Dataset Information

A Medial Meniscal Root Pullout Repair With the Use of a Tibial Tunnel Suturing Technique.

ABSTRACT: A meniscal root tear is one of the common knee injuries that can lead to degenerative changes in the knee joint. Meniscal root repairs can restore proper biomechanics of the knee joint. We have developed a suturing technique that uses a tibial tunnel for a pullout suture medial meniscal root repair. This is a straightforward technique that helps to promote simple suturing of the medial meniscal root, avoid iatrogenic injuries to the articular cartilage, and produce an additional working portal during a meniscal root repair.

SUBMITTER: Apivatgaroon A

PROVIDER: S-EPMC5021665 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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A Medial Meniscal Root Pullout Repair With the Use of a Tibial Tunnel Suturing Technique.

Apivatgaroon Adinun A Chernchujit Bancha B

Arthroscopy techniques 20160606 3

A meniscal root tear is one of the common knee injuries that can lead to degenerative changes in the knee joint. Meniscal root repairs can restore proper biomechanics of the knee joint. We have developed a suturing technique that uses a tibial tunnel for a pullout suture medial meniscal root repair. This is a straightforward technique that helps to promote simple suturing of the medial meniscal root, avoid iatrogenic injuries to the articular cartilage, and produce an additional working portal d ...[more]

PMID: 27656383

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Project description:Concomitant medial meniscus posterior horn root tears and lateral meniscus posterior horn root tears are rare in occurrence. There is limited literature on the simultaneous repair of medial and lateral meniscus root tears, with ACL reconstruction. We discuss management of concomitant medial meniscus posterior horn root tear (MMPHRT), lateral meniscus posterior horn root tear (LMPHRT), and anterior cruciate ligament (ACL) tear. We highlight the surgical technique in which we perform a repair of both medial and lateral meniscus posterior horn root repairs with ACL reconstruction. We explain the sequence of such a repair to avoid tunnel coalescence. Technique Video Video 1 The patient is in the supine position with the knee in near extension with valgus stress applied. Pie crusting of the medial collateral ligament is performed to improve the visualization of the medial meniscus posterior horn root (MMPHR) tear. FiberTape (Arthrex, Naples, FL) and FiberWire 2-0 (Arthrex) are passed through the remnant of the medial meniscus root using an antegrade suture passing device; Firstpass Mini (Smith & Nephew, London UK). The tape and sutures are passed with an antegrade suture passer, working from the anteromedial portal and visualizing from the anterolateral portal. The footprint for the MMPHR is prepared, and a guide wire is passed using a low-profile jig set at 50°. The MMPHR tunnel is reamed with a 4.5-mm reamer. The suture and tape passed through the MMPHR are shuttled out and pulled out through the tibia tunnel. With the MMPHR reduced, three all-inside devices; Fastfix 360 (Smith & Nephew) are used to repair the complex horizontal meniscus tear and the posteromedial junction radial tear. These stitches—two to the posterior capsule and the third to the posteromedial capsule—helps to reinforce the medial meniscus to the posterior capsule. We then proceed to do the LMPHRT repair. In a figure-of-four positions, lateral meniscus posterior root tear is visualized. The footprint of the lateral meniscus root is prepared. FiberTape (Arthrex) and FibreWire 2-0 (Arthrex) are passed through the remnant of the lateral meniscus root using an antegrade suture passing device; Firstpass Mini (Smith & Nephew). The FiberTape is introduced through the anteromedial portal and the FiberWire is also introduced through the anteromedial portal (Fig 3C). This is to obtain the best trajectory to pass the suture through good meniscus tissue. A guide wire is inserted at the footprint of the LMPHR using a low-profile jig set at 50°. The LMPHR tunnel is reamed using a 4.5-mm reamer. The FiberTape and the FiberWire pulled out through the LMPHR tunnel. This is followed by ACL reconstruction and passage of ACL graft. The orientation of the tunnel in the proximal tibia from medial to lateral are the MMPHR tunnel, LMPHR tunnel, and ACL tunnel. The medial and lateral meniscus roots are tensioned individually and tied over the cortical button, following which, the ACL graft is fixed with a tibial interference screw.

Project description:BackgroundThe role of meniscal lesions and repair in combination with anterior cruciate ligament (ACL) injury and reconstruction has not been extensively investigated in vivo and under weightbearing conditions.PurposeThe purposes of this study were to (1) compare the in vivo knee kinematics between patients with ACL tear and those with combined ACL and medial meniscal tears and (2) investigate kinematic differences between isolated ACL reconstruction and ACL reconstruction plus medial meniscal repair (MR). It was hypothesized that concomitant posterior horn medial meniscal tear and ACL deficiency would affect knee internal-external rotation and anterior-posterior translation but MR would restore these parameters.Study designControlled laboratory study.MethodsNineteen patients who underwent ACL reconstruction were included: 10 had intact menisci (IM group) and 9 had a medial meniscal injury that was repaired during ACL reconstruction using an all-inside technique (MR group). Preoperatively and 18 months postoperatively, active knee kinematics under weightbearing conditions was evaluated during a single-leg squat using a dynamic biplane x-ray imaging system. The general linear model was used to investigate the differences between group (IM vs MR) and time (preoperative vs follow-up) and their interactions.ResultsTibial internal rotation was higher in the MR group than the IM group both before and after surgery (P = .007). Knee valgus rotation was higher in the MR group preoperatively (P < .001), while no differences were found postoperatively because of an increase of valgus rotation in the IM group, which was significant in the descendant phase (P < .001). Preoperatively, the IM group showed a more medial tibial translation compared with the MR group in the descendant phase (P = .006).ConclusionWhen performing a single-leg squat, patients with ACL-deficient knees and a medial meniscal tear demonstrated a more valgus rotation, tibial internal rotation, and lateral tibial translation versus those with intact menisci. After ACL reconstruction and MR, these patients demonstrated significantly higher tibial internal rotation when compared with patients who underwent isolated ACL reconstruction.Clinical relevanceSurgeons should be aware that MR does not fully restore knee kinematics in vivo and under weightbearing conditions in the context of ACL reconstruction.

Dataset Information

A Medial Meniscal Root Pullout Repair With the Use of a Tibial Tunnel Suturing Technique.

Publications

A Medial Meniscal Root Pullout Repair With the Use of a Tibial Tunnel Suturing Technique.

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