Low-Profile Cartilage Repair With Knotless All-Suture Anchors: Surgical Technique

Abstract

Osteochondral and pure chondral lesions of the knee are common after patellar dislocations. There are multiple described techniques for the fixation of these lesions, including metallic screws, bioabsorbable screws, bioabsorbable implants, and suture devices. The purpose of this article is to describe a surgical technique for surgical fixation of a lateral condyle chondral lesion using knotless all-suture anchors, with second-look knee arthroscopy illustrating healing of the cartilage repair.

Fig 1

(A) Arthroscopic intraoperative image in a left knee viewing from the anterolateral portal demonstrating a loose chondral fragment (blue arrow) in the intercondylar notch adjacent to the medial femoral condyle and (B) the corresponding osteochondral defect located on the lateral aspect of the lateral femoral condyle (blue arrow). (C) Intraoperative image demonstrating the chondral fragment (white arrow) from the knee viewed on the operating room table. (D) Intraoperative image of the corresponding cartilage defect (blue arrow) viewed through an open medial parapatellar arthrotomy.

Fig 2

Intraoperative image of the defect viewed through an open medial parapatellar arthrotomy following anchor placement 8 mm apart (blue arrow).

Fig 3

(A) Intraoperative image viewed through an open medial parapatellar arthrotomy demonstrating anatomic reduction of the chondral fragment of the lateral femoral condyle with a marking at the 12:00 position demonstrating maintenance of proper fragment orientation (blue arrow). (B) Intraoperative image viewed through an open medial parapatellar arthrotomy demonstrating anatomic reduction of the chondral fragment of the lateral femoral condyle achieved using knotless suture anchors after final tensioning and cutting of the repair stitch (blue arrow).

Fig 4

(A) Arthroscopic image of the lateral femoral condyle of the left knee at second-look arthroscopy at 20 weeks after surgery, viewed through the anteromedial portal, including suture from the knotless suture anchors demonstrating a completely intact, stable, and well-healed cartilage repair with synovialized suture material (blue arrow). (B) Arthroscopic image of the lateral femoral condyle viewed through the anterolateral portal demonstrating the medial border of the healed chondral fragment (blue arrow), including (C) engagement with the lateral meniscus and lateral tibial plateau through range of motion (blue arrow) and (D) when viewed through the anteromedial portal (blue arrow).