Inside-Out Bucket-Handle Meniscus Repair With a Single-Handed Self-Advancing Zone-Specific Meniscus Repair Device

Arthroscopic Meniscus Repair Using an All-Inside, All-Suture, Knotless Device

With an increased appreciation of the importance an intact meniscus has on normal knee kinematics and function, more meniscal tears are being treated with a repair rather than partial meniscectomy. There are several techniques for repairing torn meniscal tissue, including the outside-in, inside-out, and all-inside repairs. Each technique comes with its advantages and drawbacks. The inside-out and outside-in techniques allow for greater control of the repair using knots outside the joint capsule; however, they pose a risk for neurovascular injury and require additional incisions. Arthroscopic all-inside repairs have seen increasing popularity, but with current techniques, fixation is achieved either with intra-articular knots or extra-articular implants, leading to variable outcomes and the potential for postoperative complications. This technical note describes the use of SuperBall, an all-inside meniscus repair device that provides an all-arthroscopic approach, no intraarticular knots or implants, and surgeon-guided tensioning of the meniscus repair.

The treatment of bucket handle meniscus tear using "the pulling suture technique": A new surgical technique

INTRODUCTION AND IMPORTANCE

Arthroscopic partial meniscectomy represents a challenge due to view obstruction by the tight posterior joint line. We are describing a new technique to overcome this obstacle using "the pulling suture technique" which is a simple, reproducible, and safe way to perform partial meniscectomy.

CASE PRESENTATION

After a twisting knee injury, a 30-year-old man was complaining of left knee pain and locking. An irreparable complex bucket handle medial meniscus tear was found during diagnostic knee arthroscopy and partial meniscectomy was performed using the pulling suture technique. After visualizing medial knee compartment, a vicryl suture was introduce and looped around the torn fragment then secured by a sliding locking knot. The suture was pulled, and the torn fragment was placed under tension throughout the procedure to facilitate exposure and debridement of the tear. Then, the free fragment was extracted in one piece.

DISCUSSION

Arthroscopic partial meniscectomy of the bucket-handle tears is a commonly performed procedure. Due to view obstruction, cutting of the posterior part of the tear is a challenging step. Any attempts of blind resection without proper visualization can lead to articular cartilage damage or insufficient debridement. In contrast to most described techniques to overcome this problem, the pulling suture technique doesn't require any accessory portals or additional equipments.

CONCLUSION

Using "the pulling suture technique" improves resection by allowing a better view of both ends of the tear and securing the resected part by the suture, which facilitates its removal as a one unit.

Margin Convergence Continuous Lasso-Loop Overlocking Technique for the Repair of Horizontal and Longitudinal Knee Meniscal Tears

Horizontal and longitudinal tears are the most common injuries of the meniscus. The arthroscopic all-inside suture technique using meniscal repair devices involving preloaded sutures and nonabsorbable implants is the most popular technique. The 2 main disadvantages of this technique are the high cost and complications associated with implants. We have adopted some modern shoulder surgery techniques to repair horizontal and longitudinal meniscal tears. Our technique is based on the continuous lasso-loop margin convergence technique for rotator cuff repair (Lafosse's continuous stitches). The technique is an implant-free, cost-effective procedure, which can be performed using general arthroscopic instruments.