"Zip" Lesion of the Lateral Meniscus Repair Technique Using All-Inside Meniscus Repair Device

Abstract

Ramp lesion of the medial meniscus is an established clinical entity and is one of the causes of the positive pivot-shift test with anterior cruciate ligament (ACL) injury. A similar lesion in the region of the posterior horn of the lateral meniscus extending to the posterior meniscocapsular junction posterior to the popliteal hiatus along with ACL injury is called a "zip lesion." These patients do exhibit a positive pivot shift under anesthesia. We have encountered different injury patterns to the lateral meniscocapsular junction, which can cause altered knee kinematics, and they should be looked for while performing an ACL reconstruction. Failure to identify and repair these lesions will have a deleterious effect on the knee kinematics. If untreated, these lesions may lead to compromised results of the ACL reconstruction. This Technical Note proposes a repair technique for the zip lesion.

Fig 1

(A) Left knee at 90° of knee flexion from the anterolateral (AL) port showing a full-thickness ACL tear and empty wall of the lateral femoral condyle with probe. (B) Left knee at 90° of knee flexion from the AL port showing the posteromedial compartment with an intact ramp. (C) Left knee in figure-of-4 position from the AL port showing the zip lesion of the lateral meniscocapsular junction. (ACL, anterior cruciate ligament; LFC, lateral femoral condyle; LM, lateral meniscus; PHHM, posterior horn of medial meniscus; PMC, posteromedial capsule.)

Fig 2

Left knee in figure-of-4 position viewing from the anteromedial port showing the probe palpating the zip lesion from anterolateral port. Red arrow indicates extension of the tear in the posterior root of the lateral meniscus. (LMPR, lateral meniscus posterior root; LTP, lateral tibial plateau; PLC, posterolateral capsule.)

Fig 3

Left knee in figure-of-4 position from the anteromedial port showing probing of the inferior surface tear of the lateral meniscus.

Fig 4

Left knee in figure-of-4 position from the anteromedial port showing first stitch in the vertical configuration. (AIMRD, all-inside meniscus repair device; LTP, lateral tibial plateau; PHLM, posterior horn of lateral meniscus; PLC, posterolateral capsule.)

Fig 5

(A) Left knee in figure-of-4 position the anteromedial (AM) port showing the second stitch in a horizontal configuration on the superior meniscal surface posterior to the popliteal hiatus. (B) Left knee in figure-of-4 position from the AM port showing complete deployment of the second stitch. (AIMRD, all-inside meniscus repair device; LFC, lateral femoral condyle; LTP, lateral tibial plateau; PT, popliteal tendon.)

Fig 6

(A) Left knee in figure-of-4 position from the anteromedial (AM) port showing stitch through the inferior capsule (third stitch). (B) Left knee in figure-of-4 position from the AM port showing the second pass of the third stitch through the inferior surface of the meniscus. (C) Left knee in figure-of-4 position from the AM port showing the completed stitch with meniscus stable on the tibial surface. (LFC, lateral femoral condyle; LTP, lateral tibial plateau.)

Fig 7

(A) Left knee in figure-of-4 position from the anterolateral (AL) port showing first pass of the stitch through the posteroinferior fascicle as the fourth stitch. (B) Left knee in figure-of-4 position from the AL port showing second pass of the fourth stitch through the posteroinferior fascicle. Red arrow indicates PIF. (LFC, lateral femoral condyle; LTP, lateral tibial plateau; PH, posterior horn; PIF, posteroinferior fascicle; PT, popliteal tendon.)

Fig 8

Left knee in 90° of flexion through the anterolateral port showing completed ACL reconstruction after the zip lesion repair. (ACL-R, anterior cruciate ligament reconstruction; LFC, lateral femoral condyle.)

Fig 9

Right knee in figure-of-4 position through the anteromedial port showing meniscocapsular disruption of the posterolateral capsule. (LFC, lateral femoral condyle; LMCI, lateral meniscocapsular injury; LMPR, lateral meniscus posterior root; PLC, posterolateral capsule.)

Fig 10

Left knee in figure-of-4 position through the anteromedial port showing a posterolateral meniscocapsular injury extending into the posterior root of the lateral meniscus. Blue star indicates posterolateral capsular complex. (LFC, lateral femoral condyle; LMPR, lateral meniscus posterior root; PLC, posterolateral capsule.)

Fig 11

Left knee in figure-of-4 position through the anterolateral port showing meniscocapsular injury (zip lesion) and inferior surface meniscus tear. (LFC, lateral femoral condyle; LTP, lateral tibial plateau.)