Horizontal Cleavage Tear Meniscal Repair Using All-Inside Circumferential Compression Sutures

ABSTRACT: Horizontal cleavage meniscus tears occur more frequently in older patient populations with degenerative changes within the meniscus. Traditionally, they have been managed with nonsurgical interventions or with partial meniscectomy. As increasing evidence demonstrates the link between partial meniscectomy and progressive osteoarthritis with these types of tears, as well as worse long-term outcomes and reduced cost savings, surgical repair of horizontal cleavage meniscal tears has increased in appropriate patients. This technique article highlights the evaluation, indications, and preferred repair technique for horizontal cleavage tears in appropriately selected patients. Technique Video Video 1 Demonstration of technique. The patient is placed in the supine position. A superolateral outflow portal is placed to allow for adequate intra-articular visualization followed by the creation of standard anteromedial and anterolateral portals. Initial diagnostic arthroscopy is performed viewing from the anterolateral portal. Once the tear has been identified, the meniscal tear is further visualized by preparation of the frayed edges with a combination of meniscal rasping, biting, and shaving. Following preparation, the meniscal repair is begun posteriorly working from the anteromedial portal to allow for direct access to the meniscus. In this case, the tear is of the medial meniscus. If the medial compartment is tight, prohibiting sufficient access, percutaneous trephination of the medial collateral ligament is performed to increase access. Using the Smith & Nephew NovoStitch Pro All-inside device, circumferential compression sutures are placed 3 to 4 mm apart working from posterior to anterior. At the mid-body of the meniscus, the working portal is switched to the anterolateral portal to allow for more direct access to the remainder of the more anterior portions of the meniscus.

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PROVIDER: S-EPMC10466186 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature