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ACL with lateral meniscal radial repair with the new Sutureloc
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
In this surgical video, Dr. Grant H. Garcia demonstrates a complex combination procedure: a lateral meniscus radial repair utilizing the Arthrex SutureLoc system, performed alongside a quadriceps tendon autograft ACL reconstruction.
The procedure follows these precise phases:
- Initial Assessment & Pin Placement: Dr. Garcia identifies a flipped lateral meniscus fragment. Rather than resecting it, he preserves it as it is critical structural tissue. After preparing a footprint with a curette, a 2.4 mm cannulated pin is drilled using a SutureLoc guide. The center core bone is removed to create a smooth channel for the passing wire.
- Tunnel Sequencing Strategy: To prevent any bone tunnel collisions or structural damage, the ACL femoral and tibial tunnels are drilled while keeping the initial SutureLoc pin in place. This serves as a physical boundary line. Once the ACL tunnels are complete, the pin is pulled, and the SutureLoc construct is drawn down until it deploys and expands securely beneath the cortical surface.
- Intricate Suture Passing: Working inside a tight lateral compartment, Dr. Garcia carefully passes the SutureLoc strands through the torn meniscal tissue using a knee Scorpion device:
- First Construct: A blue suture is passed to form a horizontal mattress stitch. The Scorpion must be flipped carefully to avoid scraping the tibial plateau or bending the needle.
- Radial Component Repair: To bring the torn radial edges together side-to-side, a second white suture is passed as another horizontal mattress stitch. This involves flipping the Scorpion completely upside down to capture the mobile tissue.
- The Retensioning Sequence: Crucially, the SutureLoc strands are not fully locked down right away. Tightening the meniscus completely before passing the ACL graft risks over-constraining the tissue or snapping the sutures during graft passage. The quadriceps ACL graft is pulled into position and fixed first.
- Final Fixation: After the ACL is secured, Dr. Garcia returns to the meniscus repair. He pulls the adjustable suture loops, back-tensioning the lateral meniscus until it is compressed perfectly flat against the bone. The knee is cycled through a range of motion to confirm absolute stability, establishing a solid final construct.
