Arthroscopic Meniscectomy with Medial Collateral Ligament Trephination

Symptomatic irreparable meniscal tears that have failed nonoperative management can be managed surgically with arthroscopic partial meniscectomy. Tear patterns that are generally not amenable to repair include degenerative horizontal tears, complex tear patterns, oblique tears, and chronic bucket-handle tears. Arthroscopic meniscectomy can be performed with standard anterolateral and anteromedial portals. Portal placement is key for successful visualization and access of meniscal tears. Certain arthroscopic instruments should be made available including variably angled meniscal biters, shavers, standard 30-degree arthroscopes, and 70-degree arthroscopes for less readily accessible locations. Visualization of the posterior horn medial meniscus can be challenging in some knees. Percutaneous medial collateral ligament (MCL)TrephinationMedial collateral ligament (MCL) trephination is a safe and effective measure that can significantly improve visualization and access to the medial posterior horn and posterior root so that the surgeon can identify the tear pattern and manage the lesion appropriately while minimizing the risk of iatrogenic chondral injury. Several case examples are presented in this chapter to illustrate surgical considerations with regards to arthroscopic meniscectomy.