A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal

A transection (root tear or complete radial tear) injury of the medial meniscus posterior horn is not rare in the oriental area and needs to be repaired to restore the hoop tension and to reduce the extruded meniscus, which leads to osteoarthritis of the knee. In cases with transection of the medial meniscus posterior horn, the meniscus can be repaired by a pull out suture technique. However, it is difficult to manipulate a suture hook and drill a tibial tunnel in the narrow medial joint space using the traditional anterior arthroscopic technique. This article describes a new pull out suture technique for transection of the medial meniscus posterior horn using a posterior trans-septal portal that provides a safe and wide field of vision. The handling of the suture hook and a guide may reduce the possibility of a chondral or meniscal injury.