Our technique for ACL reconstruction with a lateral meniscus root repair.

This video, titled "Our technique for ACL reconstruction with a lateral meniscus root repair," features a surgical approach performed on a young patient with a scarred, unhealed lateral meniscal radial/root tear alongside a torn ACL.

The primary steps demonstrated in the procedure are:

• Site Preparation: The surgeon clears the scarred edges of the radial tear using a shaver, ball rasp, and arthroscopic scissors. A curette is then used to microfracture the bone at the insertion site to stimulate a healing response and encourage bone ingrowth.
• Femoral Tunnel Drilling: The femoral tunnel for the ACL graft is drilled to a depth of roughly 20 to 25 millimeters.
• Meniscal Suture Passing: Working outside the main cannula to avoid tangling, the surgeon passes a high-strength tape suture through one side of the torn meniscus, then uses the passer upside down to loop it through the other side in a horizontal mattress fashion.
• Root Tunnel Drilling: A specialized root guide system is used to drill a tunnel for the meniscal root. The entry point is positioned at the lateral portion of the tibial tubercle to carefully avoid intersecting with the planned ACL tibial tunnel.
• ACL Graft & Internal Brace: The ACL tibial tunnel is drilled, the ACL graft is passed and secured, and an internal brace is completed, successfully eliminating any anterior knee instability.
• Meniscal Fixation: Turning attention back to the meniscus, the tape sutures from the radial tear are pulled down through the drilled bone tunnel and sequentially tightened down to the tibia using a SwivelLock anchor.
• Supplemental Stabilization: To address a small, residual split tear at the red-white junction of the meniscus, the surgeon places an additional "all-inside" suture anchor to completely cinch down the tissue, re-establish the structural hoop stress of the knee, and secure the meniscus against the back wall.