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Meniscal Repair 29882

synonyms:meniscal repair, medial meniscal repair, lateral meniscal repair

Meniscal Repair CPT

Meniscal Repair Indications

  • Ideal tear for repair is a longitudinal tearwithin the peripheral 3mm with a length of 1-2cm.
  • Bucket handle meniscal tear
  • Tears within 3-4mm of the meniscocapsular junction.
  • Horizontal cleavage tear in a young patient
  • Posterior Meniscal Root tears
  • General Repair guidelines: active patients (typically aged <50 years) with no significant osteoarthritis (Outerbridge grade 3 or 4), joint-space narrowing, or malalignment.

Meniscal Repair Contraindications

Meniscal Repair Alternatives

  • Nonoperative managment
  • Partial Meniscectomy
  • Meniscal Transplantation

Meniscal Repair Pre-op Planning / Special Considerations

  • Lateral repairs do better than medial tears.  PHLM has rich blood supply and does especially well with repair.  Flap tears not repairable unless PHLM.
  • Results of meniscal repairs are better in done within 8 weeks of injury.
  • rasp tear surfaces to bleeding surfaces
  • Load to failure of various repair systems: Barber FA, Arthroscopy 2000,16:613).

Lateral Meniscal Tear Inside-Out Technique

  • CPT code = 29882(arthroscopy knee with medial OR lateral meniscus repair); 29883 (medial AND lateral repair)
  • Risks = peroneal nerve, popliteal vessels
  • posterolateral incision along the posterior margin of the IT band extended distal @ 3cm.
  • Dissection between anterior border of biceps and posterior margin of IT band. 
  • Blunt dissection between arcuate complex and capsule anteriorly and the lateral gastroc posteriorly. 
  • Popliteal retractor placed ensuring protecting of peroneal nerve. 
  • Rasp tear surfaces to bleeding edges.
  • 2-0 Ethibond on tapered needle.  Veritcal mattress is best, placed 4-5mm intervals inserted from both upper and lower surfaces

Medial Meniscal Tear Inside-out Technique

  • Risks = saphenous nerve and vein, popliteal vessels
  • 3-6cm longitudinal incision in soft spot between posterior border of the superficial MCL and posterior oblique ligament. 
  • Majority of incision is below joint line. 
  • Ensure saphenous vein is not cut.
  • Dissect down to sartorial fascia.
  • Incise sartorial fascia anterior to the sartorius and retract pes tendons posteriorly.
  • Avoid excessive retraction on pes anserinus and sartorial branch of saphenous nerve which will lie posteriorly with knee flexed. 
  • Palpate direct head of semimembranosus attachment to posterior tibial tubercle. 
  • May need to release attachement if semimembranosus is too tight. 
  • Develop plane between posterolmedial capsule anteriorly, semimembranosus inferiorly and medial head of gastroc posteriorly.
  • Place popliteal retractor just behind posterior capsule. 
  • Rasp tear surfaces to bleeding edges.
  • 2-0 Ethibond on tapered needle.  Veritcal mattress is best, placed 4-5mm intervals inserted from both upper and lower surfaces. Sutures are best placed through the contralateral portal while viewing from the ipsilateral portal.

PosteriorMeniscal Root Repair

  • Positioned with the knee in 90° of flexion. 
  • Medial and lateral parapatellar arthroscopic portals created. 
  • Consider accessory posteromedial or posterolateral portals 
  • Place guidepin from anteromedial aspect of the tibia exciting at the anatomic tibial attachment of the medial or lateral posterior meniscal root using an anterior cruciate ligament aiming device
  • Confirm guide pin position with direct arthroscopic visualization or fluoroscopy
  • Drill/ream 5mm transtibial tunnel over the guide pin. 
  • Use accessory portal to place an arthroscopic grasper to firmly hold the torn root and to more effectively position it toward the suture passer.
  • Pass 2 No. 2 nonabsorbable sutures in a superior-to-inferior direction through the substance of the meniscal root, shuttled down the transtibial tunnel, and secured over the anteromedial tibial cortex with a cortical button for fixation 
  • LaPrade RF, JAAOS 2015:23:71-76

Meniscal Repair All-inside Techniques

  • All-inside techniques depend on device used. See manufactures technique.
  • Smith and Nephew Fast-Fix
  • USS Sports Meniscal Stapler XLS
  • Depuy RapidLoc meniscal repair

Meniscal Repair Complications

  • Overall complication rate = 1.8% (Small NC, Arthroscopy 1988;3:215)
  • Failure of repair: approximately 25%
  • DVT: 9.9%, proximal DVT rate = 2.1% (Ilahi OA, Arthroscopy, 2005;21:727)
  • Stiffness / Arthrofibrosis
  • Chondral Injury / Arthritis
  • Infection
  • NVI (saphenous neuralgia medially; common peroneal nerve/popliteal artery laterally)
  • Fluid Extravastion / Compartment Syndrome
  • Complex Regional Pain Syndrome: rare
  • Hemarthrosis
  • Synovial fistula

Meniscal Repair Follow-up care

  • Non-weight bearing for 6 weeks to allow meniscal healing. Generally place in post-operative brace with ROM from 0-90°.
  • 6-8 weeks post-op: removed brace, begin full weight-bearing with unrestricted motion.
  • 3months: return to full normal activities, except competitive sports.
  • 6months: unrestricted activity. Return to competitive sports.

Meniscal Repair Outcomes

  • All-inside meniscal repair success rate is between 80% and 90%
  • 89% heal (O'shea JJ, AJSM 2003;31:216).
  • 87% asymptomatic at 33 months post-op (Noyes FR, Arthroscopy 2000;16:822).

Meniscal Repair Review References