Arthroscopic all-inside repair of anterior horn tears of the lateral meniscus using a spinal needle

Several techniques have been used for the arthroscopic repair of anterior horn tears of the lateral meniscus. A commonly used method is the outside-in technique. This technique is known to be the most appropriate and safest technique for peripheral tears of the anterior horn of the lateral meniscus. But it has the disadvantage of making an additional 1-2 cm sized skin incision and tying knots subcutaneously over the capsule. Irritation may also occur. We have developed a new alternative repair method to prevent this skin incision and preserve the normal biomechanics of the lateral meniscus during motion. These techniques are modified methods of the outside-in meniscal repair using a spinal needle. They are as simple as conventional outside-in technique. In addition, they have advantages of vertical mattress suture, which is an important characteristic of the all-inside repair, and no additional incision. We recommend these methods as an alternative technique for repairing an anterior horn tear of the lateral meniscus.     

Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note

This technical note describes a new arthroscopic technique to repair a tear of posterior root of the medial meniscus. Cartilage at the insertion area of the posterior horn of the medial meniscus (PHMM) was removed using a curved curette inserted through an anteromedial portal. A metal anchor loaded with two FiberWires (Arthrex, Naples, FL) was placed at the insertion area of the PHMM through a high posteromedial portal. A PDS suture was passed the PHMM by curved suture hook through the anteromedial portal. Two limbs of the PDS were then used to pass two limbs of the FiberWire through the meniscus. The same procedure was repeated for the second FiberWire suture. The sutures were tied, achieving secure fixation of the posterior meniscal root at the anatomic insertion.     

Arthroscopic all-inside repair of Palmer type 1B triangular fibrocartilage complex tears: a technical note

Arthroscopic repair of peripheral dorso-ulnar triangular fibrocartilage complex (TFCC) lesions is now a preferred method. Both outside-in and inside-out techniques are commonly performed for repairing Palmer type 1B TFCC tear. But these techniques have disadvantages of making an additional skin incision to tie knots subcutaneously over the capsule. We performed an arthroscopic all-inside repair technique of Palmer type 1B TFCC tears, which is a modified method of the outside-in technique using a spinal needle. This all-inside technique is as simple as previously described arthroscopic techniques and also has advantages of vertical mattress suture and no additional incision. We recommend this technique as a useful alternative to the others for repairing Palmer type 1B TFCC tear.     

半月板桶柄样撕裂关节镜下行缝合修补术疗效分析

目的探讨关节镜下半月板缝合修补术在半月板桶柄样撕裂(bucket-handle tear,BHT)中的治疗价值。方法 2014年4月—2017年4月陕西省第四人民医院收治90例BHT患者,根据随机数字表法将其分成关节镜下修补组、部分切除组各45例。部分切除组行半月板部分切除术,男性26例,女性19例;年龄18～56岁,平均32. 91岁;左膝25例,右膝20例;致伤原因:道路交通伤19例、运动伤21例、其他5例。关节镜下修补组行关节镜下半月板缝合修补术,男性27例,女性18例;年龄18～59岁,平均34. 29岁;左膝28例,右膝17例;致伤原因:道路交通伤17例、运动伤21例、其他7例。两组均上门随访12个月,在末次随访时评估愈合情况。利用Lysholm评分系统评估患者术前、末次随访时膝关节功能变化,并经MRI检查分析术前、术后6个月、末次随访时的膝关节活动度,观察术后并发症发生率。结果关节镜下修补组治愈率为97. 78%,较部分切除组的95. 56%差异无统计学意义(P> 0. 05)。关节镜下修补组末次随访时Lysholm评分高于部分切除组,差异有统计学意义(P <0. 05)。关节镜下修补组膝关节活动度术后6个月(133. 92±3. 65)°、末次随访时(142. 56±5. 46)°大于部分切除组(124. 63±3. 27)°、(135. 38±5. 13)°,差异有统计学意义(P <0. 05)。关节镜下修补组并发症发生率为4. 44%,较部分切除组的13. 33%差异无统计学意义(P> 0. 05)。结论关节镜下行半月板缝合修补术能促进膝关节功能恢复,改善膝关节活动度,并发症发生率低,值得临床推广。     

Locking knee caused by subluxation of the posterior horn of the lateral meniscus

The authors report a case of repetitive locking knee caused by a subluxation of the posterior horn of a normal lateral meniscus. The posterior horn was sutured to the posterior knee capsule and the athlete resumed complete sports activity 4 months after the surgery.     

