The ARTICS Meniscal Technique: An Innovative All-Inside Meniscal Suture Technique Without Anchors.

Background: Repair of meniscal tears should be chosen whenever possible. Posterior tears are usually repaired by suture and meniscal anchors. To avoid the pitfalls associated with the use of anchors, as well as for cost-saving and environmental reasons, we describe an alternative suture technique that is all-inside and without anchors. Indications: All posterior, vertical, and horizontal meniscal tears, including ramp lesions. Technique Description: For meniscal tears affecting the posterior horn of the medial or lateral meniscus, we perform meniscal repair using a size 1 monofilament polydioxanone (PDS; Ethicon) suture. This is an all-inside suture technique performed through an anterior arthroscopy portal. We introduce a large bevel epidural needle (Tuohy needle 1.3 × 150 mm), passing under the meniscus and piercing through the meniscotibial ligament. The PDS thread is passed through, and the limb exiting from the needle is retrieved through the posteromedial (PM) arthroscopy portal. The other limb of the thread, which is still in the needle, is passed over the meniscus and then retrieved through the PM portal. The limbs are then knotted through the PM portal. The procedure can be repeated, often 3 times, as far as the mid-body, resulting in 3 separate suture stitches. Results: This technique has a number of advantages over the usual techniques: economical: a cost saving is made with every single suture stitch compared to the usual method using an anchor; environmental: lower consumption of individually packaged implantable products; reproducible/safe: use of a large epidural needle means that all posterior meniscal tears can be sutured under arthroscopic guidance, with visualization of the needle entry and exit points above and below the meniscus; and fewer risks: lower risk of secondary meniscal tear by the suture (Tachibana effect) as the thread used is absorbable, as well as lower risk of cartilage lesions caused by migration of meniscal implants. Discussion/Conclusion: The meniscal repair technique described here, using only a monofilament absorbable suture and an epidural needle, is an innovative alternative that is reliable, reproducible, low cost, and low risk. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.