An Approach to Chronic and Displaced Bucket Handle Meniscal Tear—Assessment, Repair (Push-and-Pull Technique), or Salvage
| Autor: | Jun-Nian Beatrice Tan, Sir-Young James Loh |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Bucket Handle
030222 orthopedics medicine.medical_specialty business.industry medicine.medical_treatment 030229 sport sciences Meniscus (anatomy) Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Suture (anatomy) Push and pull medicine Technical Note Orthopedics and Sports Medicine Displacement (orthopedic surgery) business Range of motion Medial meniscus Reduction (orthopedic surgery) |
| Zdroj: | Arthroscopy Techniques |
| ISSN: | 2212-6287 |
| Popis: | Meniscal repairs are preferred to meniscectomies to preserve meniscal function and mitigate the risk of degeneration. However, repair of a chronic and displaced bucket handle tear of the meniscus can be technically challenging. We introduce a systematic method for assessment, reduction, repair, or salvage in this situation with an aim of reducing operating time and improving the chance of a favorable outcome. This technique describes repair of a bucket handle tear on the medial meniscus with displacement into the intercondylar notch. An arthroscopic probe is used for reduction and suture tension (push-and-pull technique) when using an all-inside suture device (FAST-FIX 360 repair system; Smith & Nephew) on the middle and posterior part of the tear. The anterior part of the tear is repaired with an outside-in method. If reduction is not possible, then a salvage reduction and hybrid repair is carried out instead. Postoperatively, patients will be nonweight-bearing on the operated limb, and range of motion restricted from 0 to 90° for 6 weeks, with the aim of resuming running by 6 months. Technique Video Video 1 This shows the repair technique used on a medial meniscus chronic bucket handle tear in a right knee flexed to 90°. Assessment of adequate reduction is done with the scope in the anteromedial portal and the probe in the anterolateral portal. There should be no gap between the inner and outer meniscal segments, and the segment should remain reduced without the probe on it. The FAST-FIX 360 all-inside repair system is then used to place 2 suture anchors above and below the friable torn segment. The probe is used to push on the anterior part of the knot and below the tensioning length to counter the pull or tensioning of the suture, to control the tightening of the suture loop and reduce the risk of suture cut out. The same method is used to repair the posterior half of the tear. To perform an anterior repair, the scope is switched to the anterolateral portal. The repair position is determined and blunt dissection down the capsule is performed. One trocar needle is placed above and one below the torn segment. This is for the same reason to minimize the risk of further damage to a friable and thin torn segment. After passing the sutures, the meniscus reduction is optimized with the probe via the anteromedial portal. |
| Databáze: | OpenAIRE |
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