LIVRE JDG 2016

M. THAUNAT, N. JAN, J.M. FAYARD, C. KAJETANEK, C.G. MURPHY, B. PUPIM, R. GARDON, B. SONNERY-COTTET

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outside to inside. Next, the suture hook is

passed through the central (the inner portion)

of the medial meniscus. The free end of the

suture in the posteromedial space is grasped

and brought up to posteromedial portal. A

sliding knot (fishing knot type) is applied to the

most posterior part of the meniscus with the

help of a knot pusher and then cut. This

manoeuver is repeated as required depending

on the length of the tear (one knot was inserted

every 5mm for tears limited to the posterior

segment (“limited tears”) (fig. 3a)). Care is

taken during this technique to avoid tangling

the sutures. Once the posteromedial tying is

finished, the knee is positioned in valgus, near

extension and the suture is tested and repeated

if necessary. For some patients, the tear extends

to the midportion of the meniscus and requires

an additional repair through standard anterior

portal with meniscal suture anchor and/or an

outside-in suture (“extended tear”). The

posterior suture is then completed with a repair

through standard anterior portal with a meniscal

suture anchor (Fas T Fix device, Smith &

Nephew, Andover, MA) when the tear extends

to the pars intermedia and/or by Outside-In

sutures with PDS 1 (Ethicon, Inc., Somerville,

NJ) if the tear extends to the anterior segment

of the meniscus (fig. 3b). The stability of the

suture is then tested with the probe.

Fig. 2:

Suture of the posterior segment of the medial meniscus of the right knee through a posteromedial

portal with a suture hook device (25° suture lasso loaded with a N°2 fiberstick) (

a, b

) The sharp tip

penetrated the peripheral wall of the medial meniscus from outside to inside. (

) Next, the suture hook is

passed through the center (the inner portion) of the medial meniscus. (

) The first knot is tied with a knot

pusher. (

) A second suture is performed 5mm more posterior to the first one with a tigerstick. (f) The final

suture with non-absorbable suture from the anterior portal.