Detailed Explanation of Meniscus Suture Technique
shape of the meniscus
Inner and outer meniscus.
The distance between the two ends of the medial meniscus is large, showing a "C" shape, and the edge is connected to the joint capsule and the deep layer of the medial collateral ligament.
The lateral meniscus is "O" shaped. The popliteus tendon separates the meniscus from the joint capsule in the middle and posterior 1/3, forming a gap. The lateral meniscus is separated from the lateral collateral ligament.
The classic surgical indication for meniscus suture is the longitudinal tear in the red zone. With the improvement of equipment and technology, most meniscus injuries can be sutured, but the patient’s age, course of disease, and lower extremity force line also need to be considered. , combined injury and many other situations, the ultimate purpose of suture is to hope that the meniscus injury will heal, not suture for suture!
The meniscus suture methods are mainly divided into three categories: outside-in, inside-out and all-inside. Depending on the suturing method, there will be corresponding suturing instruments. The simplest There are lumbar puncture needles or ordinary needles, and there are also special meniscal suturing devices and meniscal suturing devices.
The outside-in method can be punctured with a 18-gauge lumbar puncture needle or a 12-gauge beveled ordinary injection needle. It is simple and convenient. Every hospital has it. Of course, there are special puncture needles. - Ⅱ and 0/2 of the love state. The outside-in method is time-consuming and cannot control the needle outlet of the meniscus in the joint. It is suitable for the anterior horn and body of the meniscus, but not for the posterior horn.
No matter how you thread the leads, the end result of the outside-in approach is to reroute the suture that entered from the outside and through the meniscus tear to the outside of the body and knotted in place to complete the repair suture.
The inside-out method is better and opposite to the outside-in method. The needle and lead are passed from the inside of the joint to the outside of the joint, and it is also fixed with a knot outside the joint. It can control the needle insertion site of the meniscus in the joint, and the suture is more neat and reliable. . However, the inside-out method requires special surgical instruments, and additional incisions are needed to protect the blood vessels and nerves with arc baffles when suturing the posterior horn.
All-inside methods include stapler technology, suture hook technology, suture forceps technology, anchor technology and transosseous tunnel technology. It is also suitable for anterior horn injuries, so it is more and more respected by doctors, but total intra-articular suturing requires specialized surgical instruments.
1. The stapler technique is the most commonly used full-articular method. Many companies such as Smith nephew, Mitek, Linvatec, Arthrex, Zimmer, etc. produce their own staplers, each with its own advantages and disadvantages. Doctors generally use them according to their own hobbies and Familiarity to choose, in the future, newer and more humanized meniscus staplers will emerge in large numbers.
2.The suture forceps technology is derived from shoulder arthroscopy technology. Many doctors feel that the suture forceps of the rotator cuff are convenient and quick to use, and they are transferred to the suture of meniscus injuries. Now there are more refined and specialized meniscus sutures on the market. Pliers for sale. Because the suture forceps technology simplifies the operation and greatly shortens the operation time, it is especially suitable for the injury of the posterior root of the meniscus, which is difficult to suture.
3. The real anchor technology should refer to the first-generation meniscal sature repair, which is a staple specially designed for meniscus suture. This product is no longer available.
Nowadays, anchor technology generally refers to the use of real anchors. Engelsohn et al. first reported in 2007 that the suture anchor repair method was used for the treatment of medial meniscus posterior root injury. Anchors are inserted into the printed area and sutured. Suture anchor repair should be a good method, but whether it is the medial or lateral semilunar root posterior root injury, the suture anchor should have many problems such as lack of suitable approach, difficulty in placement, and inability to screw the anchor in perpendicular to the bone surface. , unless there is a revolutionary change in anchor fabrication or better surgical access options, it is difficult to become a simple, convenient, reliable and commonly used method.
4. The transosseous tract technique is one of the total intra-articular suture methods. In 2006, Raustol first used this method to suture the medial meniscus posterior root injury, and later it was specially used for lateral meniscus posterior root injury and radial meniscus body tear and tear in the meniscus-popliteus tendon region, etc. The method of trans-osseous suture is to firstly scrape the cartilage at the insertion point after confirming the injury under arthroscopy, and use the ACL tibial sight or special sight to aim and drill the tunnel. Single-bone or double-bone canal can be used, and single-bone canal can be used. Method The bone tunnel is larger and the operation is simple, but the front must be fixed with buttons. The double-bone tunnel method needs to drill one more bone tunnel, which is not easy for beginners. The front can be directly knotted on the bone surface, and the cost is low.