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Posterior Horn of Medial Meniscal Peripheral Capsular Lesion: The Arthroscopic Repair Technique Working in the Posterior Compartment.

ABSTRACT: A posterior horn of medial meniscal peripheral capsular is usually associated with the anterior cruciate ligament injury. The conventional repair technique with the camera in the anterolateral portal cannot precisely restore the slope capsular synovium to the original attachment point. We present the arthroscopic technique for improving the accuracy and quality of the repair by working in the posterior compartment. When the posterolateral portal is used as the viewing portal, the accuracy of repair is improved because we can assess the full extent of the lesion and lift the sagging peripheral tissue to the more central part.

SUBMITTER: Kongmalai P

PROVIDER: S-EPMC5040096 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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

Posterior Horn of Medial Meniscal Peripheral Capsular Lesion: The Arthroscopic Repair Technique Working in the Posterior Compartment.

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