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Meniscal repair.

Yoon KH, Park KH - Knee Surg Relat Res (2014)

Bottom Line: The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint.Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy.In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

ABSTRACT
The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

No MeSH data available.


Related in: MedlinePlus

Outside-in repair technique. (A) A longitudinal tear is identified. (B) A suture material is passed through an 18-gauge spinal needle superior or inferior to the tear site, and the strand is pulled out of the other portal using a grasper. (C) After introducing a needle system with a wire-looped retriever passed through another surface of the tear site, the strand withdrawn into the joint is pulled out of the working portal. (D) The second suture can be carried out with the same procedure. (E) Vertical sutures are tied over the joint capsule.
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Figure 2: Outside-in repair technique. (A) A longitudinal tear is identified. (B) A suture material is passed through an 18-gauge spinal needle superior or inferior to the tear site, and the strand is pulled out of the other portal using a grasper. (C) After introducing a needle system with a wire-looped retriever passed through another surface of the tear site, the strand withdrawn into the joint is pulled out of the working portal. (D) The second suture can be carried out with the same procedure. (E) Vertical sutures are tied over the joint capsule.

Mentions: Warren40) introduced the outside-in meniscal repair technique to decrease the risk of injury to the peroneal nerve during the procedure of lateral meniscal repair. The peroneal nerve could be protected during meniscal repair because the starting point for needle entry is controlled by the surgeon41). The outside-in technique can be used for most of the meniscal tears patterns and locations, especially tears located in the anterior horn. It can also be used to fix a transplanted meniscal allograft to the joint capsule42). The technique can be carried out using an 18-gauge spinal needle or a corresponding suture-passing needle system with a wire-looped retriever. For posteromedial repairs, the knee should be flexed to 10°-20° to allow the sartorial nerve to lie anterior to the repair site. For anteromedial repairs, the knee should be flexed to 40°-50° to allow the sartorial branch of saphenous nerve to lie posterior to the repair site. For lateral meniscal repairs, the knee should be in 90° of flexion to allow the common peroneal nerve to lie posterior to the repair site. A needle is passed from outside to inside through the tear site. Then, an absorbable or nonabsorbable suture is passed through the needle and pulled out of the anterior portal using a grasper. Then a suture-passing needle system is passed from outside to inside on the either inferior or superior articular surface of the meniscus, and a wire-looped retriever is introduced through this system. After this procedure, the first suture is withdrawn back into the joint using a grasper, and delivered through the wire loop (Fig. 2). Then, the suture is pulled out of the suture passer and tied over the joint capsule16). Horizontal mattress suture can be performed with the same method.


Meniscal repair.

Yoon KH, Park KH - Knee Surg Relat Res (2014)

Outside-in repair technique. (A) A longitudinal tear is identified. (B) A suture material is passed through an 18-gauge spinal needle superior or inferior to the tear site, and the strand is pulled out of the other portal using a grasper. (C) After introducing a needle system with a wire-looped retriever passed through another surface of the tear site, the strand withdrawn into the joint is pulled out of the working portal. (D) The second suture can be carried out with the same procedure. (E) Vertical sutures are tied over the joint capsule.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061409&req=5

Figure 2: Outside-in repair technique. (A) A longitudinal tear is identified. (B) A suture material is passed through an 18-gauge spinal needle superior or inferior to the tear site, and the strand is pulled out of the other portal using a grasper. (C) After introducing a needle system with a wire-looped retriever passed through another surface of the tear site, the strand withdrawn into the joint is pulled out of the working portal. (D) The second suture can be carried out with the same procedure. (E) Vertical sutures are tied over the joint capsule.
Mentions: Warren40) introduced the outside-in meniscal repair technique to decrease the risk of injury to the peroneal nerve during the procedure of lateral meniscal repair. The peroneal nerve could be protected during meniscal repair because the starting point for needle entry is controlled by the surgeon41). The outside-in technique can be used for most of the meniscal tears patterns and locations, especially tears located in the anterior horn. It can also be used to fix a transplanted meniscal allograft to the joint capsule42). The technique can be carried out using an 18-gauge spinal needle or a corresponding suture-passing needle system with a wire-looped retriever. For posteromedial repairs, the knee should be flexed to 10°-20° to allow the sartorial nerve to lie anterior to the repair site. For anteromedial repairs, the knee should be flexed to 40°-50° to allow the sartorial branch of saphenous nerve to lie posterior to the repair site. For lateral meniscal repairs, the knee should be in 90° of flexion to allow the common peroneal nerve to lie posterior to the repair site. A needle is passed from outside to inside through the tear site. Then, an absorbable or nonabsorbable suture is passed through the needle and pulled out of the anterior portal using a grasper. Then a suture-passing needle system is passed from outside to inside on the either inferior or superior articular surface of the meniscus, and a wire-looped retriever is introduced through this system. After this procedure, the first suture is withdrawn back into the joint using a grasper, and delivered through the wire loop (Fig. 2). Then, the suture is pulled out of the suture passer and tied over the joint capsule16). Horizontal mattress suture can be performed with the same method.

Bottom Line: The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint.Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy.In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

ABSTRACT
The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

No MeSH data available.


Related in: MedlinePlus