Revista de Medicina Desportiva (English) July 2018 - Page 29

SPAT Sociedade Portuguesa de Artroscopia e Traumatologia Desportiva Rev. Medicina Desportiva informa, 2018; 9(4):27-29. Outside-In Meniscal Repair for Anterior Horn Tears materials, widely available in operat- ing rooms. A fast and Intuitive Method. Technical Note. Technique Dr. Pedro Manuel Serrano 1 , Dra. Marta Santos Silva 1 , Prof. Doutor Ricardo Sousa 2 1 Interno de formação específica; 2 Centro Hospitalar do Porto Orthopedics Department, Porto – Portugal Systematic arthroscopic examina- tion is performed through conven- tional anterior arthroscopic portals using a 30-degree arthroscope. The meniscal lesion is carefully examined to determine its location, extent, and stability. After confirm- ing that it is a repairable lesion, the suture site is prepared to stimulate fibrous response and consequent healing. At this point, the surgeon passes a needle through the skin, capsule and meniscus in order to get out pf the desired location of the meniscal rupture. The surgeon passes a needle through the skin, capsule and meniscus, to achieve the desired site for meniscal repair. We recommend the use of a smaller needle at this early stage, especially for less expe- rienced surgeons, to avoid unnec- essary tissue damage that may be caused by excessive passages. After identifying the optimal place for insertion of the needles, a transverse 10mm cutaneous incision is made in this location. Then two 16-gauge needles previously prepared with Ethibond number 2 suture are used. The wire is passed through the needle in a retrograde direction so that a loop is exteriorized at the (intra articu- lar) pointed end of the needle. The first needle with the prepared loop is then placed along the path of the smallest caliber needle, that has just been removed (Figure 1. The surgeon holds the needle and the free end of the suture at the same ABSTRACT Outside-in meniscal suture techniques may involve using expensive equipment that is not readily available, for immediate use, on most operating rooms. Aware of the different techniques available, the authors describe a quick and reproducible technique that doesn’t require the use of specific material. KEYWORDS Meniscal suture, arthroscopy, sports trauma, surgical technique Introduction Arthroscopic meniscal repair was first introduced by Ikeuchi in Tokyo in 1979. 1 Whenever a repair- able meniscal rupture is detected, arthroscopic suturing is currently the procedure of choice. Indications for meniscal suture include com- plete vertical longitudinal ruptures (over 10mm), peripheral ruptures (included in the most peripheral third) or those within 3 or 4 mm of the menisci-capsular junction. 2 Arthroscopic repair techniques can be categorized into four groups: • inside-out • outside-in • all-inside (entirely intra-articular) • hybrid, supplementing the prior art. None of these techniques is considered the gold-standard for all situations. The outside-in technique, described by Morgan and Casscells, is best indicated for ruptures of the middle or anterior meniscal third and avoids the occasional neurovas- cular complications of the inside-out techniques. 3 The all-inside technique is especially useful in posterior horn ruptures and due to the narrow articular space, it can be technically difficult to perform. The development of devices for suture passage, has made the technique progressively easier, with the advantage of not requir- ing additional skin incisions. On the other hand, the cost of these devices and the technical difficulties when they are not available (for instance when lesions were not previously diagnosed) are disadvantages. Both outside-in and inside-out techniques inevitably result in an additional incision, even larger if the repair is in the posterior horn, to provide good visualization of structures to avoid. 4 Given that outside-in meniscal suture may involve the use of expen- sive materials, the authors describe a simple, effective and reproduc- ible technique using inexpensive Revista de Medicina Desportiva informa july 2018 · 27