutures have been passed. Technique with stitches placed at 3 mm intervals: After repairing the posterior portion, the width of the repaired meniscus is confirmed to be 10 mm from the hiatus, and the stability of the meniscus is confirmed by viewing it from the anterolateral portal. Eight mm of residual anterior meniscus is confirmed through the anteromedial portal view. The stability of the meniscus is confirmed by a McMurray test through the anteromedial portal view.

SUBMITTER: Hashimoto Y

PROVIDER: S-EPMC8626769 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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.

Dataset Information

Arthroscopic Saucerization With Inside-Out Repair and Anterocentral Shift of a Discoid Lateral Meniscus With Retention of Adequate Volume of Residual Meniscus

Abstract

Level of Evidence

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