A Transosseous Bone Bridge Repair for Posterior Horn Meniscal Root Tears During Anterior Cruciate Ligament Reconstruction Jonathan M. Frank, M.D., Daniel.

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A Transosseous Bone Bridge Repair for Posterior Horn Meniscal Root Tears During Anterior Cruciate Ligament Reconstruction Jonathan M. Frank, M.D., Daniel J. Liechti, M.D., Jack Anavian, M.D., Thomas R. Hackett, M.D. Arthroscopy Techniques Volume 6, Issue 1, Pages e239-e243 (February 2017) DOI: 10.1016/j.eats.2016.09.026 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 The PassPort button cannula is placed in the inferolateral portal and allows for easy passage of instruments, including the anterior cruciate ligament guide, and for suture management. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 The footprint for the meniscus posterior root is decorticated using a 4.5-mm arthroscopic burr through the inferolateral portal. A healthy bleeding bone bed is created to increase healing potential. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 A standard anterior cruciate ligament (ACL) tip aiming drill guide is combined with the acromioclavicular (AC) reconstruction Retroconstruction drill sleeve to allow cannulated pin placement into the posterior meniscus footprint. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 A 2.4-mm cannulated pin is placed at the posterior lateral meniscus root footprint. A total of 2 cannulated pins are placed to allow for 2-tunnel fixation of the meniscus. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 The loop of the Fiberlink is passed over the barrel of the Scorpion, which allows for creation of a cinch stitch. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 When passing the suture through the meniscus, the Scorpion device must be rotated such that the needle does not cause damage to the articular surfaces. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 A cinch stitch is created in the posterolateral meniscal root by passing the looped end through the meniscus and then tightening the slip knot while working through the inferomedial portal. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 A Fiberstick is passed through the cannulated pin into the joint to serve as a shuttling suture. The Fiberstick is retrieved through the inferolateral portal. Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 With both cinch stitch suture ends out through the anterior tibial cortex, the sutures are tied together over a 5.0-mm bony bridge. Final arthroscopic evaluation ensures the meniscus is appropriately reapproximated over its native footprint with tension on both sutures prior to final knot tying. (ACL, anterior cruciate ligament.) Arthroscopy Techniques 2017 6, e239-e243DOI: (10.1016/j.eats.2016.09.026) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions