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DePuy Synthes Mitek Sports MedicineAll Inside Anterior MeniscalRepair using TRUESPAN Meniscal Repair System
IntroductionThe meniscus contributes to optimal knee joint function because of its critical role inload transmission, shock absorption, joint stability, lubrication, articular cartilagenutrition, and neuromuscular proprioception. As a result, repair of peripheral and red/white meniscal tears is recommended.The all-inside arthroscopic technique has addressed many of the limitations oftraditional meniscal repair techniques. The all-inside suture-based technique hasgained popularity because of the following advantages; the all-inside repair can besafely performed without a posterior incision: allows for vertical or horizontal mattresssutures to be placed on the femoral or tibial surface of the meniscus; reduced surgicaltime; and reduced need for 1st assistant. This can all be done with similar healingresults of the inside-out meniscal repair technique.1Dr. Tony Nguyen2DePuy SynthesAlthough the all-inside meniscal repair technique allows easy access to tears in theposterior and middle thirds of the meniscus, Surgeons may find it difficult to reach theanterior half of the meniscus. Reaching this area would typically require either aninside-out or outside-in technique. Dr. Tony Nguyen from the CORE Institute, PhoenixArizona has developed a simple solution for these tears using the TRUESPAN MeniscalRepair System.TRUESPAN Meniscal Repair SystemSurgical Technique
Surgical TechniqueStep 1Portal placement- When accessing the anterior portion ofthe meniscus, be aware of your portal placement foroptimal access to the anterior side of the meniscus,whether it being the medial or lateral side of the knee.Once the portal placement is created and the meniscaltear site is prepared, proceed to meniscal tear assessment.a. Medial portal placement for Medial sided tears:Spinal needle localization just superior to anteriorhorn of medial meniscus.b. Medial portal placement for Lateral sided tears:Spinal needle localization just over tibial spines.Step 2Determine tear location - Use a depth probe work todetermine the desired depth limit on your Truespandevice. Place the tip of the probe at the meniscosynovialjunction and measure the width of the meniscus at thedesired entry point for the delivery needle.Surgical TechniqueTRUESPAN Meniscal Repair SystemDePuy Synthes3
Surgical TechniqueStep 3Shape the malleable graft retractor- Take your MitekMalleable Graft Retractor and place a slight bend (20 )on the tip of the retractor in the direction of the repairsite. This bend will allow you to utilize the angle of yourTRUESPAN Meniscal Repair System device to it maximumcapability and place yourself into a position to access theanterior half of the meniscus. It essentially acts as a skidto avoid posterior skiving of the implant.Note: When trying to access the anterior portion ofthe meniscus, it has been traditionally difficult toaccess with a standard needle curve on your allinside repair device.Note: When performing, an anterior meniscalrepair, it is advised to use a 24 angled Truespandevice to maximize your ability to reach youranterior meniscal repair site.Step 4Insert your malleable graft retractor- insert your bentMalleable graft retractor in position.Place through the opposite portal, ie medial meniscusrepair- Malleable graft retractor in lateral portal.Place Malleable retractor into medial compartment.4DePuy SynthesTRUESPAN Meniscal Repair SystemSurgical Technique
Surgical TechniqueStep 5Insert your Truespan device- Take your, Truespan Devicewith needle facing down and slide it down the slottedportion of your graft retractor until you enter the kneejoint space. This allows it to easily enter the knee jointand avoid the fat pad.Step 6Position your malleable graft retractor. Take your graftretractor and maneuver into a position where the bentend of your graft retractor point is facing anterior. Oncedone, you now can leverage off the graft retractor toenter the meniscus without the possibility of “skiving”off the meniscus.This is a two handed maneuver, one hand on device theother on the sled. Have your assistant hold the camera.Surgical TechniqueTRUESPAN Meniscal Repair SystemDePuy Synthes5
Surgical TechniqueStep 7Place first implant– Enter the meniscus until the depthstep reaches the tissue. Once fully imbedded, fire thetrigger of your Truespan device until you hear a CLICK.Then release trigger all the way, and slowly removeneedle from meniscus.Step 8Place second implant– reposition your malleable graftretractor into desired location for 2nd implant, 2ndimplant should be no more than 6-9mm away.6DePuy SynthesTRUESPAN Meniscal Repair SystemSurgical Technique
