Die arthroskopische Meniskusnaht

OBJECTIVE: Restoration of the function of the meniscus by suturing a tear to prevent long-term degeneration. INDICATIONS: Unstable longitudinal meniscal tear in the red and red-white zones with an intact central fragment. Dislocated bucket-handle tear near the base in the presence of good-quality tissue. CONTRAINDICATIONS: Lesion of the central meniscal fragment. Meniscal tears in the white, avascular zone. Degenerative meniscal lesions. Complex meniscal lesions. Untreated knee ligament instability. Uncooperative patient. SURGICAL TECHNIQUE: Standard anterior arthroscopy approach. Revitalization of the tear margins and the perimeniscal synovial membrane, trephination of the base of the meniscus to promote healing. Fixation of the tear with a resorbable or nonresorbable suture size 2-0 to 0 USP by means of different suture techniques. "Outside-in technique": the suture is introduced from outside the joint through the base of the meniscus using a cannulated needle and is then pulled back out using a suture loop inserted with another cannulated needle. The U-suture is knotted over the joint capsule through a stab incision. "Inside-out technique": the suture is introduced using a needle through a guide cannula from outside the joint through the meniscus and joint capsule and then brought out of the joint. The U-suture is knotted over the capsule through a short skin incision. "All-inside technique": the suture loop is passed through the meniscal tear and knotted within the joint using a posterior arthroscopy approach. POSTOPERATIVE MANAGEMENT: Full weight bearing without a brace for short tears with one suture. For tears with two sutures, partial weight bearing for 4 weeks without a brace. For large tears with three to four sutures, partial weight bearing up to 20 kp for 6 weeks and restricted knee motion in a brace up to 0/0/60 degrees . RESULTS: The healing rate for knee joints with stable ligaments and an isolated meniscal tear is between 50% and 75%. In cases with simultaneous ACL (anterior cruciate ligament) plasty, the healing rate is > 75%; for unstable knee joints it is < 50%.     

Avulsionsverletzung des Außenmeniskushinterhorns

An avulsion of the posterior tibial insertion of the meniscus (root tear) is a rare clinical diagnosis. Yet, due to the inconsistent clinical symptoms and the difficult arthroscopic assessment, an injury to the root of the meniscus can be easily missed. We present a possible technique for arthroscopic management of root tears using a tibial tunnel approach. A possible injury mechanism could be a rotational distortion of the knee. Another mechanism of injury is an overly posterior tunnel placement in ACL reconstruction. The clinical assessment of the lesion is based on thorough arthroscopic diagnosis of the lateral posterior horn in the figure of 4 position. A tibial ACL aimer can be used to locate a K-wire in the anatomical footprint of the posterior root of the meniscus. After overdrilling using a 4.5-mm drill, two sutures can be passed through the meniscal tissue and the sutures can be pulled out of the tibial tunnel. Extracortical fixation can be used by tying the sutures over a button.A root tear of the meniscus is a difficult clinical and arthroscopic diagnosis. A possibility for refixation of this lesion is to use a tibial tunnel technique. An associated injury to the ACL facilitates the tunnel placement and the suture management.     

Meniscal Repair for Anterior Horn Tear of the Lateral Meniscus

This technical note describes all-inside meniscal repair for anterior horn tears of the lateral meniscus. A modified anteromedial portal is created for use in visualizing the anterior horn of the lateral meniscus. A crescent-shaped suture hook loaded with a polydioxanone suture (PDS) is inserted through an anterolateral portal. The hook tip penetrates the meniscal peripheral rim and advances across the tear. The suture hook penetrates the mobile central fragment. A leading limb of the PDS is advanced into the knee joint. Then, the leading limb of the suture is retrieved back to the anterolateral portal. With 2 limbs of PDS, endoscopic knot tying is done. With this simple technique, vertically oriented all-inside meniscal repair of an anterior horn tear of the lateral meniscus with the use of absorbable suture materials is easily performed.     

