Name: Arthroscopic Lateral Meniscus Transplant
Uploaded: 2018-08-13T00:00:00Z
Channel: Arthrex
Description: J. Lee Pace, MD, (Farmington, CT) demonstrates an arthroscopic lateral meniscus transplant providing anatomical fixation by securing the transplant to the remnant rim of the meniscus.

<p>J. Lee Pace, MD, (Farmington, CT) demonstrates an arthroscopic lateral meniscus transplant providing anatomical fixation by securing the transplant to the remnant rim of the meniscus.</p>

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VID1-01398-EN | A | Arthroscopic Lateral Meniscus Transplant

J. Lee Pace

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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Arthroscopic Lateral Meniscus Transplant

We are going to demonstrate today an arthroscopic lateral meniscus transplant using sockets created with a FlipCutter. A lateral meniscus with small little bone plugs on it. And one of the unique things that I want to show today is how to use the meniscal knee Scorpion to place a couple all meniscal based repair sutures in the posterior horn. So this is going to be different than using some sort of capsular based repair device, such as a cinch or going inside out. I really like using this knee Scorpion for this meniscal based repair, because it's going to preserve the natural give or play the posterior horn of the lateral meniscus has. So you can see we've got pretty much everything we need here. We've already prepared the lateral meniscus. So you can see here we've we've got small little bone plugs. This is the anterior horn I've put a P here for the posterior horn. We have a very small purposeful fleck of bone on the back. This is to allow it to get into the into the joint. Easy. And a more typical bone plug here. This is number two. Fiberwire. Number two. Tigerwire. This is an O FiberWire passing suture. Here we're going to use we're going to use the route repair guide to create a socket for the posterior horn. We've got the multi-use ACL guide here for the anterior horn FlipCutter mini SutureLasso NE Scorpion. So we've already got the knee prepped. So what we're gonna do first is we're going to pass a couple of sutures in the posterior horn with the knee Scorpion. What we're going to do first is we're going to pass the sutures through the residual rim of the posterior horn of the lateral meniscus. We've got A2O FiberWire taken from the inside out meniscus needles here. I've color coded this one purple on the tip just so I can kind of help tell them apart. But I'll load this up on the Scorpion standard. We've established a passport cannula here laterally, so we'll get inside the joint. We're going to come in. We're going to view medially. We've got the passport established laterally. So we'll come in with the Scorpion. You can see there's my route right over there. There's the intact the residual rim of the lateral meniscus. We've already debrided, so I'm going to come through here a little bit closer to the root. There you can see the suture passing through right there. We're going to take that and just pull that through just like that. And then we'll take the second suture and load that up. And then we'll go just a little more lateral with this bite here. Got to make sure we get underneath that rim of tissue there. So we've got a good bite. And that looks pretty good. And we'll watch the needle pass. This is where we're going to use a mini SutureLasso. And we're going to just shuttle these out of the way. And I'm going to take two stabs through here. So there I am I'm coming above the meniscus. And so we'll bring this in and then we'll shuttle that through. And we'll bring this out. Now we're going to identify the the superior limb of each of these sutures. And we're going to pass this out. So what we'll do is just kind of get all the four strands separated. And then let's watch them in the joint. We've got to find the ones that are on top going through the superior aspect of the meniscus. So you're pulling one of them there. So we'll isolate that one and then let's get the one that's more lateral. The superior limb on the more lateral one. We're going to pass those through here. Now we'll come underneath the meniscus here. And we'll pull those through. Great. So now you can see we've got through the posterior rim. We've got a suture being passed and we've got the superior limbs coming out above the meniscus up here, right up there. And then beneath the meniscus, we have the inferior limbs. After we get the the transplant in, we're going to retrieve all of these. We'll load these inferior limbs back up through the Scorpion and then pass them through the transplant to get an all meniscal based fixation. Now we can go ahead and do the sockets for the roots. I find it easier to drill through the medial portal. So this is our meniscus. The root repair guide. And this is going to hook over the back here. And for this one we've sort of predetermined that the 7.5 marking is what we want this to go. So make sure that we still like our spot. We'll rotate that how we want it. Here we are. We've got the position that we like. We're at 7.5mm offset here. So what we're going to do now is we're going to prepare our socket. So the first thing we're going to use is this 3.5mm guide pin, which is the same diameter as the FlipCutter. But we're going to use this because this should increase our accuracy and make sure that we have this right where we want it to go. And then once we have this in place, then we can swap it out for the FlipCutter. This minimizes the chance of creating a tunnel where it's malpositioned and you have to try and reposition it. So we're going to do this first, and now the FlipCutter is just going to follow that path right up. And you see that's absolutely perfect. It's exactly where we want it to go. That extra guide pin has a little bit sharper cutting flute than the FlipCutter does, so it more precisely directs you into where you want to go. So now from here, what we're going to do is we only need to create a socket that's about 15mm or so. It does not need to be very long. And then we'll get for the posterior horn. We think we have the tiger stick so we'll use that. Now what I'm going to do is I'm going to switch to the medial side so I can retrieve this through the passport okay. So we'll get that and bring that out. You can go ahead and take those off now. Now I'm back I'm viewing from my lateral portal again. You can see the sutures