Access -
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Optimal portal placement aided by a spinal needle is important and ensures an adequate approach angle for meniscal repair.
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Perform an MCL “pie-crust” release if medial joint space does not allow for optimal visualization and instrumentation during medial meniscal repair,
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A figure-of-four position, paired with a slightly higher anteromedial portal, provides safe access to the posterior horn and mid-portion of the lateral meniscus.
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Access -
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A high portal causes instrument impaction against the femoral condyle, prevents adequate access, and damages the chondral surface.
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A low portal causes the instrument to impact against tibial spines and may cause damage to the anterior meniscal roots.
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Using the NovoStitch Pro Device -
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Gently drive the device toward the periphery of the meniscus to avoid extrusion from the jaws during suture passage.
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Use the device without a canula as it is technically easier to maneuver the tip of the device without the constraint of an arthroscopic cannula.
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When passing circumferential compression sutures, for vertical tears, start suture passage from the periphery and then move centrally.
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Use a probe to relocate the repair knots, as peripherally as possible in order to minimize interaction between the knot and the condyle.
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Using the NovoStitch Pro Device -
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Positioning the device too centrally for suture passage results in nonuniform compression.
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A central position of the knots in the joint increases the risk of cartilage damage.
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Biologic Augmentation -
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Prepare the meniscal tear with a rasp and shaver to augment biological healing.
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Create 4 to 5 holes with a microfracture awl on the lateral aspect of the intercondylar notch.
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The entrance angle of the awl should be at 90°.
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The correct microfracture technique requires penetrating the calcified cartilage layer into the subchondral bone.
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Stop irrigation temporarily or use suction to aid in visual confirmation of marrow venting.
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Biologic Augmentation -
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Insufficient penetration with the microfracture awl prevents the release of bone marrow elements.
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Improper placement of the microfracture awl too deep into the lateral wall will damage the ACL fibers, while placing the awl too superior on the notch will damage the posterior cruciate ligament (PCL) fibers.
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Overly aggressive penetration and removal of the subchondral plate can cause a reactionary overgrowth.
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