What did the study look at?
The meniscus is a cartilage-like structure in the knee that helps spread load between the thigh bone and shin bone. A horizontal cleavage tear splits the meniscus into an upper and a lower layer (leaflet) and extends into central areas with a poor blood supply. It is therefore considered difficult to repair and has often been treated by removing part of the meniscus.
The authors refer to studies showing that removing meniscal tissue can adversely affect joint mechanics, whereas repair can restore contact pressures to normal. The aim of the article is to describe, step by step, the technique they use to repair this tear type.
How was it done?
This is a surgical technique article, with a video of the procedure performed on a right knee. The main steps are:
- Access and assessment: the knee is viewed through standard arthroscopic portals, and the tear pattern is examined with a probe. The leg is placed in a "figure-of-four" position to reach the lateral meniscus.
- Tear preparation: frayed edges are trimmed, taking care not to remove healthy meniscal tissue.
- Repair: a self-passing, all-inside suture device is used to place "circumferential compression stitches" that encircle both leaflets. Stitches are added along the tear until probing shows a stable construct, and knots are pushed to the edge to avoid cartilage damage.
- Marrow venting: 4 to 5 small holes are made with an awl in the notch at the centre of the knee, and leakage of bone marrow elements into the joint is confirmed visually.
After surgery, physiotherapy begins on day 1; partial weight-bearing with crutches is used for 2 weeks, and deep squatting and heavy lifting are avoided for 4 months. Suitable candidates are described as young adults whose symptoms persist despite non-operative care and who do not have significant instability or osteoarthritis.
What did it find?
This is not an outcome study and reports no new patient data. In their discussion, the authors summarise earlier work: circumferential compression stitches have shown high strength in biomechanical tests; in one randomised trial, repairs augmented with marrow venting reached a 100% healing rate at 36 months compared with 76% for repair alone; and a case series of this tear type reported 91% healing.
The authors' conclusion
The authors state that the technique gives uniform compression across both leaflets with a biomechanically stronger construct, is technically simple, and does not put nerves and blood vessels at risk during suture passage. They add that marrow venting creates a healing environment similar to that of meniscal repair performed alongside anterior cruciate ligament reconstruction.
Limitations
The disadvantages listed by the authors are:
- a risk of suture loosening if knots are not tied properly;
- it is not well suited to repairing a vertical separation of the meniscus from the joint capsule;
- a higher cost than inside-out repair.
Reference
Mameri ES, Verdejo FG, Dasari SP, Kerzner B, Shah S, Kasson LB, Khan ZA, Fortier LM, Damodar D, Gürsoy S, Chahla J. (2022). Repair of a Horizontal Cleavage Tear of the Lateral Meniscus with Circumferential Compression Stitches and Marrow Venting Augmentation. Arthroscopy Techniques, 11(11), e1937-e1944. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.eats.2022.07.008
Free full text: PubMed Central (PMC9705603)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
