Medial Meniscus Posterior Root Tear Repair Using a 2-Simple-Suture Pullout Technique  Tarek Mohamed Samy, M.D., Wael A.M. Nassar, M.D., Zeiad Mohamed Zakaria, M.D., Ahmed Khaled Farrag Abdelaziz, M.Sc.  Arthroscopy Techniques  Volume 6, Issue 3, Pages e579-e583 (June 2017) DOI: 10.1016/j.eats.2017.01.001 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Patient supine, left knee flexed 30° and valgus force applied on a side post at tourniquet level. Images seen through the anterolateral viewing portal while the anteromedial portal is the working portal. (A) The medial meniscus posterior root tear (white arrow): the tear edges as well as root undersurface were refreshened using a 3.5-mm shaver (S). (B) The meniscal root bed was curetted down to cancellous bone using a curettage spoon (asterisk) to increase the healing surface area. (C) A suture-passing Lasso device (L) was used to pass No. 0 Prolene suture (black arrow) through the meniscal root, leaving at least 5 mm between the piercing point and the tear edge. This step was repeated to pass another No. 0 Prolene relay suture at a posterior piercing point with at least 5 mm between the 2 piercing points. Both relay sutures were replaced with No. 2 Fiberwire. (MFC, medial femoral condyle; MTC, medial tibial condyle.) Arthroscopy Techniques 2017 6, e579-e583DOI: (10.1016/j.eats.2017.01.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Patient supine, left knee flexed 30° and valgus force applied on a side post at tourniquet level. Images seen through the anterolateral viewing portal whereas the anteromedial portal is the working portal. (A) A low-profile anterior cruciate ligament guide was introduced till the prepared reimplantation point and a 2.4-mm guide pin was drilled through. (B) A curettage spoon (S) was used to protect femoral articular cartilage while a 7-mm drill bit was reamed over the guide pin (small black arrow). (C) The 4 limbs were retrieved through the tibial tunnel using a right-angled probe, and the meniscal root was buried into the tibial tunnel (large black arrow). The sutures were tensioned over a 12-mm-diameter washer placed at the tibial tunnel outer orifice, with the knee in 15° flexion, and the tension was checked using a probe (P). (MFC, medial femoral condyle; MTC, medial tibial condyle.) Arthroscopy Techniques 2017 6, e579-e583DOI: (10.1016/j.eats.2017.01.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Posterior coronal magnetic resonance imaging cuts showing medial meniscus posterior root tear (blue arrow). (B) Patient supine, left knee flexed 30° and valgus force applied on a side post at tourniquet level, the arthroscope was applied through the anterolateral viewing portal (black arrow), the ACL guide was applied through the anteromedial working portal (blue arrow), the ACL guide bullet was placed at the Gerdy tubercle (white arrow), and a 2.4-mm guide pin was drilled through the guide to the root reimplantation point (yellow arrow). (C) Lateral fluoroscopy view, showing the guide pin in place (blue arrow) where the last few millimeters (articular surface) were penetrated under fluoroscopy after removing the ACL guide device. A low-profile curettage spoon is introduced to protect the articular cartilage and neurovascular bundle during tunnel reaming (black arrow). (ACL, anterior cruciate ligament; L, lateral; M, medial.) Arthroscopy Techniques 2017 6, e579-e583DOI: (10.1016/j.eats.2017.01.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Patient supine, left knee flexed 15° and valgus force applied on a side post at tourniquet level. (A) The 4 limbs of the 2 simple sutures were retrieved through the tibial tunnel outer orifice at the Gerdy tubercle (transparent arrow), and a single limb from each suture (white arrow) was passed through a 12-mm-diameter washer (blue arrow). (B) Using the washer as a bridge, the 2 suture limbs passing through it were knotted with the other 2 suture limbs making 5 half-hitch knots, with the final one in a locking mode (green arrow). Arthroscopy Techniques 2017 6, e579-e583DOI: (10.1016/j.eats.2017.01.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions