Meniscus Tears: Meniscus Repair From Inside-Out

Meniscus Tears: Meniscus Repair From Inside-Out

To perform an inside-out meniscus repair, the surgeon uses a delivery device with long, skinny needles that are joined by a small suture. These needles are fed into the back of the delivery device one by one to be placed through the meniscus to repair it. Each one is pushed forward by the surgeon. Once both needles are pushed out through the skin incision, the needles are cut off, and a knot is tied on the outside of the joint and inside the skin.

Let us take a look. Here is a left cadaver knee, and a radial tear has been created in the medial meniscus for this demonstration. The surgeon will look at the location and direction of the tear, and make sure that an inside-out repair will give the meniscus the best chance to heal. Since this tear is further toward the front of the knee or more anterior, an inside-out repair will be a better choice than using an all-inside repair.

The repair device is brought into the knee, and the surgeon will pick a location in the meniscus to place the first needle. By using the thumb pad on this device, the surgeon can push the needle just barely through the opening in the tip of this long metal tube called a cannula and be very precise in placing the needle.

Once the location is chosen and the surgeon pierces the tissue with the needle, the thumb pad is used to slowly push the needle all the way through to the outside of the joint. Through a premade incision in the skin, an assistant can help by grabbing the needle with a clamp, and finish pulling it all the way through. Here, you can see the small suture that is attached to the back end of the needle going through the meniscus.

Next, the second needle is loaded into the back of the device and advanced little by little until the needle tip is exposed. It is coming out of the cannula right next to the suture. The surgeon will pick the next spot and push the needle through, just like the first one.

Once the second needle is all the way through, the assistant will cut both needles off the suture and discard them in a sharps container for safety. At this point, the suture tails that are coming out of the incision are pulled, and the remaining suture, still in the cannula, is brought into the knee, bringing the edges of the meniscus tear together.

Finally, a knot is tied against the outside of the knee through the skin incision, keeping the edges of the meniscus tear together. With this particular tear, the surgeon will put a second suture in the meniscus in an X pattern to add strength to the repair.

The process is repeated a second time, placing the first needle and removing from the knee. Then, the second needle and the suture is tightened against the tear. A second knot is tied, and you can see the X pattern that has been created to hold the meniscus tear together during the healing process.