Surgical TechniqueStep 9Reduce Tear– Remove delivery needle from the knee,pulling the free end of the suture with continuous forceto tighten the repair until desired tension is reached. Ahooked probe can be used to help in reduction.Surgical TechniqueTRUESPAN Meniscal Repair SystemDePuy Synthes7
Surgical TechniqueStep 10Trim excess suture- once suture is fully tightened anddesired tension is reached, take your MITEK ArthroscopicKnot Pusher Cutter and cut the suture tails.8DePuy SynthesTRUESPAN Meniscal Repair SystemSurgical Technique
Additional InformationPostoperative CareThe TRUESPAN Meniscal Repair System utilizes a high strength partially-absorbable suture and was found to havecomparable system strength when compared to the OMNISPAN Meniscal Repair System.2 As a result, the standardrehabilitation protocol used with all-inside repairs can be utilized.Additional InstructionPrior to performing this technique, consult the Instruction for Use documentation provided with individualcomponents – including indications, contraindications, warnings, cautions, and instructions.Tips & Pearls Probe under the suture may help to hold meniscus reduced while cinching the knot. Prepare meniscal tear site properly. Choose the portal which most easily allows the delivery needle to be inserted perpendicular to the tear site. Set the depth penetration limiter. Put bend (20 ) in Malleable graft retractor. Vertical mattress suture: implant one inserted into the capsular side of the tear; implant two inserted on themeniscal side of the tear. Hold the device at the handle and pull the red handle until you hear a CLICK, then fully release. Thread suture onto the knot pusher/suture cutter with the suture funnel. If the knot does not cinch smoothly, it usually requires a steady and more forceful pull, which is facilitated bywrapping the suture around several fingers, like a pulley, and applying tension. You can also place a probe underthe sutures as a pulley to help cinch the knot. Cinch the knot to obtain the desired degree of compression at the tear site. Avoid over-cinching the knot, which can result in puckering of the meniscus or the suture cutting through themeniscus and weakening the repair. For the easiest knot sliding and avoidance of the neurovascular bundles, insert the needle perpendicular to the tearusing a contralateral approach.Surgical TechniqueTRUESPAN Meniscal Repair SystemDePuy Synthes9
Ordering InformationTRUESPAN PEEK & Instruments228150TRUESPAN Meniscal repair system with PEEK implants and 0 degree Needle.228151TRUESPAN Meniscal repair system with PEEK implants and 12 degree Needle.228152TRUESPAN Meniscal repair system with PEEK implants and 24 degree Needle232024Malleable Graft Retractor, 5 Pack11DePuy SynthesTRUESPAN Meniscal Repair SystemSurgical Technique
Surgical TechniqueTRUESPAN Meniscal Repair SystemDePuy Synthes11
References1. Fillingham YA, Riboh JC, Erickson BJ, Bach BR Jr, Yanke AB. Inside-Out Versus All-Inside Repair ofIsolated Meniscal Tears: An Updated Systematic Review. Am J Sports Med. 2017 Jan;45(1):234-242.doi: 10.1177/0363546516632504. Epub 2016 Jul 21. Review. PubMed PMID: 26989072.2. TRUESPAN Meniscal repair System: system strength compared to alternatiave all-inside meniscalrepair devices. Internal Data: Test Report 103248458Limited Warranty and Disclaimer: DePuy Synthes Mitek Sports Medicine products are sold with a limited warranty to the original purchaser against defectsin workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.Not all products may currently be available in all markets.Note: For recognized manufacturer, refer to the product label.Synthes USA, LLC1101 Synthes AvenueMonument, CO 80132Distributed by:Synthes USA Products, LLC1302 Wrights Lane EastWest Chester, PA 19380 DePuy Synthes 2016, 2019. All rights reserved.099739-180927 DSUS121723-190827 08/19Manufactured by:Medos International SarlChemin-Blanc 38Le Locle, Ch-2400SwitzerlandJohnson & Johnson Medical Pty Ltdt/a DePuy Synthes1-5 Khartoum RoadNorth Ryde NSW 2113AustraliaJohnson & Johnson (NZ) Limited507 Mt Wellington HighwayMt Wellington, Auckland 1060New Zealand
time; and reduced need for 1st assistant. This can all be done with similar healing results of the inside-out meniscal repair technique. 1. Although the all-inside meniscal repair technique allows easy access to tears in the . posterior and middle thirds of the meniscus, Surgeons may find
