Tools of the Trade features reviews of the hottest new products, with surgical pearls written by surgeons who know these products best.
Arthrex, Inc. (http://www.arthrex.com)
The Arthrex Knee Scorpion allows for simple passage of suture at the root to repair the tissue. The mechanism of the Knee Scorpion self-retrieving the suture after passage eliminates the need for another step in the procedure, which saves time. There are various types of suture configurations that can be incorporated into meniscus repairs with the Knee Scorpion. Depending on tissue quality and location, I will either pass the center of the suture to create a cinch or luggage tag type of stitch, or sometimes a simple stitch.
A challenging meniscal tear pattern that repair is particularly made easier by use of the Knee Scorpion is the radial tear of the lateral meniscus. Here it is easy to place a side-to-side “spanning” circumferential suture pattern, which is the strongest suture configuration, and it reduces the tissue very well. This approach also is ideal for variant root type tears, those that are 3 to 4 mm from the root commonly seen with the lateral meniscus associated with anterior cruciate ligament tears.
Benefits: The Knee Scorpion has a very low profile to facilitate placement in the joint with a 5º upcurve to avoid injury to the femoral condyle. The needle captures the suture after passage, which saves time and an additional surgical step. It can be used with both 0 FiberWire and 2-0 FiberWire.
Surgical pearl: Using a cannula through the working portal prevents any tissue bridge when passing and tying sutures. I prefer a Passport button cannula since its flexibility allows more access in different planes compared to a rigid type cannula.
Patrick A. Smith, MD, Columbia Orthopaedic Group, Head Section of Sports Medicine University of Missouri, Head Team Physician University of Missouri
Arthrex, Inc. (http://www.arthrex.com)
The SpeedCinch’s pistol grip design permits ergonomic, one-handed all-inside meniscal repair. It is best suited for meniscal tears of the posterior horn and body. The posterior horn of the meniscus can be repaired with the SpeedCinch inserted through either the ipsilateral or contralateral portal. Meniscal body tears, however, are best approached via a contralateral portal. The end of the device contains a 15g needle that should be advanced across the meniscus. After passage of the needle, the first implant is pushed through the needle when the trigger is fully deployed.
Next, the SpeedCinch needle should be moved at least 1 cm for placement of the second implant in either a horizontal or vertical mattress fashion. After the needle is brought to the second insertion site, the implant selector button is moved to 2 and the trigger is depressed until the first click is felt and heard. Next, the trigger is held in place after the first click and the needle is advanced across the meniscus before fully depressing the trigger, which will advance the second implant. The device is then removed and the pre-tied knot is secured with a knot pusher and then cut.
Vic Goradia, MD, G2 Orthopedics and Sports Medicine, Glen Allen, VA
Cayenne Medical, Inc. (www.cayennemedical.com)
The CrossFix II System
The CrossFix II System offers a unique, all-arthroscopic, suture-only meniscal repair that reduces the risk of chondral injury. Its “all-inside” technique uses 2 parallel suture delivery needles, available in both curved and straight designs, inserted through a single incision to provide an all-inside meniscus repair. This simple procedure can be performed in minutes via the device’s pre-tied, sliding knot, creating a “suture only” mattress stitch that replicates the repair of standard open suturing techniques. The speed and reproducibility of the repair dramatically improves operating room efficiency. Even complex tears requiring multiple sutures can be repaired in minutes.
Benefits: All-suture, no implants; single insertion; pre-tied, sliding knot. Parallel needles may be difficult to use in very tight knees.
Surgical pearl: Avoid torqueing the needles upon insertion into the meniscus.
Kenneth Montgomery, MD, Tri-County Orthopedics, Cedar Knolls, NJ.
Ceterix Orthopaedics, Inc. (www.ceterix.com)
The Ceterix NovoStitch Plus enables surgeons to place circumferential compression stitches around meniscus tears. These stitch patterns are designed to provide anatomical reduction and uniform compression of the tear edges, and repair the femoral surface (top) and tibial surface (bottom) of the tear with each stitch. It is also designed to eliminate neurovascular risk and avoid excessive entrapment or extrusion of the meniscus to capsule. The NovoStitch Plus passes circumferential stitches via an all-inside arthroscopic technique. In addition to anatomically repairing vertical tears, circumferential stitches also enable repair of tear types that were previously considered difficult to adequately sew.