. 2021 Jul 21;10(8):e2043–e2048. doi: 10.1016/j.eats.2021.05.006

Table 1.

Technique Tips and Pitfalls

Technique Tips	Pitfalls
High portals to avoid the fat pad Medial compartment: • extend the medial portal distally to improve access to the posterior horn • pie-crusting of the superficial MCL in case of medial stiffness Lateral compartment: • Make additional central midline portal to suture the posterior horn close to the posterior root • Second anchor of the suture can be placed into the popliteus tendon, this procedure is safe and associated with a low failure rate Use of curved devices: • upward curve to repair the superior part of the meniscus • downward curve to suture the inferior part Surgical sequence: • Effective abrading with a motorized shaver • Repair from the more unstable to the more stable, e.g., from posterior to anterior • Work on the top first (easily accessible) • Put superior stiches every 5 mm without tightening them • Tighten all superior stiches at the same time: the meniscus flips proximally which exposes its bottom part (usually difficult to access) • Put inferior stiches every 5 mm without tightening them • Tighten all inferior stiches at the same time: the meniscus flips distally to return to its conventional position	Never use the anterolateral portal to place the stitches on the posterior horn of the lateral meniscus to prevent of vascular lesions¹⁵ Place the suture as peripheral as possible to avoid the creation of holes in the white zone Limit the depth of the suture device at 16 mm to prevent the anchors from reaching out to the skin Check the posterior part of the knee after placing the anchors to prevent of a potential skin breach

Technique Tips

Pitfalls

High portals to avoid the fat pad
Medial compartment:

•
extend the medial portal distally to improve access to the posterior horn
•
pie-crusting of the superficial MCL in case of medial stiffness
Lateral compartment:
•
Make additional central midline portal to suture the posterior horn close to the posterior root
•
Second anchor of the suture can be placed into the popliteus tendon, this procedure is safe and associated with a low failure rate
Use of curved devices:
•
upward curve to repair the superior part of the meniscus
•
downward curve to suture the inferior part
Surgical sequence:
•
Effective abrading with a motorized shaver
•
Repair from the more unstable to the more stable, e.g., from posterior to anterior
•
Work on the top first (easily accessible)
•
Put superior stiches every 5 mm without tightening them
•
Tighten all superior stiches at the same time: the meniscus flips proximally which exposes its bottom part (usually difficult to access)
•
Put inferior stiches every 5 mm without tightening them
•
Tighten all inferior stiches at the same time: the meniscus flips distally to return to its conventional position

Never use the anterolateral portal to place the stitches on the posterior horn of the lateral meniscus to prevent of vascular lesions¹⁵
Place the suture as peripheral as possible to avoid the creation of holes in the white zone
Limit the depth of the suture device at 16 mm to prevent the anchors from reaching out to the skin
Check the posterior part of the knee after placing the anchors to prevent of a potential skin breach