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Title: A novel technique for modified all-inside repair of bucket-handle meniscus tears using standard arthroscopic portals
Authors: Yik, J.H
Koh, B.T.H
Wang, W 
Keywords: adult
case report
diagnostic imaging
knee injury
knee meniscus
knee meniscus rupture
Knee Injuries
Menisci, Tibial
Tibial Meniscus Injuries
Issue Date: 2017
Citation: Yik, J.H, Koh, B.T.H, Wang, W (2017). A novel technique for modified all-inside repair of bucket-handle meniscus tears using standard arthroscopic portals. Journal of Orthopaedic Surgery and Research 12 (1) : 188. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Background: Bucket-handle meniscus tears (BHMT) are often displaced and unstable. The inside-out technique of repairing such tears is currently the gold standard. All-inside repair with meniscal fixators is getting increasingly popular. Shortcomings of the inside-out technique include neurovascular complications, especially saphenous nerve palsy, and retention of a non-resorbable suture which can result in discomfort to patient, granuloma formation, and a foci of infection. Hence, the purpose of this project was to innovate a novel all-inside technique to precisely reduce and fix BHMT while avoiding neurovascular complications and retention of a non-resorbable suture. Methods: Routine arthroscopic portals were created on a patient's left knee with a displaced BHMT. Through the anteromedial portal, a conjoint pseudo double lumen cannula was inserted. Two limbs of a reduction suture were passed through the cannula, one over the "femoral" surface of the meniscus, one over the "tibial" surface of the meniscus anterior to the biceps femoris tendon, with the knee flexed at 20° to avoid injury to the saphenous nerve. Suture limbs were passed out percutaneously and tensioned. Results: Anatomic reduction was ensured under arthroscopic visualization with ease. All inside repair was performed using the vertical mattress suture configuration. Reduction sutures were subsequently removed by cutting flush to the skin and pulling on one suture limb. The patient was back to full activities with minimal discomfort 8months post-operatively. Conclusion: The technique described is superior to existing techniques for the following reasons: (1) Reduction of the displaced meniscal tear is "extra-meniscal," avoiding further trauma to a damaged meniscus. (2) Tensioning of the two suture limbs created promotes better control of reduction through tensioning. (3) Risk of discomfort, infection, and neurovascular damage caused by a retained suture is reduced. (4) No additional portals/equipment is required. We encourage this novel technique to be attempted by surgeons. © 2017 The Author(s).
Source Title: Journal of Orthopaedic Surgery and Research
ISSN: 1749799X
DOI: 10.1186/s13018-017-0692-y
Rights: Attribution 4.0 International
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