Vertical Lasso and Horizontal Lasso Sutures for Repair of Horizontal Cleavage and Horizontal Oblique Meniscal Tears: Surgical Technique and Indications

Abstract

Horizontal cleavage and horizontal oblique meniscal tears have traditionally been treated with partial meniscectomy. Recent research has shown the deleterious long-term effects of meniscectomy in these patients regarding the development of osteoarthritis. Meniscal preservation is thus the preferred method of surgical treatment in patients with these tears. However, traditional repair techniques using inside-out sutures or suture anchor–based devices do not address the horizontally aligned nature of these particular tears and thus do not compress the meniscal tissue in the correct plane. The recent development of an arthroscopic suture-passing system now allows surgeons to place arthroscopic sutures in any pattern or direction. This allows surgeons to treat tears of any type with sutures ideally placed to repair the given tears. This Technical Note describes and demonstrates 2 all-suture, all-inside, arthroscopic meniscus repair techniques to treat these challenging horizontal tear types. The repair techniques are named the vertical lasso and horizontal lasso.

More Is Not Merrier: Increasing Numbers of All-Inside Implants Do Not Correlate with Higher Odds of Revision Surgery

“…Grant et al demonstrated that, compared to inside-out repairs, all-inside implants show higher amounts of soft tissue irritation, swelling, implant migration, and in the case of older generation all-inside implants, more chondral injury 29 . This may be due to the nature of the all-inside repair implants used, which include buttons or anchors on either the superior or inferior surface of the meniscus, which may lead to complications if recognized as foreign bodies on the outside of the knee joint 49 . All-inside devices, such as the FasT-Fix™, Fast-Fix 360™ (Smith & Nephew, Andover, MA, USA), Linvatec Zone-Specific II™ (Conmed, Largo, FL) which were used in this study, and Meniscal Cinch™ (Arthrex, Naples, FL, USA), This article is protected by copyright.…”

“…29 This may be due to the nature of the all-inside repair implants used, which include buttons or anchors on either the superior or inferior surface of the meniscus, which may lead to complications if recognized as foreign bodies on the outside of the knee joint. 49 All-inside devices, such as the FasT-Fix, Fast-Fix 360 (Smith & Nephew, Andover, MA), Linvatec Zone-Specific II, which were used in this study, and Meniscal Cinch (Arthrex, Naples, FL), often employ nonabsorbable braided sutures typically ranging from No. 0 to No.…”

Horizontal Cleavage Meniscus Tears

“…In HCT cases complicated with additional tears, such as a vertical longitudinal tear, the utilization of the vertical lasso can be implemented. In this technique, compression of the leaflets is achieved through peripheral followed by central passage of suture in the meniscus, which creates a vertical pattern that effectively closes the "fish mouth" deformity 51 .…”

“…In the anterior aspect of the knee, sutures are thrown from the superior leaflet capsule to the inferior leaflet capsule in a vertical mattress fashion and tied externally over the capsule. Regarding spacing, sutures are placed at 3 to 5-mm intervals for optimal coaptation of the leaflets and prevention of fluid leaking into the tear site, which could affect healing 50,51 .…”

Repair of a Horizontal Cleavage Tear of the Lateral Meniscus with Circumferential Compression Stitches and Marrow Venting Augmentation

“…Circumferential compression suture configurations have demonstrated an ability to create stable HCT repairs with uniform compression across the torn leaflets, unlike conventional all-inside anchor-based devices, which fail to compress the leaflets together. 4 , 10 Additionally, augmentation with marrow venting has demonstrated the ability to improve HCT repair clinical outcomes. 11 , 12 Thus, the purpose of this article is to outline our technique for repair of a HCT of the lateral meniscus using an all-inside suture passing device to place circumferential compression sutures followed by subsequent biologic augmentation of the repair using an MVP ( Video 1 ).…”