Evolution of Tensionless Repair of Lateral Radial Meniscus Tear With the Use of the Traction Stitch.

Abstract

Background: Meniscus surgery remains one of the most common orthopaedic surgeries performed in the United States each year, with radial tear patterns being a common subset. In young, active patients with mechanical symptoms, surgery is often indicated. While management via partial meniscectomy predominates historically in tears of this type, recent success has been found in surgical repair. As repair techniques continue to evolve, this case demonstrates the use of the traction suture to maintain anatomic reduction throughout repair, ultimately resulting in a low-tension construct.

Indications: Meniscal repair is indicated for traumatic tears in individuals with minimal to no underlying osteoarthritis in the knee. The authors believe utilization of the traction suture is indicated for any repair of radial tears of the lateral meniscus where maintaining reduction might be difficult to aid in an ultimately low-tension construct.

Technique description: The patient is placed in a supine position. Standard anteromedial and anterolateral portals are made, and standard diagnostic arthroscopy is performed. The meniscus tear is inspected and classified. A traction suture is placed in the posterior aspect of the body of the meniscus, bolstered by capsular fixation in an inside-out method to aid in the reduction of central tears. Care is taken to maintain reduction by pulling traction on this suture throughout the repair. In the case presented here, we proceeded with repair utilizing a hashtag configuration, with a combination of vertical and horizontal mattress sutures through an inside-out technique and a posterolateral approach. Following repair, the remaining white-white tissue is debrided, and the knee is ranged through a complete arch of motion to ensure the tear remains reduced throughout this range.

Results: Results specific to the use of the traction suture on outcomes of repair are forthcoming. The authors of this study have performed several studies on radial meniscus tear repairs and outcomes previously, demonstrating improvements in patient-reported outcomes as well as favorable biomechanical outcomes.

Discussion/conclusion: Surgical intervention should be considered for symptomatic radial meniscus tears extending to the capsule of the lateral meniscus, especially in young athletes. The use of the traction suture can be helpful to maintain reduction throughout repair, ultimately allowing for a repair under minimal tension.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.