Suturing complete radial tears of the lateral meniscus

Lateral meniscus (LM) with complete radial tear (CRT) is common in patients with acute anterior cruciate ligament (ACL) injury. We have been approximating unstable LM CRT in an all-inside suture fashion. We report 3 cases of complete healing of such a torn meniscus on second-look arthroscopy. We recommend approximation of the displaced CRTs of the LM whenever possible because we expect improved healing with this approach. Surgically, the arthroscope is placed into the anteromedial portal and the suture hook into the anterolateral portal with the knee in figure-of-4 position. A suture hook loaded with Ethilon No. 1 (Ethicon, Somerville, NJ) is introduced into the anterolateral portal, and vertical penetration to a single end of the torn LM is achieved. The Ethilon is pushed out until the far-end limb is almost exhausted. The suture hook is removed from the portal, with caution taken not to pull out the penetrated limb from the meniscus. A universal cannula is introduced, and the leading limb is grasped and pulled out. The Ethilon is used as a shuttle relay and is changed to polydioxanone (PDS) II. The suture hook is reintroduced, and the other torn end is penetrated in the same fashion. With complete suture to both meniscal sides, 2 suture limb ends are pulled out, and arthroscopic tying (SMC knot) is performed.