[Arthroscopic meniscal suture].
OBJECTIVE
Restoration of the function of the meniscus by suturing a tear to prevent long-term degeneration.


METHODS
Unstable longitudinal meniscal tear in the red and red-white zones with an intact central fragment. Dislocated bucket-handle tear near the base in the presence of good-quality tissue.


METHODS
Lesion of the central meniscal fragment. Meniscal tears in the white, avascular zone. Degenerative meniscal lesions. Complex meniscal lesions. Untreated knee ligament instability. Uncooperative patient.


METHODS
Standard anterior arthroscopy approach. Revitalization of the tear margins and the perimeniscal synovial membrane, trephination of the base of the meniscus to promote healing. Fixation of the tear with a resorbable or nonresorbable suture size 2-0 to 0 USP by means of different suture techniques. "Outside-in technique": the suture is introduced from outside the joint through the base of the meniscus using a cannulated needle and is then pulled back out using a suture loop inserted with another cannulated needle. The U-suture is knotted over the joint capsule through a stab incision. "Inside-out technique": the suture is introduced using a needle through a guide cannula from outside the joint through the meniscus and joint capsule and then brought out of the joint. The U-suture is knotted over the capsule through a short skin incision. "All-inside technique": the suture loop is passed through the meniscal tear and knotted within the joint using a posterior arthroscopy approach.


METHODS
Full weight bearing without a brace for short tears with one suture. For tears with two sutures, partial weight bearing for 4 weeks without a brace. For large tears with three to four sutures, partial weight bearing up to 20 kp for 6 weeks and restricted knee motion in a brace up to 0/0/60 degrees .


RESULTS
The healing rate for knee joints with stable ligaments and an isolated meniscal tear is between 50% and 75%. In cases with simultaneous ACL (anterior cruciate ligament) plasty, the healing rate is > 75%; for unstable knee joints it is < 50%.
Petersen
Wolf
W
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstrasse 1, D-48149 Münster, Germany. wolf.petersen@ukmuenster.de
Zantop
Thore
T
D000293:Adolescent; D000328:Adult; D020679:Arthroscopes; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000517:prevention & control; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D013525:Surgical Instruments; D013536:Suture Techniques; D000070600:Tibial Meniscus Injuries; D016474:Weight-Bearing / Q000502:physiology