Dataset Information

Easy and Safe All-Inside Suture Technique for Posterior Horn Tears of Lateral Meniscus Using Standard Anteromedial and Anterolateral Portals.

ABSTRACT: The importance of the lateral meniscus in weight bearing, distribution of force, shock absorption, articular cartilage protection, proprioception, stabilization of the joint, and joint lubrication is well known. Surgeons currently agree on the importance of preserving the menisci. Different suture techniques have been standardized. These include outside-in, inside-out, and all-inside techniques. The all-inside technique can be used to repair lesions of the posterior horn of the lateral meniscus. However, this technique presents important disadvantages, such as the necessity for an accessory portal and a high risk of neurovascular damage. For these reasons, we have developed a technique in which a suture hook and a shuttle relay are used to pass the suture wire through the meniscal lesion of the posterior horn of the lateral meniscus with an all-inside technique, without the use of accessory portals and cannulas, with a standard 30° arthroscopic camera.

SUBMITTER: Fiorentino G

PROVIDER: S-EPMC3882671 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Publications

Easy and Safe All-Inside Suture Technique for Posterior Horn Tears of Lateral Meniscus Using Standard Anteromedial and Anterolateral Portals.

Fiorentino Gennaro G de Caro Francesca F Cepparulo Riccardo R Guardoli Alberto A Berni Luca L Delcogliano Marco M Ritali Alice A Guardoli Aldo A

Arthroscopy techniques 20130923 4

The importance of the lateral meniscus in weight bearing, distribution of force, shock absorption, articular cartilage protection, proprioception, stabilization of the joint, and joint lubrication is well known. Surgeons currently agree on the importance of preserving the menisci. Different suture techniques have been standardized. These include outside-in, inside-out, and all-inside techniques. The all-inside technique can be used to repair lesions of the posterior horn of the lateral meniscus. ...[more]

PMID: 24400182

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Project description:Radial meniscus tears occur commonly as traumatic tears in younger patients, as well as in association with concomitant degenerative changes. Traditional management of these tears has centered around partial meniscectomy; however, there has been a more recent trend toward preserving the meniscus and attempting repair. Because of the gapping and displacement that frequently occurs with these tears, repair is often challenging and is done under high amounts of tension. The following article describes a technique using a traction suture to aid in maintaining reduction throughout repair. This is followed by the use of a combination of techniques to form a “super-hashtag” configuration of both vertical and horizontal mattress sutures, leading to a secure repair under little tension. Technique Video Video 1 Video demonstrating technique for repair of anterolateral radial meniscus tears using a traction suture and super-hashtag orientation. This video shows arthroscopic view from the anterolateral portal with the lateral femoral condyle at the top of the view, and the lateral tibial plateau at the bottom. A standard diagnostic arthroscopy is then performed. The video first demonstrates the identification of the tear at the junction of anterior and middle thirds of the lateral meniscus, which includes a large amount of gapping. A rasp is then used to abrade the synovium and tear to generate the best biologic healing response. The traction suture is then placed in the posterior limb of the tear with the use of the NovoStitch Pro Meniscal Repair System (Smith & Nephew, Andover, MA). This is performed by making one bite in the periphery of this limb, followed by another more centrally. Suture limbs are then brought out through the lateral portal to be used to pull traction and maintain reduction of the tear throughout the remainder of the repair. The anterior and posterior limbs are then secured to the capsule in reduced position with the use of vertical mattress sutures via a combination of all-inside, inside-out, and outside-in techniques. The same sutures are then used for tie-grip or rip-stop sutures for the horizontal mattress. The sutures are tied under the iliotibial band and directly at the capsule, while keeping the meniscus reduced with the traction suture. This is followed by placement of various horizontal mattress sutures over the tie-grip or rip-stop sutures, creating a “super-hashtag” repair. Our postoperative protocol includes keeping the patient non-weightbearing for 6 weeks following surgery with hinged knee brace locked in extension for the first 2 weeks. Range of motion will be strictly 0-90° for the first 4 weeks. Deep vein thrombosis prophylaxis is continued for 6 weeks postoperatively.

Dataset Information

Easy and Safe All-Inside Suture Technique for Posterior Horn Tears of Lateral Meniscus Using Standard Anteromedial and Anterolateral Portals.

Publications

Easy and Safe All-Inside Suture Technique for Posterior Horn Tears of Lateral Meniscus Using Standard Anteromedial and Anterolateral Portals.

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