Arthroscopic all-inside repair techniques of lateral meniscus anterior horn tear: a technical note

Although the conventional outside-in technique is especially useful for repairing tears in the anterior portion of the meniscus, it has a disadvantage of making an additional 1–2 cm sized skin incision and tying knots subcutaneously over the capsule. Therefore we devised two all-inside repair techniques of lateral meniscus anterior horn tear according to the site of meniscal tear, meniscosynovial junction or red–red zone. Because 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 techniques as an alternative method for repairing an anterior horn tear of the lateral meniscus.     

All-inside versus inside-out meniscal repair: A systematic review and meta-analysis

BackgroundMeniscal repair using all-inside devices has garnered popularity compared to inside-out repair, yet few studies directly compare the two techniques in terms meniscal healing rates, surgical time, patient outcomes and incidence of complications.MethodsA systematic literature review was performed using the Medline, Cochrane and Embase databases. English-language studies comparing all-inside and inside-out arthroscopic meniscal repair techniques directly were included. Randomised controlled trials (RCTs) and observational studies with at least 10 patients in each treatment arm were included. Meta-analyses were performed using a fixed effect (when I2 < 50%) or random effects model (I2 ≥ 50%).ResultsA total of 1042 studies were identified with seven being sui for inclusion (n = 505 patients). These comprised of one RCT two prospective and four retrospective, comparative, observational studies. Meta-analyses demonstrated that there was a significant reduction in operating time favouring all-inside repair (ratio of means [ROM] 0.62, 95% confidence interval [CI] 0.48–0.79; p = 0.0002) based on 3 studies (n = 208 patients). Based on 5 studies (n = 370 patients), there was no significant difference in meniscal healing rates between the groups (OR 1.26, 95% CI 0.52–3.10; p = 0.61). Nerve injury was more common after inside-out repair. There was a 85% reduction in the odds of nerve injury with the all-inside technique (OR 0.15, 95% CI 0.05–0.47; p = 0.0013). A qualitative data analysis suggested no difference in functional outcomes between the two techniques.ConclusionsAll-inside meniscal repair is associated with reduced operative time and a lower odds of nerve injury complications compared to inside-out repair, without compromising meniscal healing or functional results.     

Arthroscopic patella realignment: An all-inside technique

Purpose: Many methods of realigning the patella have been described. Most techniques for proximal realignment involve an open medial reefing or advancement of the vastus medialis obliquus. Arthroscopically assisted methods have been described, but these all involve the need for a medial incision to tie sutures. This article describes an entirely arthroscopic technique for proximal realignment that eliminates the need for an incision, and reports the 2-year follow-up results using this technique. Type of Study: Retrospective review. Methods: Over a 5-year period, 26 patients (29 knees) with patellar instability were treated with an outpatient arthroscopic all-inside medial reefing and lateral release. Arthroscopic reefing was performed by percutaneous passage of suture followed by arthroscopic retrieval and knot tying inside the joint. Before knot tying, a healing response was initiated along the medial retinaculum by either gentle shaving with a whisker blade or by radiofrequency thermal response. Rehabilitation consisted of 1 week of immobilization followed by an accelerated program of range of motion exercises and vastus medialis obliquus strengthening. Results: At follow-up, 93% of patients reported significant subjective improvement. The average Lysholm score improved from 41.5 to 79.3 (P < .05). Preoperative and postoperative radiographs were measured for congruence angle, lateral patellofemoral angle, and lateral patella displacement, and all showed significant improvement postoperatively (P < .05). There were no complications and no redislocations. Patients reported a significant improvement in pain, swelling, stair climbing, crepitus, and ability to return to sports (P < .05). Conclusions: Arthroscopic patella realignment is a viable technique that offers results comparable or superior to published results for open or arthroscopically assisted realignment.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 940–945     

