Name: Arthroscopic Transpatellar Tendon Approach With the NanoNeedle™ Scope 2.0
Uploaded: 2026-05-07T00:00:00Z
Channel: Arthrex
Description: Robert Parisien, MD (New York, NY), demonstrates the surgical technique for an arthroscopic posterior meniscal root repair using the NanoNeedle™ scope 2.0 and SutureLoc™ implant through the transpatellar tendon.

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Robert Parisien, MD (New York, NY), demonstrates the surgical technique for an arthroscopic posterior meniscal root repair using the NanoNeedle™ scope 2.0 and SutureLoc™ implant through the transpatellar tendon.

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English  - en

video

VID1-009436-en-US | A | Arthroscopic Transpatellar Tendon Approach With the NanoNeedle™ Scope 2.0

Robert Parisien

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

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Arthroscopic Transpatellar Tendon Approach With the NanoNeedle™ Scope 2.0

Speaker  Hi, I'm Robert, Parisian orthopedic sports medicine surgeon from Mount Sinai in New York City. We're here today to discuss and demonstrate the surgical technique for arthroscopic posterior root repair with utilization of the suture lock and the nanoneedle scope 2.0. Now, interesting for this technique, we're going to demonstrate viewing through a direct central notch portal or the trans patellar tendon portal with utilization of the Nanoneedle scope 2.0 with our Anteromedial anterolateral typical portals for suture management. So now we're here inside the knee, demonstrating the views that we can get for different portals. And so this is a standard view that you're going to get for the anterolateral viewing portal with the Nanoscope. Our incisions that we've made here are just large enough to fit the nano needle 2.0 instrumentation into the knee. So this is viewing right now Antero lateral. You can see here I have the notch portal cannula cannula in here that we created as well. And prior to that we did a nice resection of the fat pad. Just we have visualization of this space. We also have our Anteromedial portal that is being created as well. So and then this one for the notch portal, again, just large enough of an incision to fit our nano needle 2.0 through this notch portal here in trans patellar tendon. So through the anterolateral portal, this is a typical viewing that you'd that you'd get of the notch. Here you have the ACL and PCL. You can see the anterior horn of the medial meniscus and view into the medial compartment. Speaker  We also did a deep MCL fenestration here in pie crust. And to get access to the medial compartment, we actually published a systematic review demonstrating that you have increased visualization and decreased iatrogenic injury without residual laxity. So I recommend certainly doing a pie crossing of the deep MCL to get access to the medial compartment. But you can see your limitations here getting over the spine to try to view that posterior medial root from the anterolateral portal, you have this limitation of getting over the spine, getting across the notch, viewing around the ACL. And so if we just switch our viewing portal and take ourselves out of the anterolateral portal and then view directly through the central notch portal here, the the patellar tendon portal. So that's the ACL directly in front of us here. Lateral compartment is here. Medial compartment is here. And now as we come right up over the spine, we can get a nice visualization of our posterior root. And we can see here we have created a posterior root tear of the medial meniscus. And then we can look right onto our footprint. Nice and easy here. And then our anterolateral portal is now going to be utilized for suture management. Once we place our suture lock suture for repair of the posterior medial meniscal root. And again you can see coming right directly over that spine viewing directly at this posterior root and directly over the footprint there, without having to work around the ACL, without having to work around that tibial spine. Speaker  And we introduced our drill guide through the Anteromedial portal, right over the footprint here. And you can see we have great visualization. We're really collinear with ourselves here. We have great visualization all the way down the footprint where we place our guide. And now the standard or what many utilize is this drilling from the medial side. But I find that the angle that you get when you drill from the lateral side as I come over here is very nice, and it comes and it allows me to rest on this footprint. Appropriately here as I drove from the lateral side as opposed to the as opposed to the medial side. And then once again, with this notch portal, you can see I'm viewing directly over our footprint, and I can see the tip of our drill guide directly on the anatomic footprint of the posterior medial root. So now we have placed the suture lock within the footprint of the posterior medial root, as you can see there. Viewing again from our notch portal. So it allows us to get directly over here and view the footprint nicely. We drilled from the anterolateral aspect of the tibia. And the incision is only about five millimeters. Just enough to pass the the the suture through. And so we have a nice small incision there on the anterolateral tibia. So for suture management purposes, as we mentioned in that technique article that we published, the sutures are coming out of the Anteromedial portal as you see here. Speaker  This is where we place the suture lock through. While viewing from the notch portal, we can actually come in with our suture retriever from the anterolateral portal and retrieve all the sutures from the anterolateral