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

  • Oleg Milenin
    Correspondence
    Address correspondence to Oleg Milenin, Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, 105120, Zemlyanoy VAL 53/1, Moscow, Russia.
    Affiliations
    Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
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Open AccessPublished:September 17, 2022DOI:https://doi.org/10.1016/j.eats.2022.06.007

      Abstract

      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.

      Technique Video

      (mp4, (49.28 MB)

      Clinical case of continuous lasso-loop overlocking repair of horizontal medial meniscal tear in right knee. The procedure is performed with the patient in the supine position on the operating table with a tight tourniquet; the knee is flexed to 90°. After tear debridement, we insert a spinal needle with a No. 0 FiberWire suture through the skin from the posteromedial aspect of the knee in the safe zone, as described for the classic outside-in technique. The needle tip initially penetrates the superior part of the tear. We grasp the suture and pass it through the anteromedial portal. Subsequently, we pull the needle back to the level of the red zone of the meniscus and then penetrate the inferior part of the tear. This maneuver creates a loop, through which we pass the free end of the suture with a probe or a suture grasper. Next, we pull the free end of the stitch, which has been passed through the spinal needle’s eye. Finally, we tighten the stitch. We repeat this maneuver several times until we create a stable W-shaped configuration of overlocking stitches. In the final stage, all stitches are checked with the probe and tightened if needed. At the end of the procedure, both ends of the sutures are aligned to the anteromedial portal with a suture manipulator, creating a classic nonsliding knot. The knot is placed under the inferior surface of the meniscus to prevent abrasion and irritation of the cartilage. Finally, a stable construction is confirmed with the probe. In case of vertical tears, the same technique can be successfully used to attain a solid repair.

      Technique Video

      See video under supplementary data.

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