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
- NVI (saphenous neuralgia medially; common peroneal nerve/popliteal artery laterally)
- Fluid Extravastion / Compartment Syndrome
- Complex Regional Pain Syndrome: rare
- 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