portal, as you can see here. So then these come across and out of our way so that when we go and place the repair sutures through the posterior root of the medial meniscus, these sutures will be will not be in our way. And the since this is a knotless mechanism, this allows for nice easy suture management. And again, it was demonstrated in our surgical technique that we published. So in this instance you can you can see we have a nice small incision for our Anteromedial portal. So I typically will will work through this and just make sure that I don't have any suture bridges, which is why we did a nice debridement of the fat pad. If you would like, you can extend this portal slightly to introduce your passport cannula. That way you can really certainly make sure that you're not going to have any suture bridges. So if you want to do that for our purposes today, we're not we're going to keep a small incision here and we're going to work minimally invasively and percutaneously. So we'll use our suture retriever through the Anteromedial portal to to retrieve the repair suture as you can see here. Speaker  So this blue repair suture that will come out here. And we'll place this within the knee scorpion to deliver through the posteromedial route. And you can see suture management or sutures are coming out of the posterior medial route through that anterolateral portal across the notch. And so they're out of our way. And they're not going to impede us when we try to pass the repair suture through the posterior root of the medial meniscus. And again viewing from this notch port, as you can see, I can come directly over this and have great visualization in this joint. Also with the fenestration and the pie crusting of that deep MCL. And you can see us working and passing this repair suture nicely. We're not going to have any iatrogenic injury. Now this repair suture is through. Now we have the repair suture that's through the posterior root of the medial meniscus. Now we're going to retrieve the looped end to deliver our knotless mechanism. So the looped end is going to be this corresponding one. You can see we're going to have that other repair suture that we're going to we're going to pass second. But we're going to we're going to convert this knotless mechanism prior to doing that. So now with both the repair suture and the looped suture being retrieved out of the Anteromedial portal. Again, we're not using the Passport Canada because we want to keep our incision as small and minimally invasive as possible. Speaker  You can come in with the suture retriever, retrieve both sutures at the same time simultaneously. As you can see here, repair suture and the loop suture. Retrieve them out the Anteromedial portal portal, therefore guaranteeing that you're not going to have a suture bridge when you're not using the passport cannula. Now we're going to convert this knotless mechanism. So we have converted the knotless locking mechanism of the one repair suture. As you can see here the blue repair suture. We did not do final tensioning because we still want to have some room and space to pass the second repair suture through the posterior horn. So now we come in with our suture retriever again using our small incisions through the Anteromedial portal. Grab the second repair suture. As you can see here that is retrieved out of the Anteromedial portal. And again the the looped suture remaining within the anterolateral portal. Out of our way for when we pass through the scorpion to get our second fixation point on the posterior root of the medial meniscus. So now as we enter the knee through the Anteromedial portal with the knee scorpion to pass our second repair suture. We have not done final tensioning, so that gives us some room to to pass the second repair suture. As we pass the second repair suture to the posterior horn of the medial meniscus. We can visualize nicely with this notch portal seeing that suture being passed through. We have our second repair suture through the posterior horn of the medial meniscus. Speaker  Again not no final tensioning here to allow us some excursion and some room for passage. So we come in to retrieve the second loop suture. You can retrieve both the repair suture that is has already been retrieved through our intermediate portal, as well as the looped suture simultaneously, again to prevent the suture bridge since we are not utilizing the passport cannula. So here retrieving both simultaneously through the Anteromedial portal to make sure that we don't have a suture bridge when we convert this Knotless mechanism. So we have converted our knowledge mechanism externally outside of the knee. And now as we shuttle this second repair suture. Through the knotless mechanism, through the suture lock. You can see the second repair suture is going to come down nicely. And we have both repair sutures through the posterior horn of medial meniscus. We have an anatomic reduction through this notch portal. We can view directly over this. We can see final tensioning of both the blue and white repair sutures. With ease. Knot battling and fighting over our spines or around the notch as we're viewing directly through the central notch. And you can see here we have one upon final tensioning and visualization through this notch portal with the nano needle scope 2.0 and anatomic reduction of that posterior root of the medial meniscus. With complete restoration of hoop stresses and our circumferential hoop stresses, and a normal physiologic excursion of this meniscus upon probing.

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Arthroscopic Transpatellar Tendon Approach With the NanoNeedle™ Scope 2.0

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