Suturing Complete Radial Tears of the Lateral Meniscus

Lateral meniscus (LM) with complete radial tear (CRT) is common in patients with acute anterior cruciate ligament (ACL) injury. We have been approximating unstable LM CRT in an all-inside suture fashion. We report 3 cases of complete healing of such a torn meniscus on second-look arthroscopy. We recommend approximation of the displaced CRTs of the LM whenever possible because we expect improved healing with this approach. Surgically, the arthroscope is placed into the anteromedial portal and the suture hook into the anterolateral portal with the knee in figure-of-4 position. A suture hook loaded with Ethilon No. 1 (Ethicon, Somerville, NJ) is introduced into the anterolateral portal, and vertical penetration to a single end of the torn LM is achieved. The Ethilon is pushed out until the far-end limb is almost exhausted. The suture hook is removed from the portal, with caution taken not to pull out the penetrated limb from the meniscus. A universal cannula is introduced, and the leading limb is grasped and pulled out. The Ethilon is used as a shuttle relay and is changed to polydioxanone (PDS) II. The suture hook is reintroduced, and the other torn end is penetrated in the same fashion. With complete suture to both meniscal sides, 2 suture limb ends are pulled out, and arthroscopic tying (SMC knot) is performed.     

Arthroscopic medial meniscal repair with or without concurrent anterior cruciate ligament reconstruction: A subgroup analysis

Background

There are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction.

关节镜下全内缝合法修补半月板53例疗效观察

目的探讨关节镜下全内缝合法在半月板修补中的应用及临床疗效。方法对53例半月板损伤患者采用全内缝合法进行半月板修补。其中采用可吸收半月板箭5例,Fast—Fix全内半月板缝合系统48例。对患者进行术后6～12个月的随访,随访时进行Lysholm评分、主观症状及查体检查。结果53例患者获得随访,Lysholm评分,术前（47．26±14．58）分,术后（90．31±17．63）分,手术前后差异有统计学意义（t=-13．6993,P〈0．01）。患者临床表现：无交锁复发,膝关节无疼痛,无内侧与后外侧关节间隙压痛,研磨挤压试验阴性。术后未见神经、血管或肌腱损伤的并发症,未见感染病例。结论关节镜下全内缝合法是修补半月板损伤的理想方法,其操作简单,并发症少,疗效确切,治愈率高。     

All-Inside Meniscus Repair

Purpose of ReviewThe indications for partial meniscectomy are becoming increasingly limited, and recent evidence suggests that the meniscus should be preserved whenever possible. Because of its many proposed advantages, all-inside meniscus repairs are becoming increasingly common. This review discusses the indications, advantages, disadvantages, and biomechanical and clinical outcomes of all-inside meniscus repair.Recent FindingsAll-inside meniscus repair demonstrates equal functional outcomes, healing rates, and complications compared to inside-out repair of vertical longitudinal and bucket-handle tears with the advantages of decreased surgical time and faster post-operative recovery. In addition, return-to-sport and activity levels are high following all-inside repair regardless of whether concomitant anterior cruciate ligament reconstruction is performed. Biomechanical studies have demonstrated advantages of all-inside meniscal based repairs on radial and horizontal tears.SummaryAll-inside meniscus repair compares favorably to inside-out repair of vertical longitudinal and bucket-handle tears and continues to increase in popularity. Both capsular based and meniscal based repairs can be used to repair a variety of tear patterns. While biomechanical results are encouraging, further research on the clinical outcomes of meniscal based repairs is needed to elucidate the role of these techniques in the future.     

All-inside anterior cruciate ligament reconstruction using semitendinosus tendon and soft threaded biodegradable interference screw fixation

A modification of anterior cruciate ligament (ACL) reconstruction using a minimally invasive and endoscopic all-inside technique is presented. Both the femoral and tibial socket are approached through the joint so that there is no open tibial tunnel, which otherwise often causes significant pain and discomfort during early rehabilitation. The autologous semitendinosus tendon is harvested with a bone plug attached to its tibial insertion. The triple-stranded semitendinosus tendon is looped around the adjacent bone plug and fixed at the original tibial attachment site of the ACL using a soft threaded biodegradable poly-(D,L-lactide) interference screw. The screw is inserted endoscopically in an inside-out direction. In the femoral socket the graft is fixed without a bone plug directly to the tunnel wall using the biodegradable screw. The free part of the graft is thus not longer than the intra-articular distance, which may increase stiffness of the construct.