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Knee Videos: Meniscus
Arthroscopic Intrameniscal Decompression for the Treatment of Lateral Meniscal Cysts
The meniscal cyst is a common complication associated with complex degenerative meniscal tears such as degenerative flaps and horizontal cleavage tears. The current gold standard treatment for this condition is arthroscopic decompression with partial meniscectomy; however, there are three concerns regarding this treatment. First, cases of meniscal cysts commonly involve an intrameniscal location of the degenerative lesion. Second, when there is difficulty in finding the lesion, a so-called “check-valve” is required, and a large-scale meniscectomy is necessary.Distal Fixation of Meniscal Root Repair by Transtibial Pullout Technique via Transtibial Tubercle Fixation Without Hardware
The meniscal roots are critical in maintaining the normal shock-absorbing function of the meniscus. If a meniscal root tear is left untreated, meniscal extrusion can occur, rendering the meniscus nonfunctional, resulting in degenerative arthritis. Preservation of meniscal tissue with restoration of meniscal continuity is becoming the standard for meniscal root pathology. Not all patients are candidates for root repair; however, repair is indicated in active patients after acute or chronic injury with no significant osteoarthritis and malalignment.Effectivity of the Outside-In Pie-Crusting Technique and an All-Inside Meniscal Repair Device in the Repair of Ramp Lesions
Ramp lesions are characteristic medial meniscus injuries seen in anterior cruciate ligament–injured knees. Anterior cruciate ligament injuries combined with ramp lesions increase the amount of anterior tibial translation and tibial external rotation. Therefore, the diagnosis and treatment of ramp lesions have received increasing attention. However, ramp lesions can be difficult to diagnose on preoperative magnetic resonance imaging. Additionally, ramp lesions are difficult to observe and treat intraoperatively in the posteromedial compartment.Arthroscopic Medial Meniscus Root Repair With Soft Suture Anchor Without Posterior Portal Technique
Medial meniscal root injury is known to cause an increase in tibiofemoral contact pressure and results in early osteoarthritis. There have been many reports on meniscal root repairing techniques, which can be categorized into 2 groups. One is transosseous suture, and the other is anchor suture repair. Both techniques show improvement in not only clinical performance, but also radiographic finding. However, the meniscal root repair procedure must be performed by experienced physicians. Most techniques require a posteromedial portal, which takes time and may even complicate the procedure.Submeniscal Portal for Horizontal Cleavage Tear with Parameniscal Cyst of the Lateral Meniscus
Horizontal cleavage tears of the medial and lateral meniscus can be difficult to treat using the standard anteromedial or anterolateral arthroscopy portals. In this Technical Note, we present a new surgical technique to better manage the inferior leaflet of horizontal cleavage tears of the medial and lateral meniscus and their associated parameniscal cysts.Suture Anchor Refixation of Meniscal Root Tears Without an Additional Portal
The biomechanical consequences of a tear of the posterior root of the medial meniscus are comparable to that of a complete meniscectomy. The integrity of the meniscal roots is crucial to enable the important function of load sharing and shock absorption. An untreated root tear leads to extrusion and loss of function of the meniscus causing early degenerative arthritis of the respective knee compartment. Meniscal root repair can be achieved by 2 main techniques: indirect fixation using pullout sutures through a transtibial tunnel with extracortical fixation and direct fixation using suture anchors.Knotless Medial Meniscus Posterior Root Repair
Medial meniscus posterior root tears are common injuries, especially in the Asian world. This injury must be repaired where indicated to restore knee biomechanics and prevent arthritis. Suturing the meniscus using suture tapes provides good hold of the tissue. The use of a 70° arthroscope and creation of a transseptal portal improve visualization of the posterior compartment. Creation of a high posteromedial portal achieves the correct trajectory for the suture anchor insertion. A knotless suture anchor can be used to fix the posterior root at its anatomic attachment site.Meniscal Ramp Lesion Repair Using an All-Inside Technique
Posteromedial meniscotibial ligament lesions, known as meniscal ramp lesions, are typically associated with ACL injuries, but frequently underdiagnosed. When correctly diagnosed, repair is mandatory in most cases. Retraction of the soft tissues makes it difficult to repair and leads to suture failure. Previously described techniques include all-inside and inside-out meniscal sutures, but do not ensure correct meniscotibial closure because of the soft tissue retraction. The purpose of this Technical Note is to describe a meniscal ramp lesion arthroscopic repair with an all-inside technique with the Fast-Fix 360 device, detailing the use of the accessory posteromedial portal, and the addition of an arthroscopic grasper that raises the retracted meniscotibial ligament, to allow correct fixation.Outside-in Repair Technique for a Complete Radial Tear of the Lateral Meniscus
