Name: ZoneNavigator™ System Anatomic Radial Meniscus Tear Reduction
Uploaded: 2019-03-07T00:00:00Z
Channel: Arthrex
Description: Aaron Krych, MD, (Rochester, MN) demonstrates the ZoneNavigator™ system by placing a cruciform suture configuration using the inside-out technique to reduce an anterior radial medial meniscus tear.

<p>Aaron Krych, MD, (Rochester, MN) demonstrates the ZoneNavigator™ system by placing a cruciform suture configuration using the inside-out technique to reduce an anterior radial medial meniscus tear.</p>

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VID1-000141-en-US | B | ZoneNavigator™ System Anatomic Radial Meniscus Tear Reduction

Aaron J. Krych

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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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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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ZoneNavigator™ System Anatomic Radial Meniscus Tear Reduction

Well, it's my pleasure to be with you here today discussing meniscus repair. We know that preservation of the meniscus is vitally important in the knee. Historically, we've utilized inside out meniscus suturing as it has many benefits, including small perforation within the meniscus. And it's really a utilitarian approach in terms of being able to fix any tear. So using vertical mattress, horizontal mattress, oblique suturing of the meniscus. Unfortunately, one of the disadvantages is the amount of team and team effort needed to perform inside out repair meniscus suturing. So therefore the ZoneNavigator was designed to help alleviate some of those issues. So the handle for the ZoneNavigator is very ergonomically designed. There are multiple attachments that really allow you to access tears in any zone of the meniscus in the posterior horn, the body, and the and the anterior horn. This one is designed for the body. An anterior horn, and there's both a left and a right that have a nice curvature to get anatomically to the posterior horn of the medial and lateral meniscus. One other advantage is that you can advance the needle one centimeter at a time. What this allows you to do is to anatomically reduce the tear before you advance the needle. Very precisely. The needles themselves are traditional inside out needles, but one advantage is the mini SutureTape that's attached to it. It has a very small diameter less than a millimeter. That allows you to perform a variety of suture configurations and again pass suture in any zone of the meniscus. It's really a utilitarian approach to meniscus repair that hopefully we've made easier. This is a left knee. We're looking at the medial compartment. And when we look at our medial meniscus we've created a radial tear Terror really at the junction of the anterior horn and body. And we're going to perform an inside out meniscus suturing technique. And the nice thing about the ZoneNavigator is really that we can reach the posterior horn, the body, the anterior horn, really all zones of the meniscus. Another advantage is that we really can have any sort of suture configuration. So we can create vertical mattress, horizontal mattress. It's really important that we get an anatomic reduction. And we'll demonstrate that technique as well as circumferential compression of this full thickness radial tear medial meniscus. So we're going to introduce the ZoneNavigator. And we're coming in from a contralateral portal. And it's really important that first stitch to get an anatomic reduction. So one of the nice features of this system is that we can advance our needle really a proscribed amount in the joint. I like to have the tip of the needle to allow me to very precisely place the suture and then obtain an anatomic reduction. So here we're going to place one throw near the capsular junction. And now we're just advancing the needle. And it's going to come out through the incision I think it's just posterior there. So the assistant's grabbing the needle. So we'll pull the first needle through. And you can see inside the joint this is our mini SutureTape. So this is less than a millimeter in diameter which really allows nice area of compression around the meniscus tear. So this is the anterior cannula that we're using again for a tear in the body and anterior horn of the meniscus. And you could consider using an outside in technique perhaps. But really what's a nice feature of the ZoneNavigator is you can hit all zones of the meniscus. So here with this radial tear we're going to do a little bit of a crisscrossing configuration. So here I'm going to precisely place my suture in the anterior portion of that tear. And now again we're going we're going to advance out our incision. You can see really a nice precise placement to the suture. So then our assistant is going to tie. And it's important that we get the tension correct. We don't want to over tension with this mini SutureTape. We really just want the right amount of compression across the tear site. And you can see with the tape, it really does a nice job of distributing forces across that repair site. So here we'll try to help with this anatomic reduction on the first stitch. That looks great. And then you can see we've just made a very small incision. We haven't had to make a traditional inside out posterior incision just because of the tear site is more anterior in the body and close to the anterior horn. So this is really a favorable position to do inside out meniscus suturing. And the advantage of inside out suturing is that it's quite a small perforation in the In the meniscus. So you can often add multiple sutures. So you can see here I'm just advancing the needle a very prescribed amount. And we'll kind of put kind of a cruciform configuration here. So we'll advance the needle. And you can see it really directs the needle nicely out through the incision. And our assistant. Has the first needle. And we'll load the second needle. And we're putting some tension on that first pass needle just so we don't advance the needle and perforate the suture. So now you really have a lot of flexibility in terms of where you want this second pass, which allows for a nice anatomic reduction of the tear. So here we've placed the needle. We'll advance it through the incision. And here again for this radial tear you can see the advantage of inside out suturing is really you can put in any stitch configuration that you wish. Here you can see nice tensioning across that tear site. And again it's important not to over tension these. But you really do get a lot of compression across the repair site. And in this case we could consider also placing one on the inferior aspect of the meniscal tear. We'll try that. It's important that you think about circumferential compression with these tears. And you can see with the curve of the ZoneNavigator we can get all the way into the anterior horn, if you wish. Again from the ChondralDrill portal. Another nice feature is you can actually back up this needle a little bit on your own. I'm going to put it just a little bit farther out the sheath. And then now we're going to try to get on the undersurface. So this will be a blind suture passage. And I'm going to come a little bit closer to the tear site. And we're going to pass the needle out through our incision. And again, we have a little tension on the stitch we just passed. You can see we can really control how much the needle advances. And then we'll move to the other side of the tear site, change our location and advance our needle. As we're tensioning, we can really look across that repair site. So really a nice anatomic repair. You can see the small perforations of the meniscus. And with these radial tears you know we don't expect them to heal in the white white zone per se. But as long as we can get 60 to 70% to heal, we will resist hoop stresses and maintain the function of the meniscus. But again, the ZoneNavigator allows us to place sutures both sides of the tear. Anatomic reduction. Circumferential fixation.

ZoneNavigator™ System Anatomic Radial Meniscus Tear Reduction

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