Arthroscopic all-inside lateral meniscus suture using posterolateral portal

Abstract

A new arthroscopic all-inside suture for lateral meniscus posterior horn tear using a single posterolateral portal is described. A lateral meniscus posterior horn peripheral longitudinal tear is often seen with anterior cruciate ligament injury or discoid lateral meniscus tear. Conventional repair methods, such as arthroscopic inside-out, outside-in, or all-inside sutures, can be cumbersome and technically demanding. Our all-inside suture using the posterolateral portal allows thorough visualization of the posterolateral structures, excellent coaptation of torn meniscus, strong knot tightening, and avoidance of inadvertent cartilage injury. The arthroscope is inserted through the anteromedial portal and reaches the posterolateral compartment by a transcondylar approach. A suture hook is introduced into the posterolateral portal without a cannula, penetrates posterior peripheral rim, crosses the tear, and passes through mobile torn fragment. A large amount of No. 0 PDS is passed, so that it curls up inside the joint. After the suture hook is removed, a suture retriever is inserted through the posterolateral portal to pull out 2 ends of the PDS at the same time. The retrieved suture ends are passed through a knot pusher and a 5.5-mm cannula is introduced over the retrieved suture materials for the SMC knot to be tied. A longitudinal tear of lateral meniscus posterior horn is repaired with 2 to 3 sutures.