Ultrasound for Treating Meniscocapsular Separation Together With Arthroscopy

Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear

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.

Sonographic Diagnosis of Medial Meniscocapsular Separation of the Knee

Medial meniscocapsular separation (MCS) is an uncommon knee injury. No dedicated sonographic study on medial MCS has been reported thus far. This article retrospectively analyzes the sonogram of two patients with medial MCS confirmed by either magnetic resonance imaging (MRI) or surgery. Both patients are in their 30s with sports-related medial knee injuries. Sonograms of their medial knees displayed similar features of fluid collection between the medial meniscus and the deep portion of the medial collateral ligament (MCL), and an unsmooth outer surface of the meniscus. Meniscal tear and MCL injury were also found in both of these patients. Sonographic diagnostic criteria for the medial MCS are proposed based on the two patient cases. The differentiation of medial MCS from other cystic lesions in the medial parameniscal area is also discussed.