What we're going to do here is we're just going to show dissection down for the meniscus repair techniques utilizing a inside out exposure for medial as well as then we'll do the lateral meniscus. And here we have the medial side of the knee, anterior here, medial here. What we have here is marked out where our pes anserine tendons were just right along this this superior dot is the upper border of the pes tendon. So we know we're going to be superior to that for our incision. I've marked out the joint line here with this skin marker coming along here so you can see that's the joint line with the knee flexed at about 70 degrees. We're going to bias the incision one third above the one third above the joint line and two thirds below the joint line and then we're going to make our skin incision which I've already made but you can see here what you're going to do is you're going to cut your skin here and once you're through that you're going to take your mets or your dissecting scissors and you're going to open up that superficial fascia here like so and once you do that and spread you want to make sure you don't cut too deep because you can see we already will encounter very clearly here one of the branches of the infrapatellar branch of the saphenous nerve right there. So that's always right in your field and so you want to try to preserve that if you can. So once we have that protected and dissected out what we're going to do is generally put a retractor in here and I wonder if I can have Kevin. Hey Kevo. Kevin you want to come over here. You want to stand right there and then what I can have you do is we can have you hold this retractor here and I can probably just come out with this thing here. Great. So now what we can do is have one of our assistants hold like that and the joint line is running right. I'm just going to move with this nerve protected up like so and hopefully you can see right at this red area right there is where our joint line is. So from there we can see right here. Great. If you can pull that right where I'm going to have my finger. I wonder if we can come. I wonder if we can come just in this way a little bit. Just kind of kind of diving in there like that. I want to I kind of want to show I kind of want to show that that tissue right right here. It's a little dark in there huh. So we're pretty close. Yeah, if we're able to just get some light in there because then I can show you that fascial, those fascial planes we have to go through and it's pretty robust tissue on the medial side. Can you go ask Ellen? There we go. For more light? Yeah, that's better. That's better, yep. Because they have to utilize the weakening center for you as well. Okay, I'll just have you hold like that. Yeah, it is kind of. So I can feel where we're at. Okay, right there. Yeah, beautiful. So that tissue plane right there is the fascial plane we have to go through. Our gastrocnemius head is gonna be right just posterior here where I'm showing. Our tibia is right here. And we're gonna open this plane up right there. So we can do that either with a pair of scissors or we can make an incision with a knife. And what I'm gonna do is just kind of open up that plane there until we can get that open like so. Yep, and then once that's there, then the rest is pretty easy. But you kind of have to open that up. And we can just dissect that off just a little bit for exposure purposes and come up like so. So once we have that, we should be able to bluntly then develop this tissue plane back here and fall right into that plane. So I'll put my finger in here like so. Sweep up and down like that to get that plane opened up here. And now what we should have is a tissue plane between our gastrocnemius head here, which you can see, and our tibia periosteum right there. So once we have that opened and we bluntly dissect it up and down, we can take a speculum or originally described just a spoon like this. And we can just kind of bend the spoon a little bit just so that the retractor is being held out of the way. And we can position this right into that area like so, right where we were. So then we have our retractor like that and we're all set to start passing our sutures and retrieving them. That's it? Yeah, then I was gonna do the lateral side. We might have to just shift around. Yeah. If we need to, Lee, if it's too difficult, we can flip the specimen around too. I can flip the tray if it's easier. Oh, I'll just bring this camera here. Yeah, that's good. Thanks, man. That was awesome. This is gonna be kind of hard because I'm right-handed. So I'm gonna be like... Oh, no, we'll get it. Yeah? I think. I wonder if it's possible if we rotate this this way, would that help? Like if we made the knee point that way? I mean, like just switch the tray. Or take this thing and just... But if, I don't know if it'll help. If it won't help, then we'll just leave it. Okay. Okay. So what do we get? So we're gonna try and pull that. So I'm gonna do this exact same incision on this side. Yeah. And I thought maybe if we point the knee that way, and then I can do it for just to have the cameras look at it. Something like that? Yeah, perfect. How's that, Ryan? How's that, Lee? Is that helpful? Yeah, you wanna come look? Yeah, say, hey, Greg, can you show this camera? Oh, it looks pretty good. Yeah, I love it. Yeah, that looks great. Get that going, it's gonna lock back up. Sounds good. Save the day. All right, so we... I think it looks great. We're good. All right, good. So what we're going to demonstrate here is the exposure for the lateral side of the knee for the inside-out meniscus repair of a lateral meniscus. Just for sake of orientation, here we have a specimen where the patellar tendon and quad tendon have been harvested for an ACL reconstruction. And so you have anterior along here, medial is a far side, which we're