Meniscal Root Repair

Background: Meniscal root tears typically result from a hyperflexion/squatting injury or are in conjunction with ligamentous knee injury. Once a complete tear occurs, the meniscus is unable to convert axial loads to transverse hoop stresses which result in increased tibiofemoral contact pressure and osteoarthritis. The goal of a meniscal root repair is to anatomically reattach the meniscal root to the tibia plateau. Complete and partial healing occurs in over 93% of cases with retear rates ranging from 0% to 7%. Indications: We present a case of a highly active 21-year-old male collegiate soccer play that sustained a medial meniscal root tear after slipping on ice. Technique: An anatomic medial meniscal root repair was performed using a transtibial guide and 2 loop sutures tied over a button. Results: Full anatomic footprint coverage was able to be achieved intraoperatively and gentle range of motion from 0 to 90° of flexion did not result in gap formation. Discussion/Conclusion: Successful outcomes with full anatomic footprint coverage of the medial meniscal root can be achieved with 2-loop suture button configuration.

Arthroscopic Medial Meniscus Root Repair With Transtibial Ripstop Technique

Background: Meniscal root tears are radial tears occurring at or within 1 cm of the meniscal root attachment. These injuries have been shown to be the biomechanical equivalent of a total meniscectomy and are thought to be responsible for a rapid progression of osteoarthritis if left untreated. Indications: Meniscal root repair is indicated if possible, with the exception of patients who have diffuse Outerbridge 3-4 osteoarthritis of the ipsilateral compartment, those who are poor surgical candidates due to age or medical comorbidity, or in whom nonsymptomatic tears are found incidentally. Technique Description: Standard 2-portal arthroscopy is performed. Once a medial root tear has been identified and concomitant pathology has been addressed, we typically begin the repair by trephinating the deep medial collateral ligament with an 18-gauge needle to enhance visualization and avoid iatrogenic cartilage injury. Arthroscopic shaver is used to debride the meniscal root as needed. A meniscal root guide is introduced into the joint and an incision is made on the anteromedial tibia for outside-in drilling of a transosseous tunnel. Drilling is performed with a 5-mm retroreaming device, and a 10-mm socket is created. Nonabsorbable suture is then passed through the meniscus using a self-capture device in an inverted mattress configuration, following by 2 cinch stitches. The sutures are then shuttled into the transosseous tunnel, and the meniscal root is reduced and tensioned in full extension, with the sutures being fixated into a suture anchor on the anteromedial tibia. Results: A recent large systematic review of 1086 patients undergoing treatment of meniscal root tear via either debridement or nonoperative management compared with meniscal repair found that conversion to total knee arthroplasty occurred in 11% to 54% of those managed via debridement or nonoperative care versus 0% to 1% for those with root repair. Discussion/Conclusion: Currently, meniscal root repair offers the greatest improvement and lowest risk of conversion to arthroplasty following meniscal root tear. The present technique offers a durable repair that we believe combines ease of execution with decreased risk of suture pull-out, by creating a ripstop-type construct. Long-term outcome studies are needed for this and other root repair techniques.

A Simple Way to Fix a Lateral Meniscal Root Tear

Background: Meniscal posterior root tears, which are often associated with anterior cruciate ligament (ACL) injury, lead to the loss of normal biomechanical and kinematic behavior of menisci. Several arthroscopic techniques have been introduced to address this kind of injury. In this video, a simple all-inside technique to repair posterior lateral root tear (PLRT) is presented. Indications: To repair type 1, type 2, and type 4 PLRT. Technique: The torn lateral meniscus root is sutured to the medial fibers of the posterior cruciate ligament (PCL), with an arthroscopic all-inside repair system, with the purpose of reproducing the stabilizing function of the meniscofemoral ligaments. Results: This procedure allows restoration of the correct position of the detached horn, and restores meniscal stability with satisfactory clinical outcomes. Discussion/Conclusion: The technique described represents a simple and fast arthroscopic all-inside procedure to repair PLRT in association with concomitant procedure, such as ACL reconstruction. However, outcome reports of this technique are still lacking in the literature, and further studies are needed to confirm the authors’ results.

Effect of meniscal root tear on pivot shift test after anterior cruciate ligament-deficient

Introduction: A review of the literature demonstrates that injury of the lateral meniscus, anterolateral capsule, and iliotibial(IT ) band or small lateral tibial plateau aggravate the instability of knee and contributes to a high-grade pivot shift in the ACL-deficient knee. Hypotheses: The hypothesis was that disruption of posterior root of the lateral meniscus will further destabilize the ACL-deficient knee and simulated a high-grade pivot shift but posterior root of medial meniscal not. Methods: 6 fresh-frozen cadaveric knees was performed the next test in a custom activity simulator.1.Determine the effect of PRLMT on the stability of ACL-deficient knee.In the pivot shift test, ITB force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N.m),and valgus moments (5 and 7 N.m). tibial translation of front drawer test were performed by applying a 90-N anterior

Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis: A case report and literature review

Background: Spontaneous osteonecrosis of the knee (SONK) was defined as a distinct clinical entity with characteristical findings that subchondral lesions in the weight-bearing region of a single condyle. In the early stage of SONK, we usually think that injury of meniscus was to blame for the knee pain. Elderly patients with medial meniscus tear should be aware of the occurrence of osteonecrosis. Case presentation：A 67-year-old male complained of pain in the left knee for 3 months in 2013. Magnetic resonance imaging (MRI) revealed a medial meniscal root tear (level III), so that he patient underwent arthroscopic meniscectomy. However, no obvious pain relief achieved at the follow-up. The pain was associated with weight bearing, of which was initially intermittent, gradually progressed in intensity and became frequent even at rest. At 18 months after the first visit, we re-examined the knee MRI and results clearly revealed subchondral bone osteonecrosis of the condyle. Finally, we performed unicompartmental arthroplasty which significantly relieved the pain and restored the walking ability of the patient. Conclusions: Meniscus injury often coexist with SONK. In the early stages of SONK, the area of necrosis is small which is very easy to be ignored causing a misdiagnosis. The case reminds us should pay much attention to the possibility of subchondral bone necrosis in patients with knee pain and meniscal injury.

Meniscal Root Tear: A Missed Epidemic?

Meniscal root tears often go unnoticed and represent unique injury patterns with unique biomechanical consequences. Meniscal root tear occurs about 10-21% of all meniscal tears. Almost 10% of ACL tears involving posterior lateral meniscus tears. Meniscal root tears interrupt the continuity of the circumferential fibers, hence meniscus will fail to function as a shock absorber and load distributor. The biomechanical implication is the accelerated degeneration of the joint comparable to total meniscectomy. Repair of meniscal root tear will reduce contact pressure and increase contact area biomechanically similar to the uninjured meniscus. However, the repair must be done as anatomic as possible. Otherwise, the goal of restoring the meniscus function may not be achieved. Sign and symptoms, physical examination and radiological findings that may suggest a meniscal root tear will be discussed in this paper. Moreover, an overview of the management will also be described.