PMC

Arthroscopic repair for horizontal cleavage tears of medial meniscus. a Extensive horizontal tears with degeneration reached the peripheral edge of the meniscus. b The Omnispan needle was inserted into the tibial (inferior) surface with the first anchor, and the second anchor was placed across the horizontal tears into the femoral (superior) surface. c The completed repair with 5- to 10-mm intervals with the effect of a vertical (overlock) mattress suture

This schema shows the double-pulley technique. (A) Two 3.5-mm nonabsorbable Twinfix suture anchors doubly loaded with number 2 Ultrabraid (Smith & Nephew Endoscopy, Andover, MA, USA) sutures were placed in the femoral footprint. (B) Two strands of a single suture from each anchor were separately passed through the ACL with a FastPass Scorpion (Arthrex, Naples, FL, USA). (C) The two free suture strands were pulled to transport the two-strand-overhand locking knot over the ligament bridge. (D) The two free suture strands were tied into a multiple-throw square knot with a knot pusher. (E) Simple stitching was performed for two strands of the other suture from each anchor to overlock the ligament stump that was not fixed using the pulley technique. (F) The final construct comprised a double-mattress-sutures configuration and two simple-suture configurations to compress the ACL remnant against the femoral footprint.

Flow diagram of exclusion criteria

The double-pulley technique was performed using arthroscopy on the left knee of Patient 2. (A) Two 3.5-mm nonabsorbable Twinfix suture anchors doubly loaded with number 2 Ultrabraid (Smith & Nephew Endoscopy, Andover, MA, USA) sutures were placed in the femoral footprint. (B) Two strands of a single suture from each anchor were separately passed through the ACL with a FastPass Scorpion (Arthrex, Naples, FL, USA). (C) The two free suture strands were pulled to transport the two-strand-overhand locking knot over the ligament bridge. (D) The two free suture strands were tied into a multiple-throw square knot with a knot pusher. (E) Simple stitching was performed for two strands of the other suture from each anchor to overlock the ligament stump that was not fixed using the pulley technique. (F) The final construct comprised a double-mattress-sutures configuration and two simple-suture configurations to compress the ACL remnant against the femoral footprint.