from the posterior root. Now we're going to come in with the multi-use guide here anterior horn root. So I'm just going to put the Mu guide just sitting right there. So again we'll push that up onto bone. And what we'll do is we'll angle this one a little bit away. Now that we've got our Mu guide in, you can see how I'm right in the middle of my anterior root of my lateral meniscus here. And then on the tibia, we've got the guide in place such that it's a safe distance away from where we drilled our posterior root tunnel. So we're going to come back in with this guide pin again. And that's going to come right up perfectly like just like that. And then we'll switch that for the FlipCutter. Now we've got our FlipCutter placed in our desired position in the anterior root. So we're going to create a similar sized socket here about 15mm. [00:06:10] There we go. Then we'll pass our FiberStick up just like that. And then again I'm going to switch portals. Grab the suture and those can come out. We've got our posterior root. We've got our anterior root sutures right there. So I'm going to come in use the mini SutureLasso one more time and air on one side. I'm going to just on the top end of the of where I want the meniscus to go. We've got everything in place now that we need to pass the meniscus, so we've got our passing stitches for the posterior root, we've got our passing nitinol wire for the body, and we've got our passing stitches for the anterior root. Pull the passport out. Posterior horn has the P on it. So we'll load that up. And we try to you know tiger with tiger here. So we keep everything straight. So we'll load this up through here. And bring that down through like that. And then what we'll do is we'll pass the nitinol wire with this o FiberWire that we placed here through the body. Again, this is sort of a shuttle stitch. And then we can pass the anterior route just like that. Just use differential tension on all these things to kind of pull them in. What we'll do is we'll go first with the posterior route. So we'll go ahead and start pulling that in okay. And once we have that now I pull a little bit of extra slack off of that body. All right. Now keep going with the posterior route. And we should start seeing that come into play just like that. Yep. Okay. And go ahead and pull the body a little bit. Now if we have something to kind of to push it with, you can see it's a little bit flipped right now, but we'll just manipulate that and go ahead and pull the posterior root just a little bit more. There it goes. And then we've got the body right there. And now we can start pulling the anterior horn in. We can see we have our posterior root dunked. We have our sutures here pulling it out to the body. Now we've got our anterior horn just like that. So now what we need to do now is we're going to retrieve these sutures from over here. There's our superior sutures right there, and then we'll come and get our inferior sutures from underneath the meniscus. Then we're going to pass these through the posterior horn to get an all meniscal based repair. So I'll actually reinsert the passport. I'm going after the superior ones first. I've got both of them there. And there those go. So we'll just kind of pull those up. Okay. And now I'll come after the inferior ones. And again, it's important to make sure you come over the top of that anterior horn when you're doing this. Okay. And then we've got both of those. I'll just bring these out first. Just like that. Once we've got this ready, you can fix your roots in place. That way, they're not going to move. So what we have here is just a standard, simple two hole suture button. And we're going to use this to anchor the roots. So the FiberWire and the TigerWire we're just going to load this through the button and then just tie it down to the anterior tibia. So we'll just take that. And we can kind of just you know if you need some retraction or whatever I'll usually just tie this down. We've already tied down the button for the anterior horn right there. And you can see that our posterior horn is going to go back here. We've got a nice, you know, at least centimeter bone bridge here again, which is going to be very helpful for this. You don't want these tunnels to converge at all. So we'll apply the second button now. And then again. So you can see here that we've got anterior posterior roots. Nice bone bridge between the two of them. So I'm going to load the inferior limb up on the Scorpion. And then we'll come in. But you can see I'll get a nice healthy bite of the meniscus right there. You can see the suture coming through, and then we'll pull through. And now we can tie it. And there it goes. Okay. We've got this nice little cutter here that's going to leave a two millimeter tail for us. Up to the knot. Yep. There's there's one. And now we'll do the second one. Again I'm going to load the inferior limb of this suture through the Scorpion. And then we'll pass the second limb. And then you can see the, you know, just if you need to just kind of turn it on its side to make sure that suture passes and the needle passes through. I use the Scorpion to pass the inferior limb of the second stitch through the meniscus. And you can see it right there, right there. So now I'm just going to tie another knot. All right. So I've had a few second looks now for other reasons. And when I've looked at my all meniscal based repairs with knots on top of the meniscus, you can't even see the knots anymore. The weight bearing aspect of the knee sort of pushes them down and they synovial size, and so you don't even see them. And there's been no scuffing of the femoral cartilage or anything. So I really don't think we have to worry about these knots. And now that we've got our route fixed we've got our posterior horn fixed. Now, if we want to, we can just do if you want to do an inside out here, or you can even keep using the mini SutureLasso and do an outside in to fix the body and the anterior horn to complete the fixation for this meniscus. You can see I placed this in a horizontal mattress fashion right here. I typically when I fix this I'll use vertical mattress stitches. So this is horizontal, which is fine. But if you get a couple of verticals in here that you really love, you can then just remove this. Or if you want to, you can just tie it over the capsule either one.

Arthroscopic Lateral Meniscus Transplant

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