Outside-In Repair of Longitudinal Tear of Medial Meniscus: Suture Shuttle Technique

Abstract

Meniscal tears are commonly encountered conditions of the knee. In the past, torn menisci were treated by excision of the loose flap. A better understanding of the meniscus anatomy and its biomechanical characteristics has led to the concept of meniscus preservation in eligible cases. Several suture-based repair techniques have been described in literature, including the outside-in technique. Although the outside-in technique of meniscus repair is commonly indicated for the anterior two-thirds of the meniscus, it can be used to repair the posterior part of the meniscus as well. Several modifications of this technique have been described in the literature. We hereby describe our modification of the outside-in technique of meniscus repair with the help of an epidural needle and highstrength sutures that is readily available in operating rooms. The advantages of our technique are that no large incision is required around knee joint, it's inexpensive, it can be performed with basic instruments, and even the tear of meniscus extending up to the posterior horn can be repaired. A supplemental video demonstration of the technique is included with this article.

Modified Outside-in Repair Technique for Chronic Retracted, Unstable Bucket-Handle Anterior Horn Lateral Meniscal Tear

“… 13 Recently, another outside-in repair technique, known as the “suture shuttle technique,” was developed by Joshi et al. 14 for longitudinal meniscal tears. However, in the case of chronic retracted anterior horn meniscal tears, it is sometimes not possible to hold the reduction of the meniscus and pass the spinal needle through it, so this conventional method of outside-in meniscal repair is not possible when treating such chronic retracted, unstable bucket-handle anterior horn meniscal tears.…”

Outside-in Continuous Meniscal Suture Technique of the Knee

“…Recently, Joshi et al. 17 described a new surgical technique for outside-in meniscal suture for the treatment of longitudinal lesions of the posterior horn of the medial meniscus. The authors cite as advantages the use of small surgical approach, the good reproducibility of the technique, as well as its low cost with the use of materials commonly found in operating rooms.…”

“…The authors cite as advantages the use of small surgical approach, the good reproducibility of the technique, as well as its low cost with the use of materials commonly found in operating rooms. 17 …”

Meniscal Tear at Knee: Repair or Resect? An Early Experience from a University Hospital in Nepal

“…Repair included either outside in suture shuttle technique as described by Joshi et al or all-inside technique with use of a Lasso device. 6 Those patients who had at least one-year of follow up were evaluated with Lysholm score for functional outcome. Data were compiled and analyzed with Microsoft Excel 2011.…”