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. 2017 Aug 14;6(4):e1329-e1333.
doi: 10.1016/j.eats.2017.05.016. eCollection 2017 Aug.

Horizontal Cleavage Meniscus Tear Treated With All-inside Circumferential Compression Stitches

Jarret M Woodmass  1 , Joshua D Johnson  1 , Isabella T Wu  1 , Daniel B F Saris  1   2   3 , Michael J Stuart  1 , Aaron J Krych  1
Affiliations

Horizontal Cleavage Meniscus Tear Treated With All-inside Circumferential Compression Stitches

Jarret M Woodmass et al. Arthrosc Tech. .

Abstract

Horizontal cleavage meniscus tears are a common orthopedic injury often treated with partial or total meniscectomy versus repair. This Technical Note presents a technique for all-inside repair with uniform compression of the superior and inferior leaflets by placement of multiple circumferential compression stitches using an all-inside self-retrieving suture passing device. The currently described technique provides several advantages for all-inside repair of a horizontal cleavage tear: (1) eliminates the need for a posterior incision, (2) minimizes the risk of neurovascular injury, (3) uses standard arthroscopy portals (or small modifications), and (4) requires only a single suture deployment with a self-retrieving device for each circumferential compression stitch. The resulting circumferential stitch provides uniform compression to the superior and inferior leaflets, promoting meniscal healing. This configuration has been shown to have the highest load to failure of all repair patterns.

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Figures

Fig 1
Fig 1
Arthroscopic image viewed from the anterolateral portal showing a horizontal tear of the left medial meniscus after mechanical stimulation (rasping) to promote bleeding for biologic augmentation.
Fig 2
Fig 2
Arthroscopic images of the medial compartment of a left knee. An anterolateral viewing portal shows placement of a circumferential compression stitch using the Ceterix Novostitch device through an anteromedial working portal. (A) The upper jaw is placed over the superior aspect of the meniscus and advanced to the meniscocapsular junction. (B) The lower jaw is advanced under the inferior leaflet of the meniscus tear. (C) After the suture has been passed through the meniscus with free limbs superior and inferior to the meniscus tear. (D) After the 2 suture limbs have been tied arthroscopically forming a circumferential compression stitch.
Fig 3
Fig 3
Arthroscopic images of a medial meniscus horizontal cleavage repair in a left knee. (A) Viewing is from the anterolateral portal using the anteromedial portal for instrument passage while repairing the posterior third of the medial meniscus. (B) Viewing is from the anteromedial portal using the anterolateral portal for instrument passage while repairing the mid-body of the meniscus.
Fig 4
Fig 4
Arthroscopic image viewing from the anteromedial portal with the probe inserted from the anterolateral portal showing repair of a horizontal cleavage meniscus tear in a left knee using circumferential compression stitches.
Fig 5
Fig 5
Schematic image showing the concept of circumferential compression stitch fixation for the treatment of a horizontal cleavage meniscus tear.
See this image and copyright information in PMC

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