Lateral Meniscus Zip Lesion of Knee: Classification and Repair Methods.

Lateral meniscus tears at the junction of the Wrisberg ligament and posterior horn are meniscocapsular injuries often seen with injury to the anterior cruciate ligament. Such lateral meniscus posterior horn lesions have been termed zip lesions. The lateral meniscus posterior horn is the major restraint for the pivot shift maneuver. Considering the morphology of condyles, lateral meniscus preservation and repair of unstable meniscocapsular posterior tear are needed to prevent future osteoarthritis. In this Technical Note, we aim to classify zip lesions of the posterior horn of the lateral meniscus. Zip lesions are located posteriorly and often are missed on magnetic resonance imaging and routine diagnostic arthroscopy. We recommend looking from the anteromedial portal and exploring the posterolateral compartment to identify hidden zip lesions, equivalent to medial-sided ramp lesions. We describe various all-inside techniques to repair these inaccessible tears.

Meniscus Root Tear: Extended Classification and Arthroscopic Repair Techniques.

The meniscus root is an attachment of the anterior and posterior horns of the meniscus onto the tibia, and its primary function is to prevent extrusion under axial load. Meniscus root tear constitutes 15% to 20% of meniscus tear. With the increased incidence of root tears being diagnosed commonly, many newer morphologic patterns of root tears have been detected, and the need to extend the conventional classification arises. At the same time, preserving the meniscus root necessitates novel techniques to repair this newer pattern. In this Technical Note, we describe the extended classification of root tears and arthroscopic repair techniques to achieve stable and secure fixation of meniscus roots.

Reconstruction of Superficial Medial Collateral Ligament: Modified Danish Technique with Dual Adjustable Loop Suspensory Fixation.

Injury to the superficial medial collateral ligament (MCL) is treated conservatively for low-grade injury and with surgery for high-grade injury, especially in association with cruciate ligament injury. Acute injuries are treated with MCL repair, and chronic injury requires reconstruction. Anatomic MCL reconstruction can be done using free allograft or autograft and fixed using screws or suspensory fixation. We describe here an anatomic technique that is a modification of a Danish technique in which we reroute the semitendinosus, keeping its tibial attachment intact. The semitendinosus is rerouted anatomically in the tibial tunnel, and a graft is then passed anatomically in the femoral tunnel. The graft is fixed in both tunnels with adjustable loop suspensory fixation, which gives the unique advantage of controlled tensioning of the graft for MCL reconstruction. In this technique further re-tensioning is possible if the knee is unstable in valgus stress, even after final fixation.