A simplification of the knee-joint meniscectomy operation.

Introduction Occasional difficulty is experienced in mobilizing the posterior horn of the medial meniscus, in spite of the use of the special cartilage knives and snares that have been designed to overcome this. The purpose of this paper is to describe a modification of the standard meniscectomy procedure and thereby simplify it. The modification consists of the section of the posterior attachment of the meniscus by the introduction of a tenotomy knife through a small skin incision placed opposite the postero-medial aspect of the joint, i.e. between the medial ligament of the knee and the inner hamstring muscles-with the knee at a right angle. In this position the hamstring muscles lie posteriorly and are out of the way of the knife. As the point of the knife is directed anteriorly there is no risk of injury to the popliteal structures. This method is not used in performing a lateral meniscectomy because of the presence of important structures on the postero-lateral aspect of the joint, viz. the lateral popliteal nerve and the popliteus tendon, which are liable to be injured by the knife. Furthermore, the configuration of the posterior horn of the lateral cartilage is such that after section too large a portion would be left in situ. The shape of the posterior horn of the medial meniscus on the other hand lends itself to this procedure, and this meniscus can be removed almost completely (see Fig. 1).