Purpose
To identify desired minimum depth setting for safe, effective placement of the all-inside
meniscal suture anchors.
Methods
Using 16 cadaveric knees and standard arthroscopic techniques, 3-dimensional surfaces
of the meniscocapsular junction and posterior capsule were digitized. Using standard
anteromedial and anterolateral portals, the distance from the meniscocapsular junction
to the posterior capsule outer wall was measured for 3 locations along the posterior
half of medial and lateral menisci. Multiple all-inside meniscal repairs were performed
on 7 knees to determine an alternate measure of capsular thickness (X2) and compared with the digitized results.
Results
In the digitized group, the distance (X1) from the capsular junction to the posterior capsular wall was averaged in both menisci
for 3 regions using anteromedial and anterolateral portals. Mean distances of 6.4
to 8.8 mm were found for the lateral meniscus and 6.5 to 9.1 mm for the medial meniscus.
The actual penetration depth was determined in the repair group and labeled X2. It showed a similar pattern to the variation seen in X1 by region, although it exceeded predicted distances an average 1.7 mm in the medial
and 1.5 mm in the lateral meniscus owing to visible deformation of the capsule as
it pierced.
Conclusions
Capsular thickness during arthroscopic repair measures approximately 6 to 9 mm (X1), with 1.5 to 2 mm additional depth needed to ensure penetration rather than bulging
of the posterior capsule (X2), resulting in 8 to 10 mm minimum penetration depth range. Surgeons can add desired
distance away from the meniscocapsular junction (L) at device implantation, finding
optimal minimal setting for penetration depth (X2 + L), which for most repairable tears may be as short as 8 mm and not likely to be
greater than 16 mm.
Clinical Relevance
Minimum depth setting for optimal placement of all-inside meniscal suture anchors
when performing all-inside repair of the medial or lateral meniscus reduces risk of
harming adjacent structures secondary to overpenetration and underpenetration of the
posterior capsule.
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Article info
Publication history
Published online: April 04, 2016
Accepted:
January 15,
2016
Received:
June 5,
2015
Footnotes
The authors report the following potential conflict of interest or source of funding: The Smith & Nephew Company supported the research by providing the FasT-Fix devices. P.C.N. reports royalties: Zimmer, Stryker, OMNI Sciences, Springer; consultant: Zimmer; Research support: Zimmer, OMNI Sciences, Ceramteh; other support: Arthrex, Musculoskeletal Transplant Foundation; publisher support: Springer; and board membership: Journal of Arthroplasty, Journal of Hip Preservation Surgery, Hip Society, Knee Society, ISTA.
Identification
Copyright
© 2016 by the Arthroscopy Association of North America
