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
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