Transosseous Posterior Meniscal Root Reinsertion Using Knotless Anchor for Tibial Fixation

Abstract

A technique for posterior meniscal root reinsertion is presented. With the arthroscope in the central transtendinous portal for a better view, a 5-mm transtibial tunnel is created with the aid of an anterior cruciate ligament guide open to 45°. A suture device, which consists of a long needle with an eyelet on its tip, is introduced through the tunnel with a suture thread inserted through the eyelet, while the meniscus is stabilized with a grasper inserted through the anterior portal. The meniscus is pierced with the device, and the suture thread is recovered with said grasper. A finger-tip pincer is inserted through the tunnel to recover the thread. The same procedure is followed to perform a second stitch. A lasso loop is made for both stitches, and the resultant tails are knotted to a knotless suture anchor, which is inserted in the anterior cortex of the tibia, 1 cm distal to the extra-articular end of the tibial tunnel.

Initial Biomechanical Properties of Transtibial Meniscal Root Repair are Improved By Using a Knotless Anchor as a Post-Insertion Tensioning Device

“…Another work compared an in-situ suture anchor repair and a transtibial technique with sutures tied over a titanium plate in a porcine model 10 In the transtibial pullout repair, the mean permanent displacement registered after 1000 cycles of a [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] N load was 2.2 mm with the transtibial technique. Again, notorious methodological dissimilarities difficult contrast of the result with our study.…”

“…A 5 mm tunnel was drilled from the anterolateral tibial epiphysis to the posterior root insertion site 4 . Two ultra-resistant N. 2 sutures (Force Fiber ™ , Stryker, Endoscopy, San José CA) were applied in a two-simple-stitch fashion, an easy suturing method previously used by our group 13,16 with proven potential to resist displacement, which is widely used 18 . A simple meniscal suture device previously used for transtibial pullout repairs 16,19 was loaded with one suture and passed through the tunnel in an outside-in manner to pierce the meniscus.…”

“…In transtibial repair techniques, sutures are frequently fixed by tying them over a cortical button or a post at the distal end of the bone tunnel exit. Some works have recently described the use of knotless anchors to secure the sutures at the distal exit of the tunnel 16,17 . However, available suture anchors are routinely used for attachment of soft tissue to bone in shoulder procedures; the adequacy of its use for transtibial meniscal root refixation should be assessed.…”