Suprameniscal Portal for Repairing Meniscal Root Tears

Abstract

Several techniques and portals have been described for meniscal root repairs. Some authors describe using anterior portals for suture passing and manipulation of meniscal tissue, with some risk of iatrogenic chondral injuries reported. Other authors describe using posterior portals to avoid this risk. In this technique, we used a suprameniscal portal, which allowed a good trajectory for passing sutures in the meniscal tissue with minimal risk of iatrogenic chondral damage without the need to use posterior portals. The meniscal bed is first prepared. The suprameniscal portal is created in 15° of knee flexion and used to pass 2 sutures through the meniscus by a Lasso. The sutures are tied in a cinch configuration, shuttled through the tibial tunnel, and tied over a Dog Bone button.

Fig 1

Arthroscopic view of the medial compartment of the right knee. The scope is introduced from the anterolateral portal, and a probe is introduced from the anteromedial portal and used for assessment of medial meniscus posterior root tear. (A) Before medial release. (B) After medial release.

Fig 2

Arthroscopic view of the medial compartment of the right knee. The scope is introduced from the anterolateral portal. The meniscal bed is shown prepared down to subchondral bone.

Fig 3

Arthroscopic view of the medial compartment of the right knee. The scope is introduced from the anterolateral portal. Placement of the suprameniscal portal (A), ensuring good trajectory to posterior root (B).

Fig 4

(A) Clinical photograph of a patient with right medial meniscus posterior root tear showing introduction of the lasso through the suprameniscal portal. Arthroscopic view of the medial compartment of the right knee. The scope is introduced from the anterolateral portal. (B) The lasso at the posterior horn of the medial meniscus after introduction through the suprameniscal portal. (C) The lasso is shown penetrating the meniscus.

Fig 5

Arthroscopic view of the medial compartment of the right knee, the scope is introduced from the anterolateral portal. (A) Introduction of ACL guide through the anteromedial portal. (B) pin seen exiting the tibial plateau at the anatomical site of root attachment (blue circle). (ACL, anterior cruciate ligament.)

Fig 6

Arthroscopic view of the medial compartment of the right knee, the scope is introduced from the anterolateral portal. Two cinch stitches, just before the PDS shuttles them into the tibial tunnel.

Fig 7

(A) Clinical photograph of a patient with right medial meniscus posterior root tear showing tying sutures over Dog Bone button. (B) and (C) Arthroscopic views of the medial compartment of the right knee. The scope is introduced from the anterolateral portal,showing final visualization.