All-Inside Suture Technique Using Anterior Portals in Posterior Horn Tears of Lateral Meniscus

Methods for the repair of meniscal tears include inside-out, outside-in, and all-inside techniques. In this article an all-inside technique is proposed for the posterior horn of the lateral meniscus that takes advantage of the capacious posterolateral recess when the knee is flexed. A device consisting of a large needle with a buttonhole in the tip (previously used for inside-out suture of the medial meniscus) is used. This technique uses only anterior portals (anteromedial and anterolateral portals and an accessory lateral or transpatellar tendon portal). The arthroscope is inserted through the accessory portal. Once the tear has been located and its edges refreshed, the suture device is placed anterolaterally. The tip of the needle is loaded with suture and passed through both sides of the tear and into the posterolateral recess of the knee (without exiting the capsule). The suture tail is recovered with the use of a suture retriever through the anteromedial portal. Next, the suture retriever is inserted through the anterolateral portal to once again retrieve and shuttle the tail before completion of an arthroscopic knot. In addition to the ease of the technique, use of this simple, reusable device adds the benefit of low cost when compared with other techniques.     

The utility medial portal: a new arthroscopic approach to the knee

Placement of accurate arthroscopic portals is crucial in arthroscopic knee surgery. Unlike the inferolateral portal that is usually used initially in arthroscopic surgery, the utility medial portal allows excellent visualization of both the medial and lateral compartments as well as the patellofemoral articulation and suprapatellar pouch. Other diagnostic advantages include visualization of the anterior horn of the lateral meniscus, access into the posterior compartment of the knee, and visualization of the intercondylar notch. Surgically, this portal is invaluable in lateral meniscal procedures. Specifically, placement of the arthroscope in the utility medial portal allows access to the complete lateral meniscus, including the anterior and posterior horns, for both visualization and instrumentation. This portal is also outstanding for use in patellofemoral surgical procedures. This portal has been used with great success as a standard arthroscopic portal without difficulty, primarily in 550 arthroscopic procedures and secondarily in 240 procedures. This portal is recommended for examination of the knee in all cases except those in which there is a high suspicion of an isolated medial meniscus tear. Also, the portal may be used routinely for surgical visualization and instrumentation due to its flexibility.     

Arthroscopic partial meniscectomy of a posteriorly flipped superior leaflet in a horizontal medial meniscus tear using a posterior transseptal portal

This article describes a case of an arthroscopic partial meniscectomy of a posteriorly flipped superior leaflet in a horizontal medial meniscus tear using the posterior transseptal portal. An arthroscopic partial meniscectomy for bucket handle or flap tears in medial or lateral compartments using ordinary portals is a relatively common procedure in irreparable cases. However, the posterior compartment of the knee is not readily accessible through ordinary arthroscopic portals. Therefore, it has been considered a blind spot. Through the posterior transseptal portal, surgeons can achieve excellent arthroscopic visualization of the posterior compartment and easily perform arthroscopic procedures of the posterior compartment of the knee. A 48-year-old woman presented with a 1-year history of pain in the medial aspect of the right knee joint. Preoperative magnetic resonance imaging revealed a thinning of the medial meniscus posterior horn in coronal images and a sharp-edged triangle arising from the medial meniscus posterior horn between the medial femoral condyle and medial meniscus posterior horn on sagittal images (flipped-over sign). During the arthroscopic procedure, we found that the flipped leaflet was displaced posteriorly and was not mobile between the medial femoral condyle and medial meniscus posterior horn. Partial meniscectomy for a posteriorly displaced fragment can be performed successfully using the posterior transseptal portal. The posterior transseptal portal is useful for an arthroscopic partial meniscectomy of a posteriorly flipped leaflet in the posterior compartment of the knee.     

Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel

According to our observation in ACL reconstruction, we find root tears of the posterior horn of the lateral meniscus as a common concomitant injury in ACL-deficient knees. This might be a consequence of initial trauma or of the increased anterior–posterior translation of the tibia and an overload impact on the posterior meniscus root in ACL-deficient knees. A tear of the posterior horn of the medial meniscus causes a 25% increase in peak pressure in the medial compartment compared with that found in the intact condition. The repair restores the peak contact pressure to normal (Allaire et al. in J Bone Joint Surg Am 90(9):1922–1931, [2008]). A tear of the posterior horn of the lateral meniscus might have similar consequences. We hypothesize the surgical anatomical reattachment of the root at the tibia helping to restore knee joint kinematics and helping to advance ACL-graft function. This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture.     

Modified Pull-out Suture in Posterior Root Tear of the Medial Meniscus: Using a Posteromedial Portal

In cases with root tear of the medial meniscus posterior horn, the meniscus usually can be repaired by a pull out suture technique. However, there is difficulty in manipulating a suture hook via the anteromedial portal and looking through the arthroscopic camera via anterolateral portal in the narrow medial joint space at the same time. This article describes a modified simple pull out suture technique for root tear of the medial meniscus posterior horn using a posteromedial portal that provides a safe and easy handling of the suture hook. Our indications of this technique used in patients with Outerbridge 1-2 arthritic change and minimal varus axis change. Benefits of this technique are simple, less invasive, and reduced operation time by simultaneous suture with a hook via posteromedial portal and pulling of a string with grasper. It may reduce the possibility of an additional chondral or meniscal injury.     

Locked knee caused by meniscal subluxation: magnetic resonance imaging and arthroscopic verification

Subluxation or dislocation of an intact lateral meniscus is a controversial and rarely reported cause of knee pain and locking. We report a case of knee locking caused by lateral meniscal subluxation in the absence of a meniscal tear or true discoid meniscus, with both magnetic resonance imaging (MRI) and arthroscopic verification. A 9.5-year-old child experienced multiple episodes of locking in full flexion of the knee. After 6 months of symptoms, arthroscopy was performed and showed no meniscal tear or a discoid meniscus. The patient’s knee locking recurred after arthroscopy. MRI was performed when the patient presented acutely with the knee locked. MRI showed anterior dislocation of the posterior horn of the lateral meniscus with the knee in the locked position. The MRI was immediately repeated after the author reduced (manipulated) the locked knee into extension. On the repeat MRI, the lateral meniscus had returned to a normal position. On repeat arthroscopy, the posterior horn of the lateral meniscus was hypermobile and could be displaced into the notch and did not show a frank tear. The meniscus was repaired to the capsule with sutures. At the 2-year follow-up evaluation, the patient had no complaints and no clinical signs of locking.     

Snapping knee caused by a popliteomeniscal fascicle tear of the lateral meniscus in a professional Taekwondo athlete

A 19-year-old male professional Taekwondo athlete presented with a 2-year history of pain-free snapping of his right knee. He reported that his right knee joint gave way during games and training and that he could induce pain-free snapping between the proximal-to-fibular head and the lateral knee joint line. None of these physical findings suggested a meniscal pathology or ligamentous instability. Routine radiographs were normal. Magnetic resonance imaging of his right knee joint showed that the shape of the lateral meniscus was normal, and no lateral meniscus tears existed. On arthroscopic examination, popliteal hiatus view showed a posterosuperior popliteomeniscal fascicle tear between the posterior horn of the lateral meniscus and the posterior joint capsule just posteromedial to the popliteus tendon. With medial traction by probing, this popliteomeniscal tear made visible the significant subluxation of the posterior horn of the lateral meniscus to the center or anterior half of the tibial plateau. Based on the diagnosis of a posterosuperior popliteomeniscal tear of the right knee, Fast-Fix (Smith & Nephew, Andover, Massachusetts) was used for the direct repair of the peripheral portion of the lateral meniscus and joint capsule, targeting the popliteomeniscal junction. At 24 months postoperatively, the patient was performing athletic exercises relevant to his profession and was taking part in Taekwondo games, with no pain or recurrence of snapping. To the authors' knowledge, this is the first report of snapping of the lateral aspect of the knee due to a popliteomeniscal fascicle tear.     

