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Emily Harnden, M. D. , Timothy Lin, M. D. , M. S. , Adam Wilson, M. D

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Presentation on theme: "Emily Harnden, M. D. , Timothy Lin, M. D. , M. S. , Adam Wilson, M. D"— Presentation transcript:

1 Technique for Transtibial Knotless Repair of Lateral Meniscus Root Avulsion 
Emily Harnden, M.D., Timothy Lin, M.D., M.S., Adam Wilson, M.D., John B. Reid, M.D.  Arthroscopy Techniques  Volume 6, Issue 3, Pages e845-e851 (June 2017) DOI: /j.eats Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

2 Fig 1 Left knee arthroscopic view probing the posterior lateral meniscus root (∗) with the patient in the supine position, the camera entering via the anterolateral portal, the probe entering via the anteromedial portal, and the patient's knee flexed to 90° off the edge of the table. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

3 Fig 2 The left knee is shown flexed with the patient in the supine position. A 10 mm × 3 cm PassPort cannula is seen in the anteromedial (AM) portal. The camera is in the anterolateral portal. A Knee Scorpion is brought through the AM portal and is used to shuttle two 2-0 FiberWire sutures through the posterior root as passing sutures. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

4 Fig 3 Left knee posterior lateral compartment viewed through the anterolateral portal with the knee in 90° of flexion. A Knee Scorpion is used through a PassPort cannula in the anteromedial portal to pass two 2-0 FiberWire sutures through the posterior meniscal root. Once the needle has been deployed with one tail of the 2-0 FiberWire suture through the meniscal root, the Knee Scorpion is released and pulled out of the PassPort cannula with the passed tail. The two suture tails are then secured outside of the cannula and the second shuttle suture passed in the same fashion. They should be passed approximately 4 to 5 mm apart in the lateral meniscus root to ensure appropriate purchase in the tissue. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

5 Fig 4 Left knee posterior lateral compartment viewed through the anterolateral portal with the knee in 90° of flexion. Two 2-0 FiberWire sutures are used to pass 2 FiberSnares through the posterior meniscal root via the PassPort in the anteromedial portal. One end of the first shuttle suture is tied around the unlooped end of a FiberSnare outside of the knee. The opposite end of the shuttle suture is then pulled to bring the tail of the FiberSnare into the knee, through the meniscus root and back out of the PassPort. The FiberSnare tail is placed into its loop outside of the PassPort, pulled to draw the loop into the knee joint, and tightened to cinch the FiberSnare locking loop around the meniscal root. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

6 Fig 5 Left knee posterior lateral compartment viewed through the anterolateral portal with the knee in 90° of flexion. The FlipCutter is drilled through the targeting guide and advanced until the cutting portion is completely visible in the joint. A Kingfisher grasper can be used through the PassPort cannula to hold the torn posterior root out of the way of the FlipCutter. The targeting guide is removed and pin location is examined to ensure that it is centered in the lateral meniscus anatomic footprint: 4 mm medial to the lateral articular cartilage edge, 12 mm anterior to the posterior cruciate ligament tibial attachment, and 10 mm posterior the tibial anterior cruciate ligament attachment. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

7 Fig 6 Left knee posterior lateral compartment viewed through the anterolateral portal with the knee in 90° of flexion. The FlipCutter blade is flipped to convert the 3.5-mm pin into a 6-mm reamer. A 1-cm-length socket is drilled in a retrograde fashion. A shaver is used to remove all debris. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

8 Fig 7 Left knee posterior lateral compartment viewed through the anterolateral portal with the knee in 90° of flexion. A FiberStick in its red plastic sheath is advanced through the FlipCutter sleeve in the anteromedial tibia into the meniscal socket and knee. A grasper is used to pull a loop of the FiberStick from the red plastic sheath out of the PassPort cannula ensuring that the 2 tails of the FiberStick remain outside of the FlipCutter sleeve in the anterior tibia. The metal sleeve and red plastic sheath are then pulled out of the tibia with care to keep the FiberStick in place. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

9 Fig 8 (A) Arthroscopic view from the anterolateral portal with the patient in the supine position with the knee flexed to 90°. Two FiberSnare locked loop sutures in the lateral meniscus (LM) root are being pulled into the FlipCutter socket at the LM posterior root anatomic footprint. (B) After docking and tensioning the FiberSnare tails in the tibial tunnel, the repair should be tensioned as tightly as possible without causing deformation or buckling of the LM. (*, lateral meniscus; +, lateral femoral condyle; arrow, anterior cruciate ligament remnant.) Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

10 Fig 9 Left knee anteromedial tibial cortex through a 2 cm longitudinal incision. The subcutaneous tissue and periosteum have been elevated. The ABS button is in place over the anteromedial tibial tunnel with the 2 FiberSnare tails through the button and tied over the top. At least 6 square knots are thrown to ensure a secure fixation, and the tails are cut to leave a few millimeters of suture to prevent the knot from untying. (ABS, attachable button system.) Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

11 Fig 10 Left knee posterior lateral compartment viewed through the anterolateral portal with the knee in 90° of flexion. Once the root repair has been secured outside of the anteromedial tibia, a probe is used to ensure the stability of the repair before the conclusion of the procedure. Arthroscopy Techniques 2017 6, e845-e851DOI: ( /j.eats ) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions


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