Circumferential Cross-Stitch Suture for Longitudinal Lateral Meniscal Tear Around the Popliteal Tendon Hiatus Region

Abstract

Lateral meniscal repair of the popliteal hiatus is technically demanding. The inside-out technique requires an additional incision and carries the risk of posterolateral soft tissue damage to the knee joint. In addition, the presence of the popliteal tendon limits the route of the suture thread. Within the current trend of the all-inside suture technique, meniscal suture-based all-inside repair demonstrates biomechanical advantages over anchor-based all-inside repair. We introduce a meniscal suture-based all-inside meniscal repair technique for longitudinal lateral meniscal tears.

Fig 1

A Knee Scorpion is inserted through the portal. The Knee Scorpion is set with a 2-0 FiberWire. A cannula may be used to aid in the insertion of the device and avoid fat or synovial interference during the procedure.

Fig 2

The Knee Scorpion captures and passes the needle through the peripheral rim of the lateral meniscus adjacent to the popliteal hiatus.

Fig 3

Retrieve the 2-0 FiberWire thread. Then draw out the thread through the portal.

Fig 4

After setting the 2-0 FiberWire in the Knee Scorpion, it is inserted into the same portal. The Knee Scorpion captures and passes the suture needle thread from the tibial side to the femoral side at the outer rim of the opposite side of the hiatus.

Fig 5

The Knee Scorpion is drawn through the portal.

Fig 6

The two free ends of the thread are pulled to apply the proper compressive force on the meniscus lesion.

Fig 7

A sliding knot or standard surgical ligation is performed to secure the knot. Because the thread runs over the meniscus forming a “V” shape, the two compression points on the injury site are more central than the suture needle entry points.

Fig 8

When a single circumferential cross-compression suture does not adequately cover the longitudinal tear, another half-overlapping suture can be fashioned on the meniscus as a consecutive additional suture, capturing and holding the meniscus securely like a net.

Fig 9

(A) Normally, a single vertical suture applies a vertical compression force to the meniscal tear region. (B) Two oblique running sutures apply a compression force on the longitudinal tear lesion (white arrows) and a transverse compression force along the outer rim of the meniscus (gray arrows). Consecutive cross stitches that apply a transverse compression force along the outer rim can maintain the hoop mechanism to prevent meniscal extrusion.