Clin Orthop Surg.  2018 Mar;10(1):111-115. 10.4055/cios.2018.10.1.111.

Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor

• Lee SK
• Yang BS
• Park BM
• Yeom JU
• Kim JH
• Yu JS

• KMID: 2405490
• DOI: http://doi.org/10.4055/cios.2018.10.1.111

Abstract

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.

Keyword

Medial meniscus; Root tear; Curved guide; Soft suture anchor

MeSH Terms

Menisci, Tibial
Surgeons
Suture Anchors*
Sutures*
Tears

Figure

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  Fig. 1 Preoperative planning of portal positions in the right knee. Anterolateral (AL) portal as viewing portal, anteromedial (AM) portal as a main working portal located just medial to the patella tendon, and far anteromedial (fAM) portal used for shuttle relay.

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  Fig. 2 (A) The tear margin of the posterior root of medial meniscus (MM; black asterisk) is debrided using a motorized shaver (white asterisk). (B) Preparation of the insertion site using a curved curette (Ⓒ). (C) Posterior one-third of the meniscus (black dotted line), 7–8 mm medial to the torn edge, is penetrated using a curved suture hook (Ⓗ). (D) The anterior one-third of the meniscus (white dotted line) is penetrated in the same manner. PCL: posterior cruciate ligament, MFC: medial femoral condyle.

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  Fig. 3 A posterior medial portal (asterisk) is established by the transillumination technique at the center of soft spot, 1–1.5 cm proximal to the joint line and 1 cm posterior to the medial femoral condyle.

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  Fig. 4 (A) Comparison of a flexible reamer (1) and a 25° curved suture anchor guide (3) with a straight guide (2). (B) The tip of a 25° curved guide (Ⓖ) is placed on the footprint of the posterior root of the medial meniscus vertically. (C) Under visualization through an anterolateral portal, a soft suture anchor along the curved guide (arrow) is inserted through a posteromedial portal at an angle of 30° with the knee flexed at 60°. (D, E) Schematic diagram showing the knee position and insertion of the curved guide through the posteromedial portal. PCL: posterior cruciate ligament, MFC: medial femoral condyle.

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  Fig. 5 (A) One limb of the polydioxanone suture (PDS, arrowhead) from the inferior side and one strand of Force Fiber (arrow) are retrieved using a suture retriever (asterisk) along a cannula through an anteromedial portal. (B) Shuttle relay by pulling a PDS (arrow) at far anteromedial portal is made to pass the Force Fiber through the meniscus from inferior to superior. (C) Two sutures are tied securely, and the posterior root of the medial meniscus (MM) is repaired to the insertion site. MFC: medial femoral condyle, PCL: posterior cruciate ligament.

Reference

1. LaPrade CM, Foad A, Smith SD, et al. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015; 43(4):912–920. PMID: 25622987.

2. Choi NH, Son KM, Victoroff BN. Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc. 2008; 16(9):891–893. PMID: 18633598.

3. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011; 27(12):1644–1653. PMID: 21982389.

4. Jung WH, Kim DH, Chun CW, Lee JH, Ha JH, Jeong JH. Arthroscopic, suture anchor repair through a novel medial quadriceptal portal for medial meniscal root tear. Knee Surg Sports Traumatol Arthrosc. 2012; 20(12):2391–2394. PMID: 22258657.

5. Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982; 10(2):90–95. PMID: 7081532.

6. Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH. A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc. 2007; 15(12):1510–1513. PMID: 17370062.

7. Cho JH, Song JG. Second-look arthroscopic assessment and clinical results of modified pull-out suture for posterior root tear of the medial meniscus. Knee Surg Relat Res. 2014; 26(2):106–113. PMID: 24944976.

8. Barber FA, Herbert MA. Cyclic loading biomechanical analysis of the pullout strengths of rotator cuff and glenoid anchors: 2013 update. Arthroscopy. 2013; 29(5):832–844. PMID: 23561482.

9. Kim YM, Joo YB. Pullout failure strength of the posterior horn of the medial meniscus with root ligament tear. Knee Surg Sports Traumatol Arthrosc. 2013; 21(7):1546–1552. PMID: 22801931.

10. McGinnis MD 4th, Gonzalez R, Nyland J, Caborn DN. The posteromedial knee arthroscopy portal: a cadaveric study defining a safety zone for portal placement. Arthroscopy. 2011; 27(8):1090–1095. PMID: 21620634.