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Meniscus Repair Three Techniques John F. Meyers, M.D. Repairable Menisci • Outer 1/3 – Red Red Zone • Middle 1/3 – Red White Zone Non-Repairable Menisci • Middle 1/3 Red White Zone • Inner 1/3 – White White Zone Inside Out Technique Technique Medial Meniscus • Scope Medial – Cannula Lateral • Prepare Meniscus and Synovium • Work from posterior to Anterior Technique Medial Meniscus • Horizontal or Vertical Mattress Sutures • Superior and Inferior Surface • Transilluminate Saphenous Vein • Posteromedial Incision Technique Lateral Meniscus • Scope lateral cannula medial • Posterolateral incision to protect peroneal nerve Combined Posterior Incicion and Arthroscopic Intra-articular Repair Lateral Meniscus • Peroneal nerve at risk with any repair medial to popliteus • Combination arthroscopic open repair Outside-In Technique Technique Medial Meniscus • Scope lateral • Pass needle through tear • Pass suture through needle Technique Medial Meniscus • Mulberry knot • Repeat with adjacent stitch • Tie sutures over capsule Technique Lateral Meniscus • Scope medial • Identical procedure Advantage Cheap & Easy Disadvantage Posterior tears difficult to reach Inside – Inside Technique Fibrin Clot • Enhances healing • Large tears • Failed repairs Fibrin Clot • Probably not necessary with combined ACL reconstruction Results Cannon • 90% success combined with ACL reconstruction • 60% success with isolated tears Rosenberg • 92% success when repaired in red red zone Dehaven – open repair • 95% success in stable knees • 62% success in ACL deficient knees Meniscus Repair – Five Techniques John F. Meyers, M.D. T-Fix Suture Anchor Advantage No incision necessary T-Fix Suture Anchor Disadvantage • Cost • Knot tying • Permanent foreign body Meniscus Arrows Advantage No incision necessary Meniscus Arrows Disadvantage • Cost • ? Articular cartilage damage Repairable Meniscii • Outer 1/3 – Red Red Zone • Middle 1/3 – Red White Zone Non-Repairable Meniscii • Middle 1/3 Red White Zone • Inner 1/3 – White White Zone Inside Out Technique Technique Medial Meniscus • Scope medial – cannula lateral • Prepare meniscus and synovium • Work from posterior to anterior Technique Medial Meniscus • Horizontal or vertical mattress sutures • Superior and inferior surface • Transilluminate saphenous vein • Posteromedial incision Technique Lateral Meniscus • Scope lateral cannula medial • Posterolateral incision to protect peroneal nerve Outside In Technique Lateral Meniscus • Peroneal nerve at risk with any repair medial to popliteus • Combination arthroscopic open repair Technique Medial Meniscus • Scope Lateral • Pass needle through tear • Pass suture through needle Technique Medial Meniscus • Mulberry knot • Repeat with adjacent stitch • Tie sutures over capsule Technique Lateral Meniscus • Scope Medial • Identical procedure Advantage Cheap & Easy Disadvantage Posterior tears difficult to reach Inside – Inside Technique Fibrin Clot • Enhances healing • Large tears • Failed repairs Fibrin Clot • Probably not necessary with combined ACL reconstruction Results Cannon • 90% success combined with ACL reconstruction • 60% success with isolated tears Rosenberg • 92% success when repaired in the red red zone Dehaven – Open Repair • 95% success in stable knees • 62% success in ACL deficient knees
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