Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear.
Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear.
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DOI：
10.1016/j.eats.2022.01.012
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发表时间：
2022-05
影响因子：
1.2
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中科院分区：
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关节镜下前外侧入路修复外侧半月板后角有损伤腘动脉的风险。在这里，我们提出了一种超声辅助，关节镜下，全内修复技术的后方LM撕裂，以减少神经血管损伤的风险。由助理外科医生将覆盖有无菌套管的超声探头水平放置在腘窝处，并确认腘动脉和后LM。从前外侧入路，插入关节镜探针以推动外侧间室的后囊，同时超声图像检测探针的尖端。在确认探针未指向腘动脉后，从前外侧入路引入全内缝合器械。当半月板被穿透时，外科医生可以通过超声图像确认针远离腘动脉。向前拉动导引缝线以牢固固定锚钉，超声确认锚钉位于LM后部后方。在超声图像的辅助下固定所有缝线，然后通过全内修复技术在关节镜下确认LM是否正确固定。前外侧入路的关节镜视图显示，由于之前的手术切除，外侧半月板体积减少。通过探查将后外侧半月板（LM）向前拉到外侧间室的中心。在超声引导下修复后LM，由助理外科医生将覆盖无菌套管的超声探头水平放置在腘窝上，以确认LM的后部和腘动脉。从前外侧入路引入全内缝合器械JuggerStitch，并在超声图像中观察针尖。当穿透LM后部时，确认针的方向不会损伤神经血管结构。在LM后侧引入JuggerStich的锚，可观察到高回声区域。引入两个锚钉后，通过前外侧入路向前拉缝线，并收紧线结。超声图像显示，两个锚钉位于后LM后面的囊上。然后重复相同的程序。腘动脉的位置和进针的方向每次都要通过超声确认。如果针头指向动脉，则应将其拔出并再次插入。共进行4次缝合，以在超声辅助下获得LM的稳定性。最后的关节镜检查显示了适当固定的修复和稳定的后方LM探测。
Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique. The arthroscopic view from the anterolateral portal shows a decreased volume of the lateral meniscus due to a previous surgical resection. The posterior lateral meniscus (LM) is pulled anteriorly over the center of the lateral compartment by probing. The posterior LM is repaired under the guidance of the ultrasound by having the assistant surgeon place the ultrasound probe, covered with a sterile sleeve, horizontally on the popliteal fossa to allow confirmation of the posterior portion of the LM and the popliteal artery. An all-inside suture device, the JuggerStitch, is introduced from an anterolateral portal, and the tip of the needle is observed in the ultrasound image. While penetrating the posterior LM, the direction of the needle is confirmed not to injure the neurovascular structures. The anchor of the JuggerStich is introduced at the posterior side of the LM and can be observed as a high echoic region. After introduction of two anchors, the sutures are pulled anteriorly through the anterolateral portal, and the knot is tightened. The ultrasound image shows that the two anchors are positioned on the capsule behind the posterior LM. The same procedures are then repeated. The location of the popliteal artery and the direction of the needle are confirmed by ultrasound every time. If the needle is directed toward the artery, it should be extracted and inserted again. A total of 4 sutures are performed to obtain stability of the LM under the assistance of ultrasound. The final arthroscopic examination shows the properly secured repair and the stabilized posterior LM by probing.