All-Inside Suture Repair for Isolated Radial Tears at the Midbody of the Lateral Meniscus

Abstract

In young athletes, radial tear of the midbody on the semilunar lateral meniscus in stable knees is most common. Conventionally, for this type of tear, meniscectomy has been considered as a first-line treatment. However, meniscectomy does not prevent degenerative change. Therefore, repair is another treatment option for a full radial tear, though this type of tear can be difficult to repair because of the lack of a vascular supply. Compared with conventional transcapsular suture techniques (e.g., inside-out/outside-in techniques or all-inside techniques with implants), all-inside suture (AIS) repair techniques can avoid bunching of the meniscus to the capsule. AIS is considered suitable for restoration of normal structure and movement of the meniscus after repair, which can be advantageous for meniscal healing. However, AIS repair for an isolated radial tear at the midbody of the lateral meniscus has rarely been reported. Therefore, we applied the AIS repair technique for isolated radial tear at the midbody of the semilunar lateral meniscus using a QuickPass SutureLasso with 2-0 FiberWire. This procedure is easier and less invasive, shortening the gap by drawing each stump of the meniscus in the direction of the circumference.

Fig 1

Arthroscopic view of oblique tear at midbody of lateral meniscus in left knee. White arrowheads shows radial tear.

Fig 2

Arthroscopic views and schemata of the surgical technique for suture penetration of the anterior stump in the left knee. First, the needle tip of the QuickPass SutureLasso 45° curve left is penetrated to the anterior stump of the lateral meniscus vertically in the left knee (A and D). Then, the wire loop is fed from the lumen of the device after turning up needle tip between the lower surface of the anterior stump and the joint surface of the lateral tibial plateau, with attention to prevent for damage the cartilage (B). Finally, 2-0 FiberWire is passed through the anterior stump of the lateral meniscus (white arrow) after extra-articular suture relay (C and E). POP, Popliteus tendon.

Fig 3

Arthroscopic views and schemata of the surgical technique for suture penetration of the posterior stump in the left knee. First, the needle tip of the QuickPass SutureLasso 45° Curve Left is penetrated to the posterior stump of the lateral meniscus vertically in the left knee (A and D). Then, the wire loop is fed from the limen of the device after turning up the needle tip between the lower surface of the posterior stump and the joint surface of the lateral tibial plateau, with attention to prevent damage to the cartilage (B). Finally, a 2-0 FiberWire is passed through the posterior stump of the lateral meniscus (white arrow) after extra-articular suture relay (C and E). POP, Popliteus tendon.

Fig 4

Arthroscopic views and schema of knot tying in the left knee. Two sutures are passed through both anterior and posterior stumps (A). The inner suture is tied (B), and then the outer suture is tied (C). For this oblique tear, 2 sutures are tied on the upper surface of the meniscus. POP, Popliteus tendon.

Fig 5

Preoperative and postoperative findings of an oblique tear at the midbody of the lateral meniscus in the left knee on magnetic resonance imaging (MRI). On preoperative MRI, an oblique tear was found at the midbody of the lateral meniscus as a high signal gap (white dotted circle) on each axial (A), sagittal (B), or coronal (C) image. However, on the 1-week postoperative MRI, there was almost no high signal (white circle) at the tear site on each axial (D), sagittal (E), or coronal (F) image.