Meniscus repair

These are just my thoughts.

Please feel free to submit a post if you know more about meniscal repair than me.

(It wouldn’t take much)

Or have a presentation about it

(like Elliot Pally)

because that would be nice to link to.

Indications:

 

1. Pathology: traumatic (degenerative tear = contraindication)
2. Location: outer 1/3, especially capsular margin
3. Direction of the tear: longitudinal or horizontal    (?deep radial tears out to capsule)
4. complexity of the tear: simple or single
5. Stability: Unstable tear in a stable knee is ideal.
6. Compliant patient: need sufficient time for recovery (~6/12 ?) before RTW or sports

 

Outside-In

Better visualization, better access, flexibility of placement, simplicity, safety(transillumination)  Better for anterior horn.

 Inside-Out

May need accessory portals (posteromedial, posterolateral)

Need to do extracapsular exposure to allow peroneal nerve to drop posteriorly.

Fix medial meniscus in near extension, and lateral meniscus in 60deg flexion.

semi-memb & medial gastroc are fair game for suture fixation.

if fixing posterior tear of lateral meniscus, probably best to place one stitch on each side of popliteal hiatus.

+/- fibrin clot (?)

safest answer on exam is inside-out because no risk of sending dart into neurovascular structures.

Classical All-inside repair

Posterior horn tears using corcscrew-like suture passer to place vertical mattress suture

Current all-inside technique

Use Fast-Fix or similar suture-dart or suture-anchor to place mattress suture.

 

Always treat instability concurrently.