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IC 208-2023: All You Need to Know about Meniscus P ...
IC 208 - All You Need to Know about Meniscus Prese ...
IC 208 - All You Need to Know about Meniscus Preservation (5/5)
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Video Transcription
When when I was your fellow we were doing all these we were doing inside out stitches so that was just to go go was that just to torture me and make me catch all the sutures because I you know I worry about the the diameter of those holes for those so the reason I switched is multiple right one is for sure that the all inside devices like the first generation was just a dart we were pushing darts in and they popped right back out and made chondrolysis it was horrible you know and now we're on the fifth generation the diameter became from a 17 gauge from a 14 gauge to a 17 gauge they're more flexible so I feel more comfortable that way but I dabbled with this maybe eight years ago and I realized it's just the holes are too big and it's just not right so I went back to it for now and feel quite comfortable with it and it speeds the procedure up and one of the cases I wanted to show you but I ran out of time making the medial arthrotomy to do the inside out sutures I have lost a few MCLs or at least compromised them somehow where late I had to go back in and do an MCL and if you go out arthroscopic you will not you know need to do that how about you guys after scope all arthroscopic extra incision I'm still doing inside out mm-hmm yeah I do inside out but I do much less points of fixation I mean the capsular healing on a meniscus transplants just incredibly reliable we just do not see early failures of meniscus transplants so I usually pre pass the plug sutures and then two other sutures and then I just use a lasso and I'll shut all those sutures so by the time that my meniscus is in I already have the entire posterior horn post your body and then I just add like four inside outs and fix the end to your horn and done you do routinely will you add centralization stitches on your meniscus transplants now good good question so what I try to do is you know all the techniques you know we try to preserve the rim try to get the you know anatomy right but sometimes you'll get these cases where gosh they just you know you start in the capsule is like three millimeters beyond the plateau there's there's no way to even co-op that tissue without extruding it so in those cases what we're doing is we're actually centralizing the capsule first so we'll try to reattach those meniscus tibial ligaments and then do the transplant second right on the lateral meniscus especially where you know that there's more mobility you know that there are no such firm attachments of the posterior lateral capsule as it is on the posterior media I bring the capsule in first because otherwise you push the sutures out in the meniscus just becomes too small because you have to now move the meniscus all the way posteriorly to attach to the capsule so I like the idea of bringing the capsule in first on all cases but as you mentioned any other questions this is good it's been very interactive please about the centralization I did some cases centralization but I'm not sure some of them we can bring the capsule very well inside but in some cases it's not good what's the peril for that help me understand your question what's the then I do these things I couldn't bring the capsule inside the knee in the same in for in for the same for the all cases you know some cases I was very good and I could bring everything inside but in some cases they were not there are not any change you know so I'm not sure what's the parent in the technique what's the so I guess the question is how do you mobilize that capsule if you really feel it you need to bring it in I think you mentioned it earlier yeah yeah so we do I would say a vigorous release of you know the entire meniscus tibial ligaments again I just think about our shoulder colleagues and that helps us so I take an elevator and I'm you know going a centimeter below the joint line in the body and posterior horn and that seems to mobilize it quite a bit in order to get it back but I agree with you there's a lot of questions where we place the sutures how far do we place the suture anchors on the face of the cartilage you know just a lot of different hands you know questions that I don't have answers to at this point but I would say it's important to mobilize that tissue because it is plastically deformed in an extruded meniscus so you have to really bring it back up and you do release from arthroscopically or yes yeah I have a Bankart elevator just like from a shoulder pan I just modify it it has a big curve on it so I'm able to get it from the lateral portal medial portal and you can get around the tibia and do you cut the capsule on the top of the meniscus to make the release from the top or not I don't I know other experts like dr. the prod is popularized that for me again I try to respect the anatomy and for me the patho anatomy is clearly the meniscus tibial ligament so that's why we're releasing they're separating the meniscus from the capsule you know we just don't see that in nature so I'm not sure that that's the best option for thank you that is in a scenario of meniscal transplantation do any of you use hay bale sutures to try to avoid violating that meniscal tissue and to help kind of seat the meniscus before you put in all your other stitches so in meniscus transplants I don't I like you bring up these hay bale sutures you know a class sutures I call them in the transplant I wouldn't because I mean obviously the tissue is native when I use these so class sutures is when you have you know vertical splits that are just too much in the white zone and you know you're you're whatever suture you use but eventually pop through and create a radial tear how about you any any tricks on the cyclosh sutures you use them liberally so this is using more like the all inside suture device going on the superior and inferior surfaces going all the way around you know I think those are it's a technique that we've definitely seen some of our Europeans and some of our Asian colleagues use and I think it can be utilized for certain type of tear patterns you have to be careful though that if you over tension you are gonna basically pucker that white white zone and likely it will lead to a radial tear but there are definitely tear patterns where I've utilized that technique because yeah it's really the only way you're gonna get a repair okay I would say they're kind of out of time and 830 we don't need any more cases so just kind of summarizing so I think it was a great course I certainly learned a lot from all of you I think the number one summarizing comment is preserve that meniscus whenever you can use all these cool sutures hashtags you know you know cross X whatever whatever sutures you can make sure you do your releases there's no tension in it follow your patients for a long time there's a great comment about the disco it meniscus but that really goes with all your meniscus repair patients it's a wrestler you know they're gonna fail it we didn't really talk about that but so yeah use all these new techniques learn about them and educate your patients on this so thanks all for your for your attendance and for the good questions and have a nice day
Video Summary
In this video, the speaker discusses their experience with different techniques for meniscus repair. They explain that they switched to using all-inside devices due to issues with the previous generation causing chondrolysis. They mention that the current fifth generation devices are more flexible and comfortable to use. The speaker also mentions using inside-out sutures and the benefits of arthroscopic procedures. They discuss techniques for meniscus transplants and how they sometimes need to centralize the capsule first. They also talk about mobilizing the capsule and releasing the meniscus tibial ligaments. The speaker mentions using a Bankart elevator for mobilization and not cutting the capsule on top of the meniscus. They briefly touch on hay bale sutures and the use of all-inside suture devices. The video ends with the speaker summarizing the importance of preserving the meniscus and educating patients on the different techniques available. No credits are mentioned.
Asset Caption
Andrew Sheean, MD; Aaron Krych, MD; David Flanigan, MD; Volker Musahl, MD
Keywords
meniscus repair
all-inside devices
chondrolysis
arthroscopic procedures
meniscus transplants
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