Meniscal Ramp Lesion Repair Using an All-Inside Technique

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Presentation transcript:

Meniscal Ramp Lesion Repair Using an All-Inside Technique Roberto Negrín, M.D., Nicolás O. Reyes, M.D., Magaly Iñiguez, M.D., Juan José Pellegrini, M.D., Mauricio Wainer, M.D., Jaime Duboy, M.D. Arthroscopy Techniques Volume 7, Issue 3, Pages e265-e270 (March 2018) DOI: 10.1016/j.eats.2017.09.001 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Diagnostic arthroscopy with knee flexed at 90°: (A) Notch view, with 30° optic, rotated at 4 o'clock. The “ramp zone” of the posteromedial meniscotibial ligament, attached to the posterior horn of the medial meniscus, is seen. (B) Notch view with 30° optic of an acute ramp lesion in a patient with ACL injury. Complete disinsertion of the meniscus and the posteromedial ligament is observed, revealing the medial plateau. (C) View through the posteromedial accessory portal with 30° optic. Posteromedial meniscotibial ligament is attached to the posterior horn of the medial meniscus. (D) Complete posteromedial meniscotibial ligament disruption and retraction. Arthroscopy Techniques 2018 7, e265-e270DOI: (10.1016/j.eats.2017.09.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Step-by-step diagram of meniscal ramp lesion repair (A). Step 1 (B): Hold the meniscotibial ligament with an arthroscopic grasper though the posteromedial portal. Step 2 (C): Using a Fast-Fix 360 device, point the curve downward through the meniscotibial ligament and release the first anchor. Step 3 (D): Then pass the device pointing upward through the meniscus and release the second anchor (E). Then pull the suture and cut (F). Arthroscopy Techniques 2018 7, e265-e270DOI: (10.1016/j.eats.2017.09.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Step-by-step cadaveric example of meniscal ramp lesion repair. Step 1 (A): Hold the meniscotibial ligament with an arthroscopic grasper through the posteromedial compartment. Step 2 (B): Using a Fast-Fix 360 device, point the curve downward through the meniscotibial ligament (C) and release the first anchor (D). Step 3 (E): Then pass the device pointing upward through the meniscus and release the second anchor (F). Arthroscopy Techniques 2018 7, e265-e270DOI: (10.1016/j.eats.2017.09.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic configuration of all the instruments used for a meniscal ramp lesion repair. The posteromedial portal is used to pass an arthroscopic grasper to hold the meniscotibial ligament. The anteromedial portal is used for the Fast-Fix 360 device. The anterolateral portal is used for the camera, changing between the anteromedial view and the notch view without leaving the anterolateral portal. Arthroscopy Techniques 2018 7, e265-e270DOI: (10.1016/j.eats.2017.09.001) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions