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Published byKelley May Modified over 8 years ago
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Meniscus Repair Three Techniques John F. Meyers, M.D.
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Repairable Menisci Outer 1/3 – Red Red Zone Middle 1/3 – Red White Zone Outer 1/3 – Red Red Zone Middle 1/3 – Red White Zone
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Non-Repairable Menisci Middle 1/3 Red White Zone Inner 1/3 – White White Zone Middle 1/3 Red White Zone Inner 1/3 – White White Zone
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Inside Out Technique
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Technique Medial Meniscus Scope Medial – Cannula Lateral Prepare Meniscus and Synovium Work from posterior to Anterior Scope Medial – Cannula Lateral Prepare Meniscus and Synovium Work from posterior to Anterior
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Technique Medial Meniscus Horizontal or Vertical Mattress Sutures Superior and Inferior Surface Transilluminate Saphenous Vein Posteromedial Incision Horizontal or Vertical Mattress Sutures Superior and Inferior Surface Transilluminate Saphenous Vein Posteromedial Incision
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Technique Lateral Meniscus Scope lateral cannula medial Posterolateral incision to protect peroneal nerve Scope lateral cannula medial Posterolateral incision to protect peroneal nerve
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Combined Posterior Incicion and Arthroscopic Intra-articular Repair
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Lateral Meniscus Peroneal nerve at risk with any repair medial to popliteus Combination arthroscopic open repair Peroneal nerve at risk with any repair medial to popliteus Combination arthroscopic open repair
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Outside-In Technique
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Technique Medial Meniscus Scope lateral Pass needle through tear Pass suture through needle Scope lateral Pass needle through tear Pass suture through needle
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Technique Medial Meniscus Mulberry knot Repeat with adjacent stitch Tie sutures over capsule Mulberry knot Repeat with adjacent stitch Tie sutures over capsule
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Technique Lateral Meniscus Scope medial Identical procedure Scope medial Identical procedure
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Advantage Cheap & Easy Disadvantage Posterior tears difficult to reach
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Inside – Inside Technique
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Fibrin Clot Enhances healing Large tears Failed repairs Enhances healing Large tears Failed repairs
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Fibrin Clot Probably not necessary with combined ACL reconstruction
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Results
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Cannon 90% success combined with ACL reconstruction 60% success with isolated tears 90% success combined with ACL reconstruction 60% success with isolated tears
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Rosenberg 92% success when repaired in red red zone
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Dehaven – open repair 95% success in stable knees 62% success in ACL deficient knees 95% success in stable knees 62% success in ACL deficient knees
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Meniscus Repair – Five Techniques John F. Meyers, M.D.
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T-Fix Suture Anchor Advantage No incision necessary
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T-Fix Suture Anchor Disadvantage Cost Knot tying Permanent foreign body Cost Knot tying Permanent foreign body
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Meniscus Arrows Advantage No incision necessary
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Meniscus Arrows Disadvantage Cost ? Articular cartilage damage Cost ? Articular cartilage damage
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Repairable Meniscii Outer 1/3 – Red Red Zone Middle 1/3 – Red White Zone Outer 1/3 – Red Red Zone Middle 1/3 – Red White Zone
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Non-Repairable Meniscii Middle 1/3 Red White Zone Inner 1/3 – White White Zone Middle 1/3 Red White Zone Inner 1/3 – White White Zone
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Inside Out Technique
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Technique Medial Meniscus Scope medial – cannula lateral Prepare meniscus and synovium Work from posterior to anterior Scope medial – cannula lateral Prepare meniscus and synovium Work from posterior to anterior
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Technique Medial Meniscus Horizontal or vertical mattress sutures Superior and inferior surface Transilluminate saphenous vein Posteromedial incision Horizontal or vertical mattress sutures Superior and inferior surface Transilluminate saphenous vein Posteromedial incision
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Technique Lateral Meniscus Scope lateral cannula medial Posterolateral incision to protect peroneal nerve Scope lateral cannula medial Posterolateral incision to protect peroneal nerve
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Outside In Technique
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Lateral Meniscus Peroneal nerve at risk with any repair medial to popliteus Combination arthroscopic open repair Peroneal nerve at risk with any repair medial to popliteus Combination arthroscopic open repair
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Technique Medial Meniscus Scope Lateral Pass needle through tear Pass suture through needle Scope Lateral Pass needle through tear Pass suture through needle
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Technique Medial Meniscus Mulberry knot Repeat with adjacent stitch Tie sutures over capsule Mulberry knot Repeat with adjacent stitch Tie sutures over capsule
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Technique Lateral Meniscus Scope Medial Identical procedure Scope Medial Identical procedure
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Advantage Cheap & Easy Disadvantage Posterior tears difficult to reach
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Inside – Inside Technique
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Fibrin Clot Enhances healing Large tears Failed repairs Enhances healing Large tears Failed repairs
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Fibrin Clot Probably not necessary with combined ACL reconstruction
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Results
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Cannon 90% success combined with ACL reconstruction 60% success with isolated tears 90% success combined with ACL reconstruction 60% success with isolated tears
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Rosenberg 92% success when repaired in the red red zone
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Dehaven – Open Repair 95% success in stable knees 62% success in ACL deficient knees 95% success in stable knees 62% success in ACL deficient knees
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