1. Meniscus Repair Three Techniques John F. Meyers, M.D.

3. 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

4. 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

7. Inside Out Technique

12. 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

13. 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

20. Technique Lateral Meniscus Scope lateral cannula medial Posterolateral incision to protect peroneal nerve Scope lateral cannula medial Posterolateral incision to protect peroneal nerve

21. Combined Posterior Incicion and Arthroscopic Intra-articular Repair

22. 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

24. Outside-In Technique

26. Technique Medial Meniscus Scope lateral Pass needle through tear Pass suture through needle Scope lateral Pass needle through tear Pass suture through needle

28. Technique Medial Meniscus Mulberry knot Repeat with adjacent stitch Tie sutures over capsule Mulberry knot Repeat with adjacent stitch Tie sutures over capsule

32. Technique Lateral Meniscus Scope medial Identical procedure Scope medial Identical procedure

33. Advantage Cheap & Easy Disadvantage Posterior tears difficult to reach

34. Inside – Inside Technique

38. Fibrin Clot Enhances healing Large tears Failed repairs Enhances healing Large tears Failed repairs

39. Fibrin Clot Probably not necessary with combined ACL reconstruction

40. Results

41. Cannon 90% success combined with ACL reconstruction 60% success with isolated tears 90% success combined with ACL reconstruction 60% success with isolated tears

52. Rosenberg 92% success when repaired in red red zone

53. 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

55. Meniscus Repair – Five Techniques John F. Meyers, M.D.

56. T-Fix Suture Anchor Advantage No incision necessary

57. T-Fix Suture Anchor Disadvantage Cost Knot tying Permanent foreign body Cost Knot tying Permanent foreign body

58. Meniscus Arrows Advantage No incision necessary

59. Meniscus Arrows Disadvantage Cost ? Articular cartilage damage Cost ? Articular cartilage damage

60. 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

61. 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

62. Inside Out Technique

63. 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

64. 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

65. Technique Lateral Meniscus Scope lateral cannula medial Posterolateral incision to protect peroneal nerve Scope lateral cannula medial Posterolateral incision to protect peroneal nerve

66. Outside In Technique

67. 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

68. Technique Medial Meniscus Scope Lateral Pass needle through tear Pass suture through needle Scope Lateral Pass needle through tear Pass suture through needle

69. Technique Medial Meniscus Mulberry knot Repeat with adjacent stitch Tie sutures over capsule Mulberry knot Repeat with adjacent stitch Tie sutures over capsule

70. Technique Lateral Meniscus Scope Medial Identical procedure Scope Medial Identical procedure

71. Advantage Cheap & Easy Disadvantage Posterior tears difficult to reach

72. Inside – Inside Technique

73. Fibrin Clot Enhances healing Large tears Failed repairs Enhances healing Large tears Failed repairs

74. Fibrin Clot Probably not necessary with combined ACL reconstruction

75. Results

76. Cannon 90% success combined with ACL reconstruction 60% success with isolated tears 90% success combined with ACL reconstruction 60% success with isolated tears

77. Rosenberg 92% success when repaired in the red red zone

78. 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