Dr. Garcia demonstrates his complex repair of a rare anterior and posterior radial meniscus tear in a high level soccer player

In this video, Dr. Grant H. Garcia presents a rare, complex joint preservation case involving a high-level soccer player who suffered both an anterior and a posterior radial tear of the lateral meniscus. Because radial tears sever the structural fibers that distribute load across the knee, they are highly destabilizing. Dr. Garcia uses a combination of surgical approaches to save the meniscus and prevent rapid onset of arthritis.

Surgical Process Breakdown

• Debridement and Bed Irritation: The surgeon begins by debriding the damaged tissue edges, noting a wide 5-millimeter gap in the anterior radial tear. He uses a ball rasp and a shaving instrument to intentionally scratch and irritate the surrounding joint capsule tissue. This localized micro-trauma stimulates bleeding and brings fresh blood flow to a region of the meniscus that otherwise has a poor native blood supply.
• Fixing the Posterior Tear (Transosseous Tunnel + Rip-Stop):
  • Through a clear passport cannula, a suture passer is used to place high-strength suture tape across the posterior tear in an inverted horizontal mattress pattern.
  • To securely anchor the tear, Dr. Garcia uses a meniscal root guide to drill a physical bone tunnel directly between the two edges of the tear. Pulling the mattress sutures down into this transosseous bone tunnel provides the tightest biomechanical compression.
  • To prevent the high-tension lines from slicing through the soft meniscus tissue, he adds a rip-stop stitch using a fast-fix device. This creates a secure criss-cross formation above and below the main stitch to maximize pull-out strength. The tunnel stitch is then tightened, pulling the edges cleanly back together.
• Fixing the Anterior Tear (Inside-Out Technique): Because of its location at the front of the knee, the anterior radial tear is much more challenging to reach with all-inside tools. Dr. Garcia switches to an inside-out technique. Using a zone-specific navigation cannula, he accurately passes three separate suture needles from inside the joint, through the unstable tear, and out the lateral side of the knee.
• Final Securement and Biologics: The three externalized suture lines are caught, tensioned, and tied down securely over the outside of the joint capsule while holding the patient's knee bent at 45 degrees. To wrap up the operation, Dr. Garcia performs a microfracture within the femoral notch, tapping tiny holes into the bone to release native stem cells and marrow to further bath the repairs and optimize healing.