All‐Inside Stabilization of Discoid Lateral Meniscus Popliteal Hiatus‐Related Instability Using Anterior Cord Release With Meniscus Retention

Abstract

Discoid lateral meniscus is a common cause of lateral knee pain, snapping, catching, and intermittent locking. Although saucerization combined with repair has been widely used, postoperative remodeling, reduced meniscal volume, extrusion, and degenerative changes on magnetic resonance imaging have raised concerns regarding meniscal resection. A meniscus‐retention concept using anterior cord release with robust suturing has been described, particularly for large displaced longitudinal tears with frank mechanical locking. In daily practice, however, many symptomatic cases present with popliteal hiatus‐related posterior peripheral disruption and popliteomeniscal fascicle insufficiency, resulting in peripheral rim instability and anterior translation of the discoid meniscus during knee motion. Here, we describe a simple and physiologic, meniscus‐retaining technique that combines anterior cord release to reduce anterior horn tension and facilitate peripheral reduction and targeted all‐inside vertical mattress fixation around the popliteus tendon. A pragmatic avoidance criterion is emphasized for extensive, notch‐locked displaced tears that likely require more robust fixation, in which inside‐out repair is preferred. This technique aims to control dynamic instability while preserving native meniscal tissue and minimizing intra‐articular environmental change.