Circumferential Cross-Stitch Suture for Longitudinal Lateral Meniscal Tear Around the Popliteal Tendon Hiatus Region

Takaki Sanada, M.D.
Tomoki Murakami, M.D.
Hiroshi Iwaso, M.D., Ph.D.
Shin Sameshima, M.D.
Yutaro Ishida, M.D.
Miyu Inagawa, M.D.

Introduction

The lateral meniscus has greater mobility than the medial meniscus, and its structure complicates surgical technique owing to the absence of a capsule attachment site at the popliteal hiatus and the presence of the popliteal tendon. Surgical treatment of meniscal tears has demonstrated that meniscectomy accelerates osteoarthritis progression. Owing to the stabilization and chondroprotective role of the meniscus, the indications for meniscal repair have been expanded to preserve function.
Modern arthroscopic meniscal repair procedures are primarily performed using inside-out, all-inside, or outside-in techniques. The inside-out technique, which is predominant among the meniscal repair procedures, fixes the meniscus to the soft tissue outside the capsule.1 However, different from the all-inside repair, which secures the meniscus independent mobility from the surrounding soft tissue, the inside-out repair technique may obstruct the normal meniscus healing process during postoperative range of motion exercises because meniscus fixation to the capsule by tying a knot over the capsule firmly.2 In addition, inside-out repair can be a risk factor for neurovascular component injuries. In particular, repairing the lateral meniscus at the popliteal hiatus via the inside-out technique requires a meticulous position of the suture needle to avoid popliteal tendon penetration and prevent damage to the posterolateral extracapsular knee structure.
To avoid the risks, the all-inside meniscal repair has been developing and increasing. This technique has led to their classification into two categories: transcapsular and non-transcapsular repairs.1 The transcapsular technique usually involves capsule-based repair using anchor fixation over the joint capsule. By contrast, the non-transcapsular technique completes meniscal repair inside the capsule that avoids incorporation of the capsule or surrounding soft tissue with the meniscus.
In addition, a recent circumferential meniscal suture technique was introduced. Although it has been used to treat horizontal tears around the hiatus region or as a salvage procedure,3,4 it has not yet been routinely adapted for longitudinal tears. Our present report describes a meniscal suture-based all-inside repair using a circumferential suture technique for a longitudinal lateral meniscus injury at the posterior segment and around the popliteal hiatus.