Arthroscopic intercruciate trans-septal all-inside repair for lateral bucket-handle meniscus tear: A current technique

Lateral bucket-handle meniscus tears are challenging to reduce and repair due to limited visualization of the posterior compartment and the risk of iatrogenic injury. We present an arthroscopic workflow that combines standard anterior portals with an intercruciate trans-septal route to enhance visualization and working space across the posterior compartments of the knee. Key steps include safe creation of posteromedial and posterolateral apertures, protected posterior portals, and guided passage of a Wissinger rod to connect compartments prior to reduction and fixation. Reduction is performed with careful meniscal preparation and controlled manipulation; fixation is achieved primarily with all-inside sutures, with optional inside-out reinforcement for stiffer or chronic tears. This technique serves as an alternative approach in selected cases where visualization is limited. This article details indications, contraindications, safety pearls, limitations, early institutional experience, and expected complications to support safe adoption of the technique.