Meniscus Tears: Meniscal Root Repair

Meniscus Tears: Meniscal Root Repair

This cadaveric surgical video demonstrates a meniscal root repair to treat a meniscal root tear. The knee has a meniscus within each side of the joint: the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee.

Each meniscus is C-shaped and is secured to the middle portion of the top of the tibia, or shinbone, by the meniscal roots in the front and back. In this procedure, a soft, all-suture implant specifically designed for reattaching the meniscal root back to the top of the shinbone will be used.

This implant has 2 sets of sutures, each containing a repair suture and a striped looped suture, that are used to tack down the meniscal root without having to tie knots. Here, we see a right knee. Two small incisions, called portals, have already been made to access the inside of the knee joint.

Here is a view from inside the knee showing a meniscal root tear in the back of the lateral meniscus. Here is where the meniscal root used to be attached. The surgeon begins by grabbing onto the free end of the torn meniscal root.

The surgeon places an aiming guide into the area where the meniscal root was attached and taps a guide sleeve into place. An inner sleeve is then inserted into the guide, and a drill pin is inserted into the sleeve to drill a small tunnel in the shinbone.

The guide and sleeve are removed, as well as the inner portion of the drill pin, leaving behind a hollow drill pin. A metal wire is passed through the drill pin into the knee joint. The drill pin is then removed, leaving the wire in place through the drilled tunnel.

The metal wire is retrieved from within the knee and used to pass the all-suture implant into the knee. The wire is removed. The surgeon then sets the implant so it bunches up and is secured into the top of the shinbone.

A plastic tube called a cannula is then inserted into the knee to help complete the procedure. The surgeon grabs the sutures from the implant from inside the knee and pulls them out of the other side of the knee. There are 4 sutures: 1 blue, 1 white, and 2 striped sutures with loops.

The surgeon uses a suture-passing device to grab the blue suture and pull the end out of the cannula. Then, the surgeon passes it through the meniscal root. The surgeon then pulls 1 of the striped looped sutures out of the cannula.

Outside the knee, the blue suture is passed into the loop of the striped suture, which is pulled to bring it back down through the implant. The implant has a knotless mechanism that secures the sutures in the meniscal root to the implant without tying knots once they are passed through the suture loops.

Before the blue suture is tightened all the way, the same steps are repeated for the white suture and other striped suture. Now, both the blue and white sutures are tightened one after another until the meniscal root is firmly attached down to the bone.

Once secured, the free ends of the sutures will be cut off and the skin incisions will be closed with additional sutures. The meniscal root repair is now complete.