The lateral meniscus is vital in dissipating the force in the lateral compartment of the knee. A complete radial tear of the meniscus can lead to extrusion, rendering it nonfunctional and resulting in deleterious arthritic changes to the lateral compartment. Arthroscopic repair of a complete radial tear of the lateral meniscus poses a challenge to orthopaedic surgeons. Although some would advocate for meniscectomy, we present a technique for an outside-in repair using 3 sutures and standard arthroscopic portals.Arthroscopic Treatment of Tibial Eminence Avulsion Fracture With Suture Tensioning Technique
Although a tibial eminence avulsion fracture is a rare knee injury, it can result in some complications such as nonunion, limited range of motion, and anterior instability of the knee if the displaced fracture is not well reduced. Arthroscopic procedures for this fracture have been commonly performed in recent years. In patients with small fragments, a pullout operation is usually performed, but arthroscopic suture reduction is technically difficult. In addition, anterior instability of the knee may remain even if the fragment is well reduced at the time of the surgical procedure.Repair of a Chronic Large Meniscal Defect With Implantation of Autogenous Meniscal Fragments Using a Tubular-Shaped Fibrin Clot
We present a technique to implant autogenous meniscal fragments using a fibrin clot to repair a large degenerative meniscal defect. A total of 25 mL of the patient's blood is agitated for 10 minutes using a stainless steel swizzle stick in a sterile glass syringe. The elastic fibrin clot subsequently adheres to the stick in a tubular manner. Using arthroscopic debridement, native meniscal tissue is resected. The meniscal fragments are packaged into the tubular-shaped fibrin clot, and the tube is tied at both ends using 4-0 absorbable sutures.All-Inside Meniscus Repair Method for Injury of the Margin of the Anterior Segment of the Meniscus
Although the outside-in method has been used to treat injuries to the anterior segment of the meniscus, this method has drawbacks including the need to make a skin incision and portals for arthroscopy, pain caused by strangulation of the subcutaneous tissue and joint capsule, and protrusion of the knots. To resolve these problems, we present an all-inside method that enables simple suture of injuries to the anterior segment of the meniscus through arthroscopic portals placed only on the anteromedial and lateral sides without using a specific instrument.Bone Trough Lateral Meniscal Allograft Transplantation: The Tapered Teardrop Technique
The meniscus plays a vital role in knee biomechanics, and its physical absence or functional incompetence (e.g., irreparable root or radial tear) leads to unacceptably high rates of joint degeneration in affected populations. Meniscal allograft transplantation has been used successfully to treat patients with postmeniscectomy syndrome, and there is early laboratory and radiographic evidence hinting at a potential prophylactic role in preventing joint degeneration. We present a technique for lateral meniscal allograft transplantation using the CONMED Meniscal Allograft Transplantation system.Meniscal Allograft Transplantation Made Simple: Bridge and Slot Technique
Over recent years, appreciation for the critical role of the meniscus in joint biomechanics has led to an emphasis on meniscal preservation. Meniscal allograft transplant (MAT) is a promising biological solution for the symptomatic young patient with a meniscus-deficient knee that has not developed advanced osteoarthritis. As surgical techniques are refined and outcomes continue to improve, it is vital to consider the utility of such procedures and offer a straightforward approach to MAT. This article and accompanying video provide a step-by-step tutorial on how to perform a MAT using the bridge and slot technique, its key pearls and pitfalls as well as the relevant advantages and disadvantages of MAT.Meniscal Repair With Fibrin Clot Augmentation
Meniscal injuries and meniscal loss are associated with changes in knee kinematics and loading, ultimately leading to poor functional outcomes and increased risk of progression to osteoarthritis. Biomechanical studies have shown restored knee function, and clinical studies have reported improved outcomes and decreased risk of osteoarthritis after meniscal repair. This has led orthopaedic surgeons to try and save the meniscus by repair whenever possible, as shown by increasing incidence of meniscal repair surgeries.Vertical Lasso and Horizontal Lasso Sutures for Repair of Horizontal Cleavage and Horizontal Oblique Meniscal Tears: Surgical Technique and Indications
Horizontal cleavage and horizontal oblique meniscal tears have traditionally been treated with partial meniscectomy. Recent research has shown the deleterious long-term effects of meniscectomy in these patients regarding the development of osteoarthritis. Meniscal preservation is thus the preferred method of surgical treatment in patients with these tears. However, traditional repair techniques using inside-out sutures or suture anchor–based devices do not address the horizontally aligned nature of these particular tears and thus do not compress the meniscal tissue in the correct plane.Suture Repair of Full Radial Posterior Lateral Meniscus Tears Using a Central Midline Portal
