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AOSM A new technique for arthroscopic meniscectomy using a traction suture

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Arthrosc Orthop Sports Med 2015;2(2):117-119 117 A new surgical technique for excision of irreparable meniscal tears is presented in this article. A spinal needle, a suture hook, and a suture material (#1-0 Prolene; Ethicon, Malmo, Sweden) are used to maneuver the mobile portion of a torn meniscus during meniscectomy. Manually maneuvering the free fragment with a traction suture makes it possible to excise any parts of the tear under direct visualization without the need for an additional portal. It also reduces the risk of iatrogenic cartilage injury and loss of the excised fragment in the knee joint. The technique using a traction suture is convenient and easy to perform based on our experience.

Keywords: Arthroscopic menisectomy; Irreparable meniscus tear; Traction suture

http://dx.doi.org/10.14517/aosm15001 pISSN 2289-005X·eISSN 2289-0068

A new technique for arthroscopic meniscectomy using a traction suture

Byoung-Kook Kim

1

, Jinmyoung Dan

1

, Yoon-Seok Lee

1

, Ho-Jae Lee

1

, Seong-Eun Byun

2

1Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University, Gumi; 2Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Copyright © 2015 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine. All rights reserved.

CC This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/

by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received February 2, 2015; Revised February 20, 2015; Accepted February 21, 2015

Correspondence to: Jinmyoung Dan, Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University, 12 Sinsi-ro 10-gil, Gumi 730-040, Korea. Tel: +82-54-450-9869, Fax: +82-54-450-9899, E-mail: osjmdan@gmail.com

Technical Note

Arthroscopy and Orthopedic Sports Medicine

AOSM

INTRODUCTION

A meniscus tear is a common source of pain and functional impairment of the knee that is frequently enco untered by orthopedic surgeons [1]. The goals of surgical intervention for meniscal tears include pain relief, return to pre-injury level of daily activities, and pre vention of early degeneration of the cartilage of the knee joint. Although repair of a torn meniscus should be attempted whenever possible [2], meniscectomy should be considered for a displaced lon- gitudinal tear, a bucket-handle tear in the avascular zone, a tear with degenerative changes due to the inability to obtain anatomic reduction of the displaced fragment and deformation of a torn fragment [3].

Sometimes, resection of meniscus tears can be very challenging because the displaced or torn meniscus can be an obstacle to visualization of the compartments during arthroscopy. Furthermore, the joint space only allows insertion of a few instruments to handle the free fragment of a torn meniscus.

There are several reports describing different surgical techniques to overcome the difficulties encountered

during the removal of a free fragment of a meniscus tear [4–6]. Although numerous techniques have been introduced for meniscetomy, no manuscript has thoroughly described on the visualization and accurate resection of the torn meniscus using a traction suture.

Therefore, we describe a new technique for resection of a torn meniscus without creation of additional portals.

TECHNIQUE

The patient is positioned for a standard arthroscopic knee procedure. Diagnostic arthroscopy of the knee is performed using the standard anterolateral and anteromedial portals. Once the decision is made to perform a meniscectomy, a spinal needle or a suture hook is introduced into the knee joint through the working portal (Fig. 1).

Upon the spinal needle or suture hook penetrates the torn fragment, the suture material (#1-0 Prolene; Ethicon, Malmo, Sweden) is fed through the spinal needle or suture hook. After passing the suture through the torn fragment, the free end of the suture is retrieved through

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Byoung-Kook Kim, et al. A new technique for arthroscopic meniscectomy using a traction suture

www.e-aosm.org

118

the ipsilateral portal (Fig. 2). The hand-held suture is used to apply traction and handle the torn fragment. The same portal is then used to introduce a meniscal knife or a scissors (Fig. 3). The torn fragment is incised under tension and retrieved through the same portal. If necessary, the portals can be switched and the arthroscopic camera or other instruments can be slipped over the suture. This procedure can be done without instrument crowding and can also prevent loss of the excised fragments in the joint (Fig. 4). After complete excision, the remaining rim of the meniscus is contoured by a basket forceps or a motorized shaver.

DISCUSSION

Menisectomy requires removal of the mobile fragments and maintenance of the stable and smoothly contoured meniscal rim. Most of those steps are easily performed.

However, it can be difficult when surgeons encounter a large and long tear, a bucket-handle tear, or a small stiff joint that can cause iatrogenic cartilage damage during the arthroscopic procedure [7].

Fig. 1. Illustration of the proposed procedure. Using a traction suture allows optimal and stable handling of the torn and displaced meniscus without crowding of arthroscopic instruments.

Fig. 3. Using a traction suture can prevent collision of arthroscopic instruments.

Fig. 2. The torn meniscal fragment is handled with a traction suture (#1- 0 Prolene; Ethicon, Malmo, Sweden).

Fig. 4. The removal of the torn meniscal fragment is performed through the same portal in the patient who underwent arthroscopic meni- scectomy.

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Byoung-Kook Kim, et al. A new technique for arthroscopic meniscectomy using a traction suture

www.e-aosm.org 119

A displaced bucket-handle tear or a long oblique tear makes it difficult to visualize all the compartments during arthroscopy. In complicated cases, surgeons usually make some additional working portals to introduce other instruments to grasp and cut the mobile fragments. In addition, crowding of arthroscopic instruments can cause iatrogenic chondral injury during the arthroscopic procedure. The spinal needle or suture hook has a low profile to handle in the knee. Our technique allows penetration through the torn meniscus and introduction of a suture material through the spinal needle or suture

hook without difficulties. With our technique, arthroscopic resection of the torn meniscus can be performed as a whole using a traction suture without creation of additional portals while reducing the risk of damaging healthy articular cartilage during the procedure.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Clayton RA, Court-Brown CM. The epidemiology of musculo- skeletal tendinous and ligamentous injuries. Injury 2008;39:

1338-44.

2. Jarit GJ, Bosco JA 3rd. Meniscal repair and reconstruction. Bull NYU Hosp Jt Dis 2010;68:84-90.

3. Lento PH, Akuthota V. Meniscal injuries: a critical review. J Back Musculoskelet Rehabil 2000;15:55-62.

4. Paksima N, Ceccarelli B, Vitols A. A new technique for arthro- scopic resection of a bucket handle tear. Arthroscopy 1998;14:

537-9.

5. Binnet MS, Gürkan I, Cetin C. Arthroscopic resection of bucket-

handle tears with the help of a suture punch: a simple technique to shorten operating time. Arthroscopy 2000;16:665-9.

6. Ahn JH, Oh I. Arthroscopic partial meniscectomy of a medial meniscus bucket-handle tear using the posteromedial portal.

Arthroscopy 2004;20:e75-7.

7. Uzümcügil O, Doğan A, Yalçinkaya M, Mumcuoğlu E, Kabukçuoğlu Y. The three portal (including transpatellar tendon portal) versus two portal technique in the arthroscopic menisectomy procedure for isolated medial bucket-handle type meniscal tears. Eklem Hastalik Cerrahisi 2010;21:38-43.

수치

Fig. 2. The torn meniscal fragment is handled with a traction suture (#1- (#1-0 Prolene; Ethicon, Malmo, Sweden).

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