All-Inside Lateral Meniscal Repair via Anterolateral Portal Increases Risk of Vascular Injury: A Cadaveric Study

Mao, David Weijia; Upadhyay, Upasana; Thalanki, Srikiran; Lee, Dave Yee Han

doi:10.1016/j.arthro.2019.07.023

Cited by 22 publications

(24 citation statements)

References 21 publications

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“… 8 Moreover, during the repair of the posterior horn of LM with a meniscal repair device, the popliteal vessels are reported to be at an increased risk of injury. 10 This risk may be minimized by the repair of meniscal tear with a conventional suture since a surgeon, during this procedure, maintains superior control of the extent of punctured tissues. As presented, the nonabsorbable ETHIBOND EXCEL suture is favored over the PDS suture.…”

Section: Discussionmentioning

confidence: 99%

You Can Repair More Tears Than You Think—Tricks for All-Inside Lateral Meniscal Repair With Nonabsorbable Sutures

Malinowski¹,

Ebisz

Góralczyk³

et al. 2020

Arthroscopy Techniques

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Since the role of the menisci has been better understood, there is a trend toward the meniscal repair rather than meniscectomy in the management of meniscal tears. Although numerous techniques of meniscal repair have been described and many authors advocate for and against each of them, no single method is universally accepted. The allinside repair provides several advantages, such as a lower risk of neurovascular injury, the early introduction of exercises in passive range of motion, or the high strength of the repair. However, the all-inside meniscal repair with nonabsorbable suture is considered to be a technically demanding procedure with a long learning curve needed to perform it properly. The purpose of this Technical Note is to present the technique of lateral meniscus repair with nonabsorbable sutures and to provide surgical pearls to facilitate this procedure.

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Section: Discussionmentioning

confidence: 99%

You Can Repair More Tears Than You Think—Tricks for All-Inside Lateral Meniscal Repair With Nonabsorbable Sutures

Malinowski¹,

Ebisz

Góralczyk³

et al. 2020

Arthroscopy Techniques

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“…The all-inside device for posterior repairs must not be inserted from the anterolateral portal. The popliteal artery was found to be only 4.7 ± 2.3 mm and popliteal vein 6.7 ± 2.9 mm from the device needle in a cadaveric experiment by Mao 46 . Massey et al recommended insertion of these repair devices from an anteromedial or a transpatellar portal because of the lowest risk of neurovascular penetration 47 .…”

Section: Lateral Meniscus Longitudinal Tearsmentioning

confidence: 94%

Lateral Meniscus Tears in Acl Injured Knee

Tapasvi¹

2021

Hip Knee J.

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Anterior cruciate ligament (ACL) tears can be associated with injuries to the lateral meniscus (LM) in about 20-30% cases. The lateral meniscus is more mobile than the medial and besides contributing to load transmission, it also stabilizes the knee in pivot-shift testing. The LM tears more often in the acute setting and its incidence does not rise in cases of chronic ACL instability. Lateral meniscus tears can be minor or major depending how severely the knee function gets impaired. Major tears are the complete radial tears, longitudinal bucket handle tears and posterior root tears. Male gender, high body mass index and contact injury mechanism are all risk factors for an LM tear. Anatomic factors which can contribute to LM tears include a high posterior tibial slope, varus malalignment and greater asymmetry between medial and lateral slopes. The lateral meniscus must be saved and repaired whenever possible to prevent residual knee instability and progressive lateral compartment arthritis, which can set in soon after a meniscectomy. The development of techniques and technology have rendered most tears amenable to repair. Longitudinal tears can be repaired by the all-inside or inside-out technique and the needles and devices must be inserted through a high anteromedial or transpatellar portal to prevent injury to the popliteal neurovascular structures. A lateral safety incision must always be used for inside-out repairs. Radial tears can be repaired by two horizontal sutures, a cross stich, a cross-tag or a hash-tag suture configuration. Lateral meniscus posterior root repairs are repaired by transtibial technique, either by drilling an independent anatomic tunnel or the sutures pulled out via the ACL tibial tunnel. The lateral meniscus has high healing rates and repairs yield improvement in functional outcome, beside delaying radiographic arthritis.

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“…Ideal viewing of the lateral meniscus should be from an anterolateral portal with FAST-FIX 360 all-inside meniscal repair device entry guided by a slotted cannula ( Fig 1 ) via an anteromedial portal to reduce the risk of vascular injury. 6 There may sometimes be a requirement for the meniscal repair device to be introduced from the anterolateral portal for optimal stitch placement. This brings the tip of the repair device closest to the posterior vascular structures; therefore, the surgeon must be cognizant of the depth setting in relation to stitch placement to reduce the risk of vascular injury ( Table 1 ).…”

Section: Surgical Techniquementioning

confidence: 99%

All-inside Techniques for Meniscal Radial Root Tear Repair

Mao

Lee

2020

Arthroscopy Techniques

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Meniscal radial root tears can disrupt the load-bearing function of the meniscus and worsen instability in anterior cruciate ligament–deficient knees. Paracentral radial tears adjacent to the root (types 1, 2, and 4) repaired with a transtibial pullout suture technique can lead to over-medialization of the meniscal root and a high-tension nonanatomic repair. We propose 2 all-inside techniques for anatomic repair of medial and lateral meniscal radial root tears with (1) an all-inside meniscal repair device and (2) an antegrade suture passer. We present the technical requirements and tips for these techniques. For lateral meniscal radial root repair with an all-inside meniscal repair device, ideal viewing is from an anterolateral portal with device entry from an anteromedial portal to reduce the risk of vascular injury. We recommend at least 2 stitches across the tear, with the depth setting limited to 18 to 20 mm for a central stitch and 16 mm or less for a peripherally placed stitch. For root repair with an antegrade suture passer, viewing should be from an anteromedial portal with the passer entering from an anterolateral portal. At least 2 stitches should be placed across the tear, with 1 central and 1 peripheral or 1 superior and 1 inferior.

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All-Inside Lateral Meniscal Repair via Anterolateral Portal Increases Risk of Vascular Injury: A Cadaveric Study

Cited by 22 publications

References 21 publications

You Can Repair More Tears Than You Think—Tricks for All-Inside Lateral Meniscal Repair With Nonabsorbable Sutures

You Can Repair More Tears Than You Think—Tricks for All-Inside Lateral Meniscal Repair With Nonabsorbable Sutures

Lateral Meniscus Tears in Acl Injured Knee

All-inside Techniques for Meniscal Radial Root Tear Repair

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