Techniques for meniscal refixation

Abstract

Surgical Principles Midline approach for arthroscopy [7]. Palpation of the joint line of the involved compartment from outside. A needle armed with a suture is passed through skin, fat tissue, capsule, peripheral, and central meniscal fragment. A second armed needle is placed 1 cm beside the first in identical fashion. With the probe which is introduced by an anteromedial or lateral portal, the suture of the first needle is brought back outside the joint. Depending on needle location sutures can be placed in horizontal or vertical fashion. After preparation of the necessary number of sutures, the sutures are tightened one by one under direct arthroscopic vision of the meniscal tear. A far posteriorly located part of a rupture is thereafter treated via a short posteromedial or -lateral arthrotomy with the knee flexed at 90°. The capsular ring is transected vertically to get access to the central meniscal fragment. Vertical sutures are placed starting from the most posterior aspect of the tear, and then one by one the sutures are tightened. The capsular ring is sutured. The vertical sutures with the open technique usually show a better initial fixation strength than the arthroscopic sutures [17].