All-inside Arthroscopic Meniscal Repair Technique Using a Midbody Accessory Portal

Abstract

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. The tear pattern and location present another layer of difficulty. The most widely used all-inside repair devices are harpoon-style devices and present their own challenges in using them without causing harm to the meniscus and surrounding cartilage. In this article, we describe a simple all-inside meniscal repair technique to improve the reproducibility and reliability of meniscal repairs using an accessory midbody meniscal portal and a surgical probe. This ensures proper placement of mattress sutures in a reduced meniscus, with a reduced risk of collateral injury to the meniscus and articular cartilage. Furthermore, this surgical technique is adaptable to any meniscal fixation method to the medial or lateral meniscus.

Meniscus tears and repair: assessing failure rates of all-inside and outside-in methods

“…It involves small incisions, carries a low risk of complications, and has a high success rate, especially for tears in the front two-thirds of the meniscus. 30 However, a downside to the outside-in method is the need for an extra 1-2 cm skin incision and tying knots under the skin over the capsule. 31 The "all-inside" technique is another option with good results, but it's not as commonly used because it can be expensive and sometimes lead to nerve or blood vessel issues.…”

“…The meniscus is sutured posteriorly to anteriorly with sequential superior and undersurface mattress sutures to recreate the normal position of the meniscus and reestablish the meniscal flounce sign. 30…”