膝关节半月板撕裂的磁共振表现

目的进一步认识膝关节半月板撕裂的磁共振成像(MRI)表现。方法回顾分析50例膝关节半月板撕裂的MRI资料,所有病例均经关节镜手术证实。采用永磁型MRI机,场强0.2T。结果50例半月板撕裂中,按照部位分类,半月板撕裂位于内侧半月板前角2例,内侧后角37例,外侧半月板前角5例,外侧后角3例,同时累及半月板前角、体部和后角者内侧2例,外侧1例。按照半月板撕裂的形式分为:水平撕裂8例;垂直撕裂4例;斜形撕裂26例;纵形撕裂3例;放射状撕裂4例;桶柄状撕裂2例;复杂撕裂3例。结论MRI能够清楚显示膝关节半月板撕裂的部位和形式,为临床治疗提供可靠的依据,是目前诊断半月板撕裂的最好的影像学检查方法。     

Repair of meniscal tears with the absorbable Clearfix screw: results after 1–3 years

Introduction Total meniscus resection usually leads to osteoarthritis of the knee joint. Preservation and refixation of the injured menisci are therefore of great clinical importance.Materials and methods The present study examines 40 meniscal injuries in 37 patients that were arthroscopically treated with Clearfix meniscal screws (Mitek, Norderstedt, Germany) in the period from August 1999 to December 2002. The mean patient age was 27.7 (range 16–62) years. Nine patients were female. A total of 24 patients (27 meniscal tears) also had an anterior cruciate ligament (ACL) lesion, and 5 patients had cartilage injuries. Twenty-two patients were treated within the first 2 weeks following the trauma, 10 patients within 8 weeks, and 5 patients after 8 weeks. The lesions were a bucket-handle tear of the medial meniscus in 11 cases and a bucket-handle tear of the lateral meniscus in 2 cases. The posterior horn of the medial meniscus was torn in 13 cases, and the pars intermedia in 3 cases. The posterior horn of the lateral meniscus was torn in 8 cases, and the pars intermedia in 3 cases. The mean tear length was 2.9 (±1.5) cm and was fixed with an average of 1.8 (±0.7) screws. In 7 cases, the anterior horn was treated with an additional meniscal suture. A total of 35 patients were examined after an average of 18 (range 7–45) months.Results In the event of a moderate outcome, MRI was performed as part of the follow-up investigation. The average Lysholm score was 93 (±7.4), the Tegner activity index was 6.3 (±2.0) before the accident and 5.8 (±2.0) at the follow-up, the Marshall knee score was 47 (±3.8). The VAS pain assessment was 1.6 (±1.3) and the VAS function assessment was 7.9 (±1.6). Of the 7 patients with a moderate result, 2 patients without additional ligament lesions suffered re-ruptures after 6 and 13 months, respectively. The other 5 patients with a moderate result each had multiple accompanying injuries or pre-existing damage to the affected knee joint.Conclusion The Clearfix screws achieved a clinical success rate of 82% in isolated meniscal tears in stable knee joints and a clinical success rate of 100% with additional ACL reconstruction. In view of the good clinical results and the simple procedure for use, the implant should be recommended for meniscal refixation.     

Stage-based treatment by partial meniscectomy, meniscal refixation and transplantation

Clinical and experimental studies have demonstrated that the meniscus is important for normal knee function. Loss of meniscus results in abnormal load transmission across the knee and may lead to degenerative joint disease. Preservation of meniscal tissue is therefore important. About 10 % of all meniscal tears are repairable. The most successful repairs occur in younger patients who have an acute, vertical tear in the vascular portion of the meniscus. Currently, arthroscopic meniscal repair procedures include the inside-out, the outside-in and the all-inside technique. Vertical suture techniques are superior to horizontally placed sutures. From a biomechanical point of view, 2-0 to 1 sutures are recommended for suture repair. Various meniscus implants are also available for meniscal repair. The initial fixation strength of the implants is lower compared to vertical sutures. A combination of suture techniques and implants might be a treatment option in posterior meniscal lesions. The collagen meniscus implant has been designed to support tissue ingrowth after segmental medial meniscectomy. Although fibrocartilage matrix formation has been shown, long-term clinical follow-ups are still required. Meniscal allograft transplantation may be indicated in limited situations. Younger patients with meniscal deficiency due to previous meniscectomy who have only early arthrosis, normal axial alignment, and a stable knee may currently considered appropriate candidates for meniscal transplantation.     

Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma

Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post-traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior–inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage-to-bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759-767, 2020     

关节镜下半月板分区的临床意义

目的探讨关节镜下半月板分区的概念及其对半月板缝合手术操作的指导意义。方法根据关节镜下半月板缝合的临床实践,针对术中操作的特点和规律进行半月板损伤部位的分区:Ⅰ区,前角区;Ⅱ区,前侧方区;Ⅲ区,后侧方区;Ⅳ区,后角区。按照分区方法,Ⅰ区15例,Ⅱ区106例,Ⅲ区36例,Ⅳ区49例。对患者术前与术后的症状改善情况及膝关节功能评分变化进行评估。结果 206例随访25～76个月,平均38个月,膝关节无症状率92.7%(191/206),有临床症状患者的分布:Ⅲ区10例,Ⅱ区1例,Ⅰ区2例,Ⅳ区2例。术前Lysholm评分(52±11)分,显著低于术后(92±8)分(t=-45.153,P=0.000)。多个独立样本比较的Kruskal-Wallis H检验显示各区疗效存在显著性差异(χ2=30.289,P=0.000);组间两两比较的Mann-Whitney U检验显示各区间疗效均存在显著性差异(P<0.05)。结论关节镜下半月板各区缝合具有不同的中期临床疗效,关节镜下半月板分区对指导关节镜下半月板缝合操作具有一定的临床意义。     

Bilateral PCL hypoplasia resulting in posterior, posterolateral rotatory instability and tears of the lateral meniscus anterior horn

This article describes a case of bilateral sagged knees presenting as posterior, posterolateral rotatory instability with tears of the anterior horn of the lateral meniscus. Each knee had identical tears of the lateral meniscus anterior horn. A 42-year-old woman reported bilateral anterior knee pain and painful instability during running or jarring exercises. She reported no major trauma to her knees. Arthroscopic findings of her right knee revealed a posterior cruciate ligament that looked hypoplastic but was without acute injury, and the anterior horn of the lateral meniscus showed chronic complex tears with some degeneration. Posterior cruciate ligament reconstruction, posterolateral corner sling, and meniscal repair of the lateral meniscus anterior horn was performed on her right knee. Three months later, a similar operation was performed on her left knee. However, menisectomy was performed because the lateral meniscus anterior horn tear was in the junction of the red-white and white zones. At 18 months postoperatively, the patient reported no symptoms and was satisfied with her results. Physical examination showed no joint line tenderness, and posterior stress radiographs on both knees showed grade I posterior instability. She showed no posterolateral subluxaion by supine dial test, and her prone dial test also improved approximately 15° on both knees. Lysholm score was 74 preoperatively and improved to 92 postoperatively.     

膝关节内外侧半月板后根部撕裂的MRI诊断价值

目的:探讨MRI对膝关节内外侧半月板后根部撕裂的诊断价值。方法:回顾性分析2012年1月至2016年1月,关节镜下证实为半月板后根部撕裂的患者43例。其中男25例,女18例;年龄27~69(42.5±8.3)岁;右侧27例,左侧16例。由2名医师采用双盲法独立回顾性分析经关节镜证实的43例半月板后根部撕裂患者的MRI表现,计算MRI对半月板后根部撕裂的诊断敏感性、特异性和准确性,并计算膝关节韧带损伤及半月板脱位等伴随情况。结果:143例中,关节镜手术证实43例半月板后根部撕裂,包括内侧撕裂24例,外侧撕裂19例。医师A诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为91.67%、86.6%、83.9%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为73.7%、79.9%、79%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。医师B诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为87.5%、87.4%、87.4%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为78.9%、82.3%、82.5%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。2名医师采用MRI诊断内、外侧半月板后根部撕裂的一致性均好,Kappa值分别为0.81和0.67。结论 :膝关节MRI诊断内外侧半月板后跟部撕裂及其伴随征象具有较大价值,为临床医生术前诊断提供依据,值得临床推广应用。     

