Arthroscopic All-Inside Meniscal Repair



Arthroscopic All-Inside Meniscal Repair


Matthew H. Blake

Darren L. Johnson






Anesthesia

• General with laryngeal mask airway (LMA) or sedation and local anesthesia

• 0.5% ropivacaine at the portal sites

• ±Regional block

• Weight-based dose of third-generation cephalosporin

• ±Anticoagulation: stratified by risk factors such as prior deep venous thrombosis (DVT) or clotting disorder


Positioning

• The patient is positioned supine.

• A bump can be placed underneath operative hip.

• Leg support must allow the knee to achieve full range of motion including application of varus and valgus stress and should be positioned to allow circumferential access to the knee.

Leg holder:

▪ Placed perpendicular to the femur at mid- to upper thigh to allow placement of varus and valgus forces on the knee.

▪ The leg should be internally rotated before the holder is secured so that the patella is en face.

▪ The end of the table is lowered past 90 degrees from horizontal to allow the leg to hang freely (Fig. 35-1).






Figure 35-1 | Patient positioned with a leg holder to allow circumferential access to the knee.

Lateral post:

▪ Placed midthigh and angled to allow a valgus force on the knee.

▪ The surgeon may leave the end of the table up or drop the end of the table.

• The contralateral leg with a sequential compression device (SCD) is placed in a padded well-leg holder of surgeon’s choosing.



Surgical Approach

• Overview

• Portals are created using no. 11 blade.

• Standard portals are the anterolateral and anteromedial portals.

• Accessory portals can be used depending on tear patterns and repair strategies (Fig. 35-2).






Figure 35-2 | Standard anterolateral and anteromedial portals shown with possible accessory portals (right knee).

• Portals

• The anterolateral portal is created 5-10 mm lateral to and at the level of the inferior pole of the patella in the anatomic “soft spot.”

• The arthroscope is introduced to the notch, and the fat pad is swept anteriorly.

• The anteromedial portal is established under direct vision by localizing the entry point with a spinal needle.

▪ If the lateral meniscus is to be repaired, then the portal should be 3-5 mm superior to the anteromedial horn of the meniscus so that the suture passage device can be advanced over the tibial eminence and underneath the femoral condyle (Fig. 35-3).

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Oct 1, 2018 | Posted by in SPORT MEDICINE | Comments Off on Arthroscopic All-Inside Meniscal Repair

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