All-inside Techniques for Meniscal Radial Root Tear Repair

Meniscal radial root tears can disrupt the load-bearing function of the meniscus and worsen instability in anterior cruciate ligament-deficient knees. Paracentral radial tears adjacent to the root (types 1, 2, and 4) repaired with a transtibial pullout suture technique can lead to over-medialization of the meniscal root and a high-tension nonanatomic repair. We propose 2 all-inside techniques for anatomic repair of medial and lateral meniscal radial root tears with (1) an all-inside meniscal repair device and (2) an antegrade suture passer. We present the technical requirements and tips for these techniques. For lateral meniscal radial root repair with an all-inside meniscal repair device, ideal viewing is from an anterolateral portal with device entry from an anteromedial portal to reduce the risk of vascular injury. We recommend at least 2 stitches across the tear, with the depth setting limited to 18 to 20 mm for a central stitch and 16 mm or less for a peripherally placed stitch. For root repair with an antegrade suture passer, viewing should be from an anteromedial portal with the passer entering from an anterolateral portal. At least 2 stitches should be placed across the tear, with 1 central and 1 peripheral or 1 superior and 1 inferior.