Transtibial Tunnel and Combined Hashtag Inside-Out Repair of Lateral Meniscus Radial Tear With Marrow Venting.

Background: Radial meniscal tears have traditionally been managed with a partial meniscectomy. Recently, repair of these tears has become more popular. The inside-out method of meniscal repair has increased stability provided by a greater number of sutures and smaller insertion holes from the suture placement compared to all-inside sutures. Transtibial tunnels are often used for the repair of meniscus root tears but can also be used to restore apposition for widely separated radial meniscus tears. Marrow venting procedures may be utilized to release biological agents into the knee to improve healing. Indications: Transtibial tunnel and combined hashtag inside-out repair of the lateral meniscus with marrow venting is indicated for radial meniscus tears that are widely separated. Technique Description: A scissor biter was used to release the lateral meniscus anteriorly and posteriorly to allow for edge reapposition. A transtibial tunnel guidepin with a cannula was drilled, entering the anteromedial tibia medial to the tibial tubercle and exiting where the posterior leaf of the radial tear was planned to be reduced. After confirmation that the cannula was properly located, a self-capture meniscus suture device was used to place a vertical mattress suture at the rim of the posterior leaf of the tear. The suture was shuttled down the cannula and secured to the anteromedial tibia over a cortical button. Two hashtag inside-out vertical mattress sutures were placed on each side of the radial tear, and 4 further horizontal mattress sutures were used to reduce the radial tear to an anatomic position to complete the hashtag repair. Four microfracture awl holes were created on the lateral aspect of the intercondylar notch for a marrow venting procedure. Results: Transtibial tunnel radial and combined hashtag inside-out repair with marrow venting can be used to repair complicated complete radial tears of the lateral meniscus and presumably slows the progression of arthritis. Discussion/Conclusion: Previous management of retracted radial meniscus tears has focused on partial meniscectomy. We describe a technique that repairs lateral meniscus radial tears using a transtibial tunnel to pull the posterior aspect of the tear into position, a hashtag inside-out meniscal repair technique, and a marrow venting procedure to assist with biological healing. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.