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Keyhani et al. have recently reported the outcomes of 48 locked bucket-handle medial meniscal tear (BHMMT) repairs using an arthroscopic posterior approach during anterior cruciate ligament (ACL) reconstruction. This study showed that posterior knee arthroscopy can be safe in all-inside repair of the locked BHMMTs, resulting in significant improvements in IKDC, Lysholm and Tegner activity scale.
The all-inside posterior arthroscopic method used in this study has some unique advantages: (1) vertically-oriented sutures are applied, thereby improving meniscal healing due to anatomical reduction; (2) capsular and MCL entrapment are avoided, resulting in faster rehabilitation; and (3) avoidance of the anterior approach and the safe knot placement prevents chondral damage; and (4) the technique is performable only with a 30 degree lens and without the use of a cannula.
We conclude that using the Posterolateral (trans-septal) and posteromedial portals can be safe and provide excellent visualization of the posteromedial compartment to repair locked BHMMTs. Relying on this good view, surgeons can approach and abrade the peripheral fragment completely and lift it to the same level as the central fragment to improve reduction. It also allows us to insert vertically-oriented mattress sutures, resulting in sufficient repair and good healing.
– Study author Sohrab Keyhani, MD