关节镜下肩袖缝线过线器捆扎缝合半月板撕裂伤疗效观察

目的:探讨采用肩袖缝线过线器进行关节镜下半月板撕裂捆扎缝合的临床疗效。方法:自2015年7月至2019年5月采用关节镜下肩袖缝线器捆扎缝合半月板撕裂损伤患者40例,其中男27例,女13例;年龄20～55(36.0±1.4)岁。观察术后并发症情况,术前及术后12个月采用Lysholm膝关节评分标准评价临床疗效,采用疼痛视觉模拟评分(visual analogue scale,VAS),膝关节屈伸活动范围评估疼痛与功能恢复情况。结果:所有患者获得随访,时间12～15(12.6±0.7)个月。未出现关节积液、缝合失效等并发症。2例患者末次随访时膝关节存在轻度疼痛,但临床查体无异常;1例患者中度疼痛合并关节间隙局部按压痛,其余患者均无异常。Lysholm膝关节评分由术前的(49.55±1.21)分提高到术后12个月的(98.95±0.42)分,VAS评分由术前的(5.18±0.78)分降至术后12个月的(1.03±0.77)分,膝关节屈伸活动范围由术前的(50.63±9.20)°提高到术后12个月的(130.38±4.99)°,差异有统计学意义(P0.05)。结论:关节镜下使用肩袖缝线过线器捆扎缝合适用于大部分的半月板损伤,包括内侧半月板后角撕裂,及外侧半月板体部、后角撕裂。此项技术解决了缺乏专用半月板缝合器情况下的半月板全内缝合需求,且具有手术操作方便,并发症少,术后功能好等优点。     

Altered signal intensity in the posterior horn of the medial meniscus: an MR finding of questionable significance

Introduction MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee. However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface. This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention. The aim of this study was to investigate the occurrence of such borderline findings in relation to the posterior horn of the medial meniscus and to correlate the arthroscopic results.Materials and methods Sixty-four patients with suspected post-traumatic internal derangements of the knee who underwent MR imaging prior to arthroscopy were evaluated retrospectively. There were 48 men and 16 women. Their mean age was 28.2 years.Results Tears of the posterior horn of the medial meniscus were diagnosed unequivocally (grade 3 signal) in 18 patients and equivocally (grade 2/3 signal) in 10 patients. Arthroscopic correlation revealed 16 tears (89%) in the unequivocal group and only 1 tear (10%) in the equivocal group.Conclusion A meniscal tear is unlikely when MR shows a focus of high signal intensity in the posterior horn of the medial meniscus that does not unequivocally extend to involve the inferior or superior joint surface. An appropriate trial of conservative treatment is recommended in such questionable cases. MR is a useful diagnostic tool—however, it should be used selectively, and in conjunction with history and clinical examination in evaluating internal derangements of the knee.     

Arthroscopic All-Inside Repair of Tears of the Anterior Horn of the Lateral Meniscus

Presently, the outside-in or inside-out meniscal repair techniques are recommended for the repair of tears of the anterior horn of the lateral meniscus. However, an incision about 1 to 2 cm or more in length is needed, and the biomechanics of the lateral meniscus may be altered during motion. We have developed a new alternative repair technique to prevent this skin incision and preserve the normal biomechanics of the lateral meniscus during motion. We use 3 portals: a lateral patellofemoral axillary portal, a standard anterolateral portal, and an extreme far medial portal. We perform all-inside repair for tears of the anterior horn of the lateral meniscus using suture hooks.