Essential Surgical Techniques

New all-video "Key Procedures" article: "Proximal Tibial Valgus Osteotomy: Lateral Closing Wedge"

Latest Surgical Technique

November 11, 2015
  • Robert F. LaPrade , MD, PhD
  • Samuel G. Moulton , BA
  • Tyler R. Cram , MA, ATC, OTC
  • Andrew G. Geeslin , MD
  • Christopher M. LaPrade , BA
  • Lars Engebretsen , MD, PhD
  1. Robert F. LaPrade, MD, PhD1,
  2. Samuel G. Moulton, BA1,
  3. Tyler R. Cram, MA, ATC, OTC1,
  4. Andrew G. Geeslin, MD1 and
  5. Christopher M. LaPrade, BA1
  1. 1Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657
  1. Lars Engebretsen, MD, PhD2
  1. 2Department of Orthopaedic Surgery, Oslo University Hospital, Oslo Sports Trauma Research Center, PB 4014 Ullevål Stadion, 0806 Oslo, Norway


Meniscal tears differ in terms of pattern and location. If left untreated, a meniscal tear can lead to the development of osteoarthritis and increased pain, swelling, and functional limitations. Tears in the vascularized outer two-thirds of the meniscus can often be successfully repaired with use of an inside-out technique. Vertical mattress sutures stabilize the meniscal tear in place, allowing for proper healing.

The principal steps in the procedure include (1) assessing the location and pattern of the tear arthroscopically, (2) performing a medial or lateral meniscal repair incision in the proper anatomic location, (3) passing the sutures in a vertical mattress pattern through the torn meniscus, and (4) tying the sutures while verifying sufficient reduction of the tear arthroscopically.

Postoperatively, patients remain non-weight-bearing for the course of six weeks. Passive knee flexion from 0° to 90° is allowed for the first two weeks. After two weeks, motion is increased as tolerated. At six weeks postoperatively, patients are allowed to progress to weight-bearing as tolerated and initiate the use of a stationary bicycle. They should avoid squatting, sitting cross-legged, and squatting and lifting for four months postoperatively to avoid substantial stress on the healing meniscus. After four months, sports-specific activities are initiated. Patients are expected to return to normal physical activity within four to six months postoperatively.


  • Published outcomes of this procedure can be found at: Knee Surg Sports Traumatol Arthrosc. 2015 Jan;23(1):164-70, J Bone Joint Surg Am. 2012 Dec 19;94(24):2222-7, and Arthroscopy. 2011 Sep;27(9):1275-88.

  • Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

View Full Text

The Latest from JBJS Essential Surgical Techniques

  • Posterior Arthroscopic Subtalar Arthrodesis
    Bernhard Devos Bevernage, MD; Laurent Goubau, MD; Paul-André Deleu, MSc; Vincent Gombault, MD; Pierre Maldague, MD; Thibaut Leemrijse, MD
  • Proximal Tibial Valgus Osteotomy: Lateral Closing Wedge
    Tom M. van Raaij, MD, PhD; Reinoud W. Brouwer, MD, PhD
  • Medial and Lateral Meniscal Inside-Out Repairs
    Robert F. LaPrade, MD, PhD; Samuel G. Moulton, BA; Tyler R. Cram, MA, ATC, OTC; Andrew G. Geeslin, MD; Christopher M. LaPrade, BA; Lars Engebretsen, MD, PhD
  • Single and Dual-Incision Fasciotomy of the Lower Leg
    Keerat Singh, MD; Jesse E. Bible, MD, MHS; Hassan R. Mir, MD, MBA