Vertical Continuous Meniscal Suture Technique

Abstract

Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device.

Fig 1

Longitudinal lesion seen in the posterior horn and body of the medial meniscus on a right knee (A). The Meniscus 4 A-II prepared with 2-0 FiberWire passed in its ends asymmetrically (B). The meniscal suture device is inserted into the most posteriorly injured region of the medial meniscus, with the Meniscus 4 A-II being inserted through the anterolateral portal (C). After the device has crossed the meniscus and capsules through the posteromedial approach, we identify the shortest wire and pull it out of the joint with the help of a probe or a Kelly tweezers (D and E). We return with the device to the interior of the joint (F). We insert the Meniscus 4 A-II 5 to 7 mm vertically, this time crossing only the capsule. With the help of a probe or Kelly tweezers, we hold the first loop formed outside of the joint (G). We return to the joint again with the device (H). We introduce the device again vertically more anteriorly than the last one, and this time crossing the injured meniscus again, and we form the second handle, repairing it with a Kelly or probe (I). We return to the joint again (J). We insert the Meniscus 4 A-II vertically again, crossing only the capsule forming the third handle, holding it with a probe or Kelly (K). We return with the device to the joint again (L). We cross the meniscus again, forming the last handle, repairing it with a Kelly or probe (M). We return to the joint (N). We cross the capsule for the last time and pull the other end of the wire out of the device (O).

Fig 1

Longitudinal lesion seen in the posterior horn and body of the medial meniscus on a right knee (A). The Meniscus 4 A-II prepared with 2-0 FiberWire passed in its ends asymmetrically (B). The meniscal suture device is inserted into the most posteriorly injured region of the medial meniscus, with the Meniscus 4 A-II being inserted through the anterolateral portal (C). After the device has crossed the meniscus and capsules through the posteromedial approach, we identify the shortest wire and pull it out of the joint with the help of a probe or a Kelly tweezers (D and E). We return with the device to the interior of the joint (F). We insert the Meniscus 4 A-II 5 to 7 mm vertically, this time crossing only the capsule. With the help of a probe or Kelly tweezers, we hold the first loop formed outside of the joint (G). We return to the joint again with the device (H). We introduce the device again vertically more anteriorly than the last one, and this time crossing the injured meniscus again, and we form the second handle, repairing it with a Kelly or probe (I). We return to the joint again (J). We insert the Meniscus 4 A-II vertically again, crossing only the capsule forming the third handle, holding it with a probe or Kelly (K). We return with the device to the joint again (L). We cross the meniscus again, forming the last handle, repairing it with a Kelly or probe (M). We return to the joint (N). We cross the capsule for the last time and pull the other end of the wire out of the device (O).

Fig 2

We cut all the handles formed in the central region (A). After all the handles are cut, we suture thread by thread (B and C). The final aspect of the vertical suture remains in the schematic model on the left, and the arthroscopic view of this type of meniscal repair in the cadaver knee on the right, with the black arrows showing the vertical continuous meniscal suture (D). MFC, medial femoral condyle; MM, medial meniscus.