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Horizontal meniscus repair in a high level soccer player
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.
This video, titled "Horizontal meniscus repair in a high level soccer player," showcases an arthroscopic repair technique for a significant horizontal cleavage meniscus tear. The procedure is performed on a very young athlete (under 30 years old), a population where preserving the native meniscus biomechanics is vital to preventing long-term arthritis.
The primary steps of the procedure shown in the video include:
- Accessing the Tear: At the start of the arthroscopy, a horizontal cleavage tear is difficult to fully see. The surgeon trims away a tiny strip of the inner "white-white" junction of the meniscus to open up and access the main tear.
- Preparation and Debridement: The tear is large, extending nearly from the meniscus root all the way toward the anterior (front) horn. The surgeon uses a biter, shaver, and a ball rasp to break up fluid pockets (loculations) and clear out frayed tissue, cleaning the tear all the way back to the vascular capsule to ensure optimal healing conditions.
- Promoting Healing (Trephination): The surgeon performs trephination (making tiny punctures) into the vascular joint capsule and the surrounding tissue. This intentionally triggers localized bleeding and encourages stem cell migration to the repair site.
- Suture Passage: A specialized instrument called the "Firstpass Mini" is introduced through a portal cannula. This curved device is helpful for reaching tough angles, particularly near the anterior horn. It is loaded with a thin 0.9 mm mini tape suture to pierce and compress the top and bottom flaps of the horizontal tear back together.
- Sequential Knot Tying: The surgeon places a total of five sutures, spaced about 3 to 5 millimeters apart to maximize uniform compression without strangulating the tissue. The knots are secured using alternating half-hitches (a "hay-barrel" technique) and trimmed with minimal tails to prevent irritation to the nearby joint cartilage.
- Marrow Venting: After ensuring the meniscus has been completely stabilized and shows no remaining gapping upon probing, the surgeon performs marrow venting (microfractures in the bone) to release bone marrow elements and further boost the biologic healing response.