膝板股韧带附着区外侧半月板后角撕裂的MRI表现及诊断价值

目的 探讨膝板股韧带附着区外侧半月板后角（PHLM）撕裂的MRI表现及鉴别诊断价值。 方法 选取2012年12月至2018年6月因前交叉韧带（ACL）损伤在南通市通州区中医院就诊的35例膝板股韧带附着区PHLM撕裂患者作为观察组,搜集同期30例ACL损伤但非PHLM撕裂患者作为对照A组,另选取同期例行体检的30名健康者作为对照B组。3组受试者均行膝关节MRI检查,观察3组受试者的MRI表现。分别应用χ 2检验、单因素方差分析和t检验分析膝关节MRI征象的发生率、膝关节周围结构的损伤情况及膝关节线状高信号影显示的层数和长度,并采用受试者工作特征（ROC）曲线分析鉴别诊断PHLM真、假性撕裂的效能。 结果 观察组患者在MRI矢状面和横断面图像上均表现为明显的PHLM周缘部线状高信号,矢状面上可连续检出（5.75±1.38）层（称“连续线征”）,横断面上自内向外延伸（15.06±5.02）mm（称“拉链征”）,与对照A组、B组比较差异均有统计学意义（F=43.231、36.113,均P<0.05）。以“连续线征”和“拉链征”作为阳性标准,MRI诊断膝板股韧带附着区PHLM撕裂的灵敏度为85.71%、特异度为95.00%、准确率为91.58%。 结论 膝板股韧带附着区PHLM撕裂在MRI上有明显的征象,辅以“连续线征”和“拉链征”进行鉴别诊断,可明显提升诊断效果。     

Arthroscopic meniscal repair: a comparative study between three different surgical techniques

The purpose of this prospective study was to evaluate and compare the results of arthroscopic meniscal repair using three different techniques. Between January 2002 and March 2004, 57 patients who met the inclusion criteria underwent an arthroscopic meniscal repair. The outside-in technique was used in 17 patients (group A), the inside-out in 20 patients (group B), while the rest of the 20 patients (group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All meniscal repairs were considered healed according to our criteria in group A, while 19 out of 20 repairs (95%) healed in group B. Finally 7 of 20 repairs (35%) were considered failures in group C and this difference was statistically significant in comparison with other groups. The time required for meniscal repair averaged 38.5 min for group A, 18.1 min for group B, and 13.6 min for group C. Operation time for meniscal repair in group A was statistically longer in comparison with other groups. There were no significant differences among the three groups concerning complications. According to our results, arhtroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time.Presented at the 11th ESSKA 2000 Congress, Athens, Greece, 2004     

Arthroscopic reduction and internal fixation of an avulsion fracture of the posterior horn of the lateral meniscus

We report a very rare case of an avulsion fracture of the posterior horn of the lateral meniscus associated with ACL tear, which was successfully treated by arthroscopic reduction and pullout fixation of the fragment along with ACL reconstruction.     

Arthroscopic management of the postero-medial or postero-lateral capsule tear in the knee joint: technical note

We describe the arthroscopic management of the posterior capsule tear using posterior trans-septal portal. This technique is usually used in acute cases where a torn capsule is found but we can also use this technique for reefing of stretched capsule by refreshing the injured capsule. When arthroscopic ligament reconstruction accompanies postero-medial or postero-lateral capsular insufficiency, using the posterior trans-septal portal could ensure better visualization of the capsule and a subsequent more accurate management of the capsule. Since it is helpful in lessening the instability, it could contribute to achieving successful clinical results although this is not a mighty procedure.     

