Dr Garcia demonstrates his new meniscal extrusion technique to further improve meniscus root repairs.

In this video, Dr. Grant H. Garcia demonstrates an advanced surgical technique for repairing a chronic (one-year-old) medial meniscus root tear. Because the tear is chronic, the meniscus has experienced meniscal extrusion—meaning it has popped out and shifted sideways off the edge of the knee joint by over 4.5 millimeters. To address this, Dr. Garcia introduces a specialized centralization/extrusion stitch to pull the meniscus back inward alongside the traditional root repair.

The procedure consists of the following key steps:

• Preparing the Root Bed: The surgeon uses a ball rasp to clean up and raw the bone surface at the natural meniscal root attachment site. A surgical curette is also used on the medial femoral condyle to stimulate localized bleeding, which improves the overall biology for healing.
• Placing the Root Sutures: Two high-strength tape sutures are passed through the body of the meniscus. Dr. Garcia intentionally places these slightly away from the frayed, fragile edge of the torn root to get a much stronger, more reliable "bite" in healthier tissue and prevent the stitches from pulling out.
• Capsular Elevation & Rim Preparation: To make room to pull the pushed-out meniscus back onto the bone, the surgeon switches viewing portals. Working from the lateral portal, he uses an elevator tool to peel the joint capsule away from the edge of the tibia, clearing off the rim of the tibial plateau.
• Deploying the Extrusion (Centralization) Stitch: Through an anteromedial portal, a suture passer is used to weave an additional tape suture through the central-to-posterior body of the meniscus in a wide horizontal mattress pattern. This stitch acts as a leash to pull the body of the meniscus inward.
• Drilling the Anchor Sockets: Using a specialized dual-cannula guide system, the surgeon drills two precise holes: one down into the anatomic root location and a secondary one right off the edge of the medial tibial plateau for the centralization mechanism.
• Tensioning and Anchor Fixation: All four suture tails (two from the root repair, two from the extrusion stitch) are threaded onto a single knotless bone anchor. The arthroscopy fluid is briefly turned off to ensure clear visibility. The surgeon sequentially tensions each strand—starting with the root sutures to bring the meniscus back to its origin, followed by the extrusion stitch to drag the shifted body 2 to 3 millimeters inward across the bone plateau.
• Final Seating: The anchor is fully deployed and sunk into the tibia, locking all four lines down simultaneously. A final structural test with a probe confirms excellent pull-out strength, rigid stability, and successful reduction of the extruded meniscus back into its native, shock-absorbing position.