Iatrogenic chondral damage of the knee joint is a likely possibility during knee arthroscopy when sharp tools are used. We report a practical, simple and cost effective technique inorder to prevent potential damage to the articular cartilage of the knee during arthroscopic meniscal repair. A paediatric endotracheal tube, which is readily available in all operating theatres, was used to protect the surrounding soft tissue and cartilage from damage. This technique does not require ordering any extra instrumentation and reduces the operating time by allowing a quicker, safer and reproducible access to the meniscus during arthroscopic repair. Introduction Meniscal tears are usually caused by excess axial load or shear stress within the knee joint. Menisci act as shock absorbers in the knee and convert the axial load into radial strain so as to disperse the weight over a larger surface area and prevent chondral damage [18]. Many studies have shown that menisectomy increases the risk of osteoarthritis [6,8,9,10,12,13,14,15,16]. Several reports however have recommended meniscal repair to be undertaken in all cases of meniscal tear injuries [3]. Despite the controversies regarding the technique used, internal biodegradable devices are increasingly being used for this purpose [5].However, occasional complications such as cyst formation, chondral damage and transient posterior knee pain have been reported [4,7,11,17,20]. Late reabsorption of the device, inaccurate insertion of rigid absorbable fixators and breakage may lead to chondral damage [1,2,19]. Iatrogenic chondral damage at the time of insertion is another concern; in particular with sharp devices which have no protective sheath for safe insertion.Only a few devices available in the market today are designed with a plastic cannula or sheath to protect the articular cartilage. However most of the devices have introducers with sharp spikes which could cause a serious injury to the articular cartilage. Cannula sheaths which function as tissue guards may not be available for this purpose or might be an expensive necessity that has to be ordered preoperatively. Repetitive insertion of this sharp introducer could be hastened with a protective sheath to maintain the orientation and the pathway through the portal hole to the meniscal site.We use a sterile plastic paediatric endotracheal tube routinely as a tissue guard in our arthroscopic meniscal repair whenever the meniscal repair system is not equipped with a cannula to guard the portal holes. We present a case where an endotracheal tube was used as a cannula in the portal hole to protect the surrounding structures while advancing the sharp meniscal repair introducer. Case Report A 25 year old male who had sustained a knee injury while playing football, was referred to the Orthopaedic Clinic two weeks later, complaining from a painful locked knee (with active and passive range of knee flexion from 15° to 120°). This was associated with medial joint line tenderness and moderate knee effusion. Medial meniscus tear was diagnosed and urgent therapeutic arthroscopy was performed a week later. A traditional two portal knee arthroscopy was performed which showed a medial meniscus bucket handle tear. As this was fresh injury with peripheral tear (in the red-red area), this was suitable for meniscal repair which was undertaken arthroscopically as all-inside technique, using bio absorbable meniscal staple The distal end of a size 6.0 paediatric endotracheal tube was inserted through the medial portal hole and advanced to the site of the tear under direct vision. The size of the tube was large enough to allow the introduction and manoeuvres of different instrumentation (probe, meniscal gun, meniscal rasp) within the knee joint in a controlled fashion. The medial meniscus was prepared for the repair by adequate trimming of the edges to stimulate healing.
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