Triple Cross-Locking Technique for Medial Meniscus Root Repair

Medial meniscal root tears (MMRTs) are significant injuries that can lead to knee instability, joint dysfunction, and severe pain. Posterior root tears of the medial meniscus are primarily degenerative and typically affect middle-aged women with a high body mass index, and they may account for up to 21% of all meniscal tears. The need for reliable arthroscopic techniques for repair is critical. Numerous techniques have been proposed for the arthroscopic reconstruction of MMRTs; however, recurrence rates remain a concern. Traditional methods often involve various suture configurations that do not adequately address the mechanical forces acting on the meniscus during weight-bearing activities. To improve surgical outcomes, we describe the triple cross-locking technique, a more secure and reliable method for arthroscopic repair of MMRTs. This technique uses a 45° curved hook and 3 sutures: 2 for the posterior horn of the medial meniscus and 1 for the joint capsule. Each suture forms a loop that interlocks with the others. This cross-locking mechanism reduces the risk of creating different tension vectors that can lead to the "cut-through" phenomenon often seen in meniscal repair. By ensuring that all sutures effectively share a common pulling force, our technique creates a singular vector of traction. This is critical in maintaining the stability of the repair during the healing process.