The "cruciate suture" for arthroscopic meniscal repair: a new technique

Abstract

Meniscal repair has become the treatment of choice whenever a reparable tear is diagnosed. Fixation strength of the repair technique is always of paramount importance in comparison of various techniques, especially after the evolution of many arthroscopic all-inside devices. We present a new arthroscopic meniscal repair suturing technique called "cruciate suture." One 18-gauge needle and suture material are used. The needle is loaded with the suture material from its tip. The suture is folded at the tip of the needle, which is inserted to penetrate the skin obliquely to appear inside the joint, making a loop. The needle is retracted, while the suture is kept inside of it. The needle is reinserted at the same hole, appearing inside the joint and making a second loop. The needle is retracted completely. With the use of a probe, the loop at the second point is pulled through the loop at the first point, thereby forming a free end. The 2 limbs of the loop are pulled, thus driving the limb with the free end outside of the joint. The first oblique vertical suture is completed at this point. The needle is reloaded by the suture limb from the first point. The previous procedure is repeated, with use of the second skin hole and the third and fourth points to make the second oblique vertical suture. The cruciate suture is now complete. We tested the ultimate tension load (UTL) of the cruciate suture in comparison with that of the vertical suture (the gold standard). A total of 36 tests (18 for the cruciate suture and 18 for the vertical suture) were performed on human menisci. The mean UTL of the cruciate suture was measured at 110 N; the mean UTL of the vertical suture was 67 N.