Meniscus Tears: Meniscus Repair Using an All-Inside Technique

Meniscus Tears: Meniscus Repair Using an All-Inside Technique

This is a cadaver demonstration of an arthroscopic all-inside meniscus repair surgery. It is called an all-inside procedure because there are no incisions that need to be made on the side or the back of the knee to do the repair.

The implant that will be used in this video is made entirely of suture. There are no plastic pieces used in the knee. This is a left knee with the scope camera in the lateral or outside portal. It is looking across the knee joint and looking at the medial compartment. Here is the end of the thigh bone, or femur. Here is the top of the shin bone, or tibia, and here is the meniscus.

The surgeon is using a probe instrument to find the meniscus tear and to see how big it is. Here is the torn tissue that needs to be fixed. It goes all the way through the meniscus from top to bottom. First, the frayed edges get trimmed, so there are nice clean edges to heal together.

When the surgeon decides where they will put the suture implants, the first device is brought into the knee and the needle is inserted on one side of the tear. The surgeon will place the first implant through the needle and behind the tissue in the knee by spinning the thumb wheel on the handle of the device. The needle is then moved to the second location on the other side of the tear and the same steps are repeated.

After the second implant is behind the tissue in the knee, the device is completely removed and the sutures that remain are a loop and a long tail. Next, the surgeon will place a smooth metal instrument up through the loop and pull. This tightens the first suture between the two implants and brings the edges of the tear together. The instrument is removed from the loop and the long tail is then pulled, tightening the second suture across the tear.

Since this is a larger tear, the surgeon will place multiple sutures next to each other to bring all of the tissue back together. She will put a few more on top of the meniscus, but this makes the inner edge of the tissue flip up and out of place. The same sutures can be placed under the meniscus to bring the edges underneath together and as a result, bring the inner edge of the meniscus back to its normal position. Here is what the final repair looks like.