not going to see, and lateral is this side here. So here's the lateral portion of the knee. And what we're going to do is we're going to mark out a couple of anatomic landmarks just so that we can get our orientation together. So what I'm feeling here is the proximal portion of the fibula or the fibular head, and I'm just going to mark that, hopefully mark that out like so. So there's our fibular head. Our peroneal nerve is going to be exiting just along the neck of the fibula, somewhere in this area right there. I'm going to mark out our joint line, so we can see the joint line orientation to this. And our joint line is going to be right about like that. I wonder if I can grab this other pen. So our joint line is going to be here, like that. I can feel our LCL pretty stoutly right here. So our LCL is going to be running just basically right along here in this orientation. And our next thing I'm going to do is our biceps, look for our biceps femoris here, which I believe is coming in through there, something along those lines there. So again, our incision is going to be biased slightly inferior to our joint line here. Probably right along that line where I was, somewhere in there. Our joint line is actually just, I think our joint line is just above where that mark is, so dotted line there. We're going to come down like so. We're going to make an incision here. I'm going to get our knife, make our incision. Right along this line here. With our knee flexed, so all the important structures in the posterior knee are sort of relaxed and on, kind of out of the way, and do like so. Once we're through, once we're through there, we're going to develop that plane. going in there and just kind of developing through that tissue plane like so. Good, once we get the adhesions of the scarpus fascia sort of cleared off in here, we should have a pretty decent mobile plane for our skin, like so, great, now we got that exposed pretty well here, see the top portion of our fibula is right there, we don't want to go too far towards that fibular neck, let's see if we can get a retractor in here just for right now, probably better, Kevin I might have you come over here man, and maybe if you stand over there and just kind of reach around, we can do like, we can do something like this probably, good, yeah good, and then maybe a rake right like that, good, so this is our plane of our dissection right there, in fact we can already start to see on this side that gastrocnemius fascia here, just find my mets, what do I do with them, I'm looking for my medicine ball scissors, I know, anyway, so I think we can kind of come through that plane here, that tissue plane like so, kind of develop that plane here, we want to be just superior to that biceps tendon there, and just then posterior to the LCL, and oh here they are, great, so we have the tissue plane here, like so, kind of just developing this plane here, there's some adhesions in through here, so that's fine, no problem, good, great, and our LCL is right, so what I'm going to do is just kind of take a sponge, and just if I can show this to you a little bit more cleanly, I will, I'm just going to remove some of this fat for the sake of illustration purposes here, great, and then what I'm going to do for you Kevin, so I'm going to see if I can, yeah, see if I can just get you a little deeper in here actually, like that, great, and if you could pull out, yeah, perfect, so yep, perfect, so now what we have here is the LCL fibers are running right underneath that deep, that deep tissue fibers, right there you can see it, I'm going to just again for sake of purposes of this, let's see if I can just open up this plane here, so we can be able to see those fibers of the LCL a little bit better, I think you don't necessarily need to open this up, but you can just to show the, I can't see it as well as I can feel it, I really wish I could show it a little bit nicer to you for us, we're making the video for the January course for the dissection for the meniscus stuff, a pre-recording stuff, so that's the LCL coming down right there, you can see it coming down right along here, from right there to there, so we're going to be right behind that LCL, so we can come in here and dissect this open, and be right in that tissue plane right there, and once we got that open there, we should be able to get our finger in the back here, and just expose between the capsule and the gastroc head, and there's just a little bit of, so close, there it is, good, so now I'm back in the right plane here, I just want to make, spread this up enough, so we can fit our retractor in there for the purposes of the dissection posteriorly, there we go, so that was a blow for freedom, just spreading back there, now we're pretty good in regards to our dissection right there, I can feel joint line right where I need to be, there's just, sometimes there's some adhesions between the head of the gastroc, and the tibial periosteum, but I think you can see now pretty nicely that tissue plane that we've developed right in here, and then once we have that open again, what we're going to do is, we're going to take a speculum, or in this case, we have our standard spoon here, and we're going to fit that in the back, between the head of the gastroc, and the tibia capsule in the front, and so that's exactly what it's going to look like here, and then we're going to be ready to pass our sutures, and then the person on the lateral side is going to be able to retrieve the sutures right from here, so you're going to see the needle head coming right out there, and you're going to be able to take that, and bend that suture right along there, sound good, all right great, I think that's all we need to do on this one, that's it.

meniscus repair

inside-out exposure

medial meniscus repair

lateral meniscus repair

dissection process