Full radial posterior lateral meniscus root tears are frequently associated with injuries to the anterior cruciate ligament. Left unrepaired, they result in loss of the meniscus hoop stress function and can lead to overload of the lateral compartment and early degenerative changes. Arthroscopic suture repairs show successful results with long-term follow-up. However, previously described suture repair techniques have often required special instrumentation and can be technically demanding. This Technical Note describes the use of an accessory portal through the patellar tendon as a safe and easy method for repairing full posterior radial tears of the lateral meniscus.Arthroscopic Lateral Meniscal Allograft Transplantation With the Key-Hole Technique
The efficacy of meniscus allograft transplantation (MAT) for the meniscus-deficient knee has been widely recognized as being excellent in terms of pain relief and functional improvement. Lateral MAT is usually performed with the bone bridge technique that uses a bone bridge connecting the anterior and posterior horns of an allograft. The slot position for the meniscal graft insertion is of great importance with the bone bridge technique, especially in the key-hole method. The purpose of this Technical Note is to describe lateral MAT using the key-hole technique in which an allograft with a bone bridge carved to accommodate the key-hole-shaped slot is properly secured to the slot.All-inside Arthroscopic Meniscal Repair Technique Using a Midbody Accessory Portal
Treatment of symptomatic meniscal tears continues to evolve as we improve our understanding of the biomechanical role of the meniscus and its long-term importance to the health of the knee joint. Suture repair of meniscal tears is challenging, yet the incidence of repairs among our colleagues continues to rise as we aim to preserve meniscal tissue. Many elements of performing a repair are tedious and difficult, including proper meniscal preparation, reduction, mattress suture placement, and fixation.Posterior Lateral Meniscus Root Reattachment With Suture Anchors: An Arthroscopic Technique
The posterior lateral meniscus root (PLMR) provides the circumferential tension required to stabilize the lateral meniscus. Thus, preservation of the PLMR is important to prevent an increase in tibiofemoral contact pressure, which could result in osteoarthritis. We describe an all-arthroscopic approach to the fixation of PLMR using suture anchors through associated posterolateral arthroscopic portals that result in a more favorable inclination of the anchors. Initially, the anatomical insertion site of the root on the tibial plateau is debrided, 1 to 2 anchors are placed through the posterolateral portals into the root's footprint area, and the meniscus is finally sutured from the posterolateral portals.Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique
The occurrence of posterior root tear of both the lateral and medial menisci, combined with anterior cruciate ligament rupture, is rare. Problems may be encountered such as the difficulty to access the medial meniscal root tear, the confusing circumstances about which structure to repair first, and the possibility of the tunnel for each repair to become taut inside the tibial bone. We present the arthroscopy technique step by step to overcome the difficulties in an efficient and time-preserving manner.Platelet-Rich Fibrin Clot–Augmented Repair of Horizontal Cleavage Meniscal Tear
Although horizontal tears of the meniscus have historically been treated with partial meniscectomy due to poor vascularity within the tear, evidence suggests that repair of horizontal meniscal tears may be advantageous to partial meniscectomy. Furthermore, the addition of platelet-rich plasma has shown promise in improving meniscal healing. We present our technique of platelet-rich fibrin clot–augmented repair of horizontal cleavage meniscal tear.Circumferential Suture Repair of Isolated Horizontal Meniscal Tears Augmented With Fibrin Clot
Traditionally, horizontal cleavage meniscus tears have been associated with osteoarthritis, indicative of the degenerative process. Recent treatment measures have focused on maintaining as much meniscal tissue as possible, despite the routine extension of these tears into the central white-white zones. In the absence of tunnel drilling for cruciate ligament reconstructions, the use of an exogenous fibrin clot is a useful adjunct to increase the local growth factors at the tear repair to aid in healing.Meniscal Allograft Transplantation With Concomitant Osteochondral Allograft Transplantation
Surgical strategies for knee joint preservation are numerous, with the procedure(s) of choice for a given patient dependent on the status of the articular cartilage, meniscus, overall alignment, and ligamentous stability. For patients with large, isolated, osteochondral defects of the articular cartilage of the femoral condyle, osteochondral allograft transplantation (OCA) is often performed in an effort to reduce pain and improve function. Similarly, for appropriately indicated patients with symptomatic meniscus deficiency, meniscus allograft transplantation (MAT) is an excellent surgical solution.Arthroscopic Inside-Out Repair of a Meniscus Bucket-Handle Tear Augmented With Bone Marrow Aspirate Concentrate
Bucket-handle tears of the meniscus comprise nearly 10% of all meniscus tears and commonly affect the young male population. Displacement of the free segment can lead to significant pain and disability, necessitating reduction and surgical treatment. General contraindications include malalignment, severe arthritis, significant comorbidities, or chronic asymptomatic tears, but otherwise repair should almost always be performed. Options for surgical treatment include partial meniscectomy and arthroscopic repair using an all-inside, outside-in, or inside-out technique.