“All-inside” arthroscopic meniscus repair

The arthroscopic “all-inside” meniscus suturing technique offers the arthroscopist a way of placing vertically oriented sutures through peripheral posterior horn tears located posterocentral without the risks of nerve, vessel, or posterior capsular entrapment inherent in both the “outside-in” and the “inside-out” arthroscopic methods. This technique introduces new instrumentation that allows the surgeon to both place sutures and tie suture knots intra-articularly under arthroscopic control.     

Modified cruciate suture technique for arthroscopic meniscal repair: a technical note

Arthroscopic meniscal repair is the procedure of choice whenever a reparable tear is diagnosed. The cruciate suture for arthroscopic meniscal repair is a type of the outside-in technique. It has advantages like: (1) its ultimate tension load (UTL) is 1.6 times higher than the UTL of the vertical suture (gold standard), (2) it holds the circumferential collagen fibers of the meniscus in a three-dimensional plane compared to the vertical and horizontal sutures which hold the circumferential fibers of the meniscus in a two-dimensional plane, (3) simple instrumentation, (4) could withstand not only distraction forces on the repaired meniscal tear but also, shear forces because of the oblique orientation of the cruciate suture limbs. It has disadvantages like: being difficult to perform and time-consuming. A modified technique is presented in this study which has the following advantages; (1) less time-consuming, (2) performed through a smaller skin incision, (3) a sliding knot is used to tie the cruciate suture.     

关节镜下同时修复重建前交叉韧带合并半月板损伤

目的　探讨关节镜下同时修复重建前交叉韧带 (ACL)合并半月板损伤的临床效果。方法　 4 8例患者全部在关节镜下完成ACL、半月板损伤的修复重建术。术前临床症状、体征包括 :膝关节行走痛 4 1例 ,膝关节不稳定感 36例 ,关节交锁史 8例 ,Lachman试验阳性 4 5例 ,前抽屉试验阳性 38例 ,外侧轴移试验阳性 2 4例。半月板损伤采用系列导管下特制长缝合针由内向外缝合法修复 ;ACL损伤修复采用半腱肌、股薄肌 ,闭合拉出微型钢板法重建 ,术后采用康复治疗。　结果　本组随访 13～ 6 5个月 ,平均 2 7个月。 1例剧烈活动后膝关节胀痛 ,2例活动受限 2 0° ,其余关节功能正常。Lyshlom膝关节评分 ,术前 5 8± 9,术后 95± 5 (P <0 .0 1)。　结论　关节镜下同时修复重建ACL、半月板损伤的疗效显著 ,值得推广。     

Arthroscopic repair of L-shaped tear of the anterior band of the inferior glenohumeral ligament complex in a pediatric patient: a technical note

The present study reports on a case of a 10-year-old patient with recurrent right shoulder instability after a traumatic event leading to a mid-substance tear of the anterior band of the inferior glenohumeral ligament complex in an L-shaped pattern. Arthroscopic repair consisting of a 2.4 mm bioabsorbable suture anchor at the apex and a four PDS sutures placed through the capsulolabral junction leads to an anatomic repair with excellent short-term results similar to those found in other studies. The injury pattern is thought to be about 1% of shoulder dislocations, but tear pattern recognition is critical for a successful repair and clinical result.     

The modified outside-in suture: vertical repair of the anterior horn of the meniscus after decompression of a large meniscal cyst

This article describes a modified suture technique designed for the vertical repair of the anterior horn of the meniscus after arthroscopic decompression of a large meniscal cyst. This procedure comprises of three steps: first, the meniscus was pierced vertically using a suture hook and a No. 0 PDS suture. Second, both ends of the No. 0 PDS on the femoral and tibial surfaces of the meniscus were pulled to the outside of the joint capsule using a spinal needle preloaded with suture material. Finally, a skin incision was made adjacent to the suture materials, and both ends were tied. We recommend this technique not only for the vertical repair of the anterior horn of the meniscus after decompression of large meniscal cyst, but also to repair a longitudinal tear of the meniscus.     

