Meniscus-Side-Knot-tying Technique Instead of Capsular-Side-Knot-Tying in Arthroscopic Outside-In Meniscal Repair: A Small but Meaningful Modification

Abstract

Arthroscopic outside-in meniscal repair technique, which was first described by Warren in 1985, including all its later modifications, involved tying the final knot on the outer surface of the capsule. Capsular-side knot-tying has reported complications such as catching sensory nerves under the knot with resultant postoperative focal sensory loss and paresthesia, as well as pain under the skin because of irritation from the knot. Meniscus-side-knot-tying technique involves tying the knot on the outer surface of the meniscus. Advantages of the meniscus-side knot-tying technique include the following: avoiding catching nerves under the knot; avoiding pain under the skin because of irritation from the knot; the tension of the sliding knot and the subsequent half hitches, which can be monitored accurately under vision; no skin incisions needed; no possibility of cutting the suture limbs while performing the skin incision between the two needle holes; and, the ability to suture tears in mobile parts of the meniscus without fixing them to the capsule like tears in the anterior horn of the lateral meniscus.