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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The effect of suture type on meniscus repair. A clinical analysis.Am J Knee Surg. 1997; 10: 2-9
- All-inside meniscus repair: A systematic review.Clin Orthop Relat Res. 2007; 455: 134-141
- The “all-inside” meniscus repair.Arthroscopy. 1991; 7: 120-125
- Arthroscopic all inside repair of the lateral meniscus root tear.Knee. 2009; 16: 77-80
- Biomechanical evaluation of arthroscopic all-inside meniscus repairs.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1347-1353
- Meniscal repair using the FasT-Fix all-inside meniscal repair device.Arthroscopy. 2005; 21: 167-175
- Arthroscopic evaluation of meniscal repairs: Factors that effect healing.Am J Sports Med. 1994; 22: 797-802
- Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears.Arthroscopy. 2015; 31: 293-298
- All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: Introducing 10,000 and 100,000 loading cycles.Am J Sports Med. 2014; 42: 2226-2233
- Biomechanical evaluation of an all-inside suture-based device for repairing longitudinal meniscal tears.Arthroscopy. 2015; 31: 428-434
- Determination of the safe penetration depth during all-inside meniscal repair of the posterior part of the lateral meniscus using the FastT-Fix suture repair system.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1868-1875
- Vascular risk associated with meniscal repair using Rapidloc versus FasT-Fix: Comparison of two all-inside meniscal devices.J Knee Surg. 2007; 20: 235-240
- Pitfalls associated with FasT-Fix meniscal repair.Arthroscopy. 2002; 18: 939-943
- The effect of knee flexion angle on the neurovascular safety of all-inside lateral meniscus repair: A cadaveric study.Arthroscopy. 2015; 31: 2138-2144
- Location of the popliteal artery and its relationship with the vascular risk in the suture of the posterior horn of the lateral meniscus.Rev Esp Cir Ortop Traumatol. 2015; 59: 165-171
- Meniscus repair: Considerations in treatment and update of clinical results.Clin Orthop Relat Res. 2002; 402: 122-134
- Can interepicondylar distance predict joint line position in primary and revision knee arthroplasty?.Am J Orthop. 2011; 40: 175-178
- Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients.Arthroscopy. 2008; 24: 810-816
- Results of all-inside meniscal repair with the FasT-Fix meniscal repair system.Arthroscopy. 2006; 22: 3-9
- Microvasculature of the human meniscus.Am J Sports Med. 1982; 10: 90-95
- Decision-making factors in the treatment of meniscal lesions.Clin Orthop Relat Res. 1990; 252: 49-54
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