Radial tears in the root of the posterior horn of the medial meniscus

The purpose of this study is to define the clinical features and characteristics of radial tears in the root of the posterior horn of the medial meniscus and to report the outcome of arthroscopic treatment. Arthroscopic meniscus surgery was performed on 7,148 knees. Of those, 722 (10.1%) were radial tear in the root of the posterior horn of the medial meniscus. We reviewed the medical records from a random sample of 67 subjects studied (mean age 55.8 years, range 38-72, mean follow-up period 56.7 months, range, 8-123), which included surgical notes and detailed arthroscopic photographs of 70 knees. All patients were treated with arthroscopic partial meniscectomy. The age distribution, preoperative physical signs, results of magnetic resonance imaging , body mass index, and surgical findings of the study subjects were analyzed and the clinical results were graded with the Lysholm knee scoring scale and a questionnaire. Radiologic evaluation consisted of preoperative and at the latest follow-up radiographs. Eighty percent of the patients were older than 50 years, and 80.6% were either obese or morbidly obese. The mean Lysholm score improved from a preoperative value of 53 to a value of 67. The average preoperative Kellgren-Lawrence radiograph grade was 2 (range 0-3 points), a value that increased to 3 (range 2-4) at the latest follow-up, which showed a significant worsening. The preoperative MRI was reevaluated after the arthroscopic confirmation of a medial meniscal root tear. A tear could be demonstrated in only 72.9% of the patients, the rest of whom demonstrated degeneration and/or fluid accumulation at the posterior horn without a visible meniscal tear. Radial tears in the root of the medial meniscal posterior horn, which may not be visible in about one-third of the preoperative MRI scans, are common. That type of meniscal tear is strongly associated with obesity and older age and is morphologically different from the degenerative tears that often occur in the posterior horn. Partial meniscectomy provides symptomatic relief in most cases but does not arrest the progression of radiographically revealed osteoarthritis.     

A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal

A transection (root tear or complete radial tear) injury of the medial meniscus posterior horn is not rare in the oriental area and needs to be repaired to restore the hoop tension and to reduce the extruded meniscus, which leads to osteoarthritis of the knee. In cases with transection of the medial meniscus posterior horn, the meniscus can be repaired by a pull out suture technique. However, it is difficult to manipulate a suture hook and drill a tibial tunnel in the narrow medial joint space using the traditional anterior arthroscopic technique. This article describes a new pull out suture technique for transection of the medial meniscus posterior horn using a posterior trans-septal portal that provides a safe and wide field of vision. The handling of the suture hook and a guide may reduce the possibility of a chondral or meniscal injury.     

Arthroscopic appearances of the meniscofemoral ligaments: introducing the “meniscal tug test”

To evaluate the feasibility of identifying the anterior and posterior meniscofemoral ligaments (aMFL and pMFL, respectively) at arthroscopy, both visually and using the “meniscal tug test”, which exploits the anatomical attachments of the posterior cruciate ligament (PCL) and MFLs. This is an observational type of study. Arthroscopy using anteromedial and anterolateral portals was performed in 68 knees in 68 patients (36 right, 32 left). The MFLs were identified using several anatomical cues, including their femoral and meniscal attachments, their obliquity relative to the PCL, and the meniscal tug test. Identification was classed as easy or hard by the operating surgeon. From 68 knees, the aMFL was seen and confirmed to be an MFL using the tug test in 60 (88%). Identification of the aMFL was classed as easy in 64 (94%), whilst the pMFL was easy to identify in only 6 (9%) of knees, of which 3 had a ruptured PCL. Thus, with the exception of PCL-deficient knees, it was felt that the meniscal “tug test” as applied in this study was not suitable for the pMFL. The study shows that identification of the aMFL is possible in most knees at arthroscopy, using the “tug test” and other anatomical cues. However, identification of the pMFL may require a posterior portal. A subgroup of PCL injuries in which the MFLs were intact was also observed. The “meniscal tug test” can be used in arthroscopic examinations of the PCL to distinguish between fibres of the true PCL from the MFLs, thus avoiding the misdiagnosis of partial versus complete PCL rupture. This will also aid studies examining the role of the MFLs in stabilising the PCL-deficient knee.