Cutting Edge Orthopedics - Issue 3

Arthroscopic Meniscus Repair for Recurrent Subluxation of the Lateral Meniscus • 45  April 2014. All procedures were performed by two surgeons, with the same arthroscopic tech- niques used for all operations. The inclusion criteria were: (1) patients with knee pain, locking or snapping symptoms despite 3 months of conservative treatment; (2) non-discoid lateral meniscus; (3) stable knee, and (4) peripheral tears involving the red–white or red–red zone. Exclusion cri- teria were: (1) displaced bucket-handle tears of the lateral meniscus demonstrated on MRI, and (2) any combined intra-articular ligament surgery. Thirteen patients were excluded because of bucket-handle tears demonstrated by MRI. Three patients were lost during follow-up. Thus, our sample included 23 patients (24 knees) who returned for the final evaluation after a minimum of 2 years (median, 41 months; range 24–124 months). Median age at the time of the operation was 24.5 years (range 13–57 years). Ten of the 24 knees were right knees, and ten were female knees. After 3 months of conservative treatment if a patient still had persistent lateral knee pain, locking or snapping, MRI evaluation was recommended, while arthroscopic treatment was recommended for subjects who persistently complained of symptoms despite normal MRI findings. Surgical Technique The arthroscopic meniscus repair technique for the posterior horn of the lateral meniscus has been described previously [2, 6]. Careful probing was performed with an anteromedial viewing portal in a figure-4 position, which enabled better inspection of the lateral meniscus with the popliteal hiatus. Careful probing was applied to observe hypermobility of the lateral meniscus, peripheral detachment of the posterior horn of the lateral meniscus, or popliteal hiatus widening (Fig. 1; Video 1). Peripheral longitudinal tears at the posterior horn of lateral meniscus are dif- ficult to visualize through standard anterior portals, and therefore the posterolateral compartment was assessed with the posterolateral viewing portal or a 70° arthroscope that was inserted in the anteromedial portal if the posterior horn of the lateral meniscus was unstable and hypermobile (Fig. 2). All repairs were performed using absorbable sutures (No. 0 PDS: Ethicon, Somerville, NJ, USA) and different suture techniques were used depending on the properties of the tear site after freshening the tear sites using a motorized shaver. A modified all-inside suture technique was Fig. 1: a The arthroscope inserted from the anteromedial portal shows normal shape of the lateral meniscus (LM). b The posterior horn of the lateral meniscus (LMPH) was displaced to the lateral compartment by probing. LFC lateral femoral condyle