Dr. Who ass socks with seams

The arthroscopic meniscal suture

Operation objective

Restoration of the function of the meniscus by suturing a tear to avoid long-term degenerative damage.

Indications

Unstable longitudinal meniscus tear in the red and red-white zone with an intact central fragment.

Dislocated basket handle tear near the base with good tissue quality.

Contraindications

Lesion of the central fragment of the meniscus.

Meniscal tears in the white, avascular zone.

Degenerative meniscal lesions.

Complex meniscal lesions.

Untreated knee ligament stability.

Uncooperative patient.

Surgical technique

Standard anterior arthroscopic approaches. Freshening the edges of the cracks and the perimeniscal synovial membrane, trepanation of the meniscus base to promote healing. Fixation of the tear with an absorbable or non-absorbable suture of size 2-0 to 0 USP using various suturing techniques.

"Outside-inside technique": The thread is inserted from the extra-articular through the meniscus base via a puncture cannula and pulled back extra-articularly with a thread loop over a second puncture cannula. Knot the U-suture over the joint capsule through a stab incision.

"Inside-outside technique": The thread is guided via a guide cannula with a needle from intra-articular through meniscus and joint capsule to extra-articular. Knot the U-suture over the capsule through a short skin incision.

"Inside-inside technique": Laying a thread loop through the meniscus tear and knot intra-articularly with special instruments. A posterior arthroscopic approach is required with the conventional technique.

Follow-up

For short tears with one seam, full load without an orthosis. In the case of tears treated with two sutures, partial load for 4 weeks without an orthosis. For larger cracks with three to four seams partial load of 20 kp for 6 weeks and limitation of knee mobility in an orthosis to 0/0/60 °.

Results

In knee joints with stable ligaments and an isolated meniscus tear, the healing rate is between 50% and 75%. If a cruciate ligament replacement is performed at the same time, the healing rate is> 75%, for unstable knee joints <50%.