Dataset Information

Reconstruction of the Popliteomeniscal Fascicles for Treatment of Recurrent Subluxation of the Lateral Meniscus.

ABSTRACT: Recurrent subluxation of the lateral meniscus is characterized by episodes of mechanical locking of the knee joint. To completely preclude the posterior segment of the lateral meniscus from undergoing anterior dislocation during deep knee flexion, the structures to which it is attached need to be relatively taut. The posterosuperior popliteomeniscal fascicle retains its tension during deep knee flexion; therefore, reconstruction of the posterosuperior and anteroinferior popliteomeniscal fascicles was performed with an autograft harvested from the iliotibial band. This technique provides stabilization of the posterior segment of the lateral meniscus during deep knee flexion without interfering with the normal movement of the lateral meniscus throughout the range of motion of the knee joint.

SUBMITTER: Suganuma J

PROVIDER: S-EPMC5442319 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Reconstruction of the Popliteomeniscal Fascicles for Treatment of Recurrent Subluxation of the Lateral Meniscus.

Suganuma Jun J Inoue Yutaka Y Tani Hideaki H Sugiki Tadashi T Sassa Tomoki T Shibata Reo R

Arthroscopy techniques 20170306 2

Recurrent subluxation of the lateral meniscus is characterized by episodes of mechanical locking of the knee joint. To completely preclude the posterior segment of the lateral meniscus from undergoing anterior dislocation during deep knee flexion, the structures to which it is attached need to be relatively taut. The posterosuperior popliteomeniscal fascicle retains its tension during deep knee flexion; therefore, reconstruction of the posterosuperior and anteroinferior popliteomeniscal fascicle ...[more]

PMID: 28580243

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Project description:BackgroundIndependent transtibial pullout repair is a common surgical technique for repairing lateral meniscus posterior root tears (LMPRTs). The shared anterior cruciate ligament (ACL) bone tunnel technique is an alternative technique for LMPRT repair combined with ACL reconstruction (ACLR) to avoid the establishment of additional bone tunnels.PurposeTo compare the clinical outcomes of the shared ACL bone tunnel versus the independent transtibial pullout techniques for LMPRT repair combined with ACLR.Study designCohort study; Level of evidence, 3.MethodsBetween March 2014 and February 2018, a total of 48 patients were diagnosed with ACL injury with concomitant LMPRT; 22 patients underwent independent transtibial pullout repair (group T), and 26 patients underwent the shared ACL bone tunnel technique (group S). At a follow-up of >2 years, we compared knee functional recovery using the Lysholm, Tegner, and International Knee Documentation Committee scores and the pivot-shift test. Lateral meniscal extrusion, and cartilage degeneration on magnetic resonance imaging (MRI) scans were also compared. The healing status of the lateral meniscus posterior root was compared using second-look arthroscopy and MRI.ResultsThe duration of surgery was significantly shorter in group S compared with group T (98.3 ± 11.1 vs 127.9 ± 17.5 min; P = .001). At final follow-up, there were no significant differences between the 2 groups in knee functional scores, pivot shift, or grade of cartilage degeneration. Lateral meniscal extrusion was decreased in group S compared with group T (2.41 ± 0.61 vs 1.59 ± 1.35 mm; P = .014). Second-look arthroscopy revealed stable healing in 16 of 18 patients (88.9%) in group S and 10 of 15 patients (66.7%) in group T (P = .38).ConclusionBoth the shared ACL bone tunnel and the independent transtibial pullout techniques led to satisfactory clinical outcomes. The shared ACL bone tunnel technique is the simpler of the 2 procedures for combined LMPRT repair with ACLR.

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:BackgroundAnterolateral knee laxity (ALLx) has been linked to tears of the lateral meniscus (LM) and anterior cruciate ligament (ACL) injury.PurposeTo investigate the longitudinal relationship between the signal intensity (SI) of the repaired LM on magnetic resonance imaging (MRI) and residual ALLx after ACL reconstruction (ACLR).Study designCohort study; Level of evidence, 3.MethodsIncluded were 87 patients who underwent double-bundle ACLR and lateral meniscal repair (mean age, 23.5 years; body mass index, 23.7 kg/m2; 56 women) at a single institution between 2010 and 2019. Proton density-weighted (PDW) and T2-weighted (T2W) MRI was performed at 3, 6, and 12 months postoperatively, and the SI ratio (SIR) was calculated as (SI of the repaired LM)/(SI of the posterior cruciate ligament). At the 12-month follow-up, ALLx was evaluated using the pivot-shift test; an International Knee Documentation Committee grade ≥1 indicated residual ALLx.ResultsOverall, 12 patients (13.8%) exhibited ALLx at 12 months postoperatively. At 3 months postoperatively, the SIR on PDW images (SIR-PDW) was significantly higher in patients with ALLx versus those without ALLx (1.98 ± 0.77 vs 1.49 ± 0.52, respectively; P = .007); there was no difference in the SIR on T2W images between the groups. SIR-PDW at 3 months postoperatively was correlated negatively with patient age (r = -0.308, P = .004). When patients were stratified into a younger (≤22 years; n = 53; ALLx = 7 [13.2%]) and an older (>22 years; n = 34; ALLx = 5 [14.7%]) group, the area under the receiver operating characteristic curves (AUCs) for SIR-PDW in the younger group were statistically significant for predicting the prevalence of ALLx at all follow-up times (AUCs, 0.733-0.788) with optimal cutoff values of 2.00 at 3 months, 1.50 at 6 months, and 1.50 at 12 months. Logistic regression analysis revealed that if younger patients consistently had higher SIR-PDW values than the cutoff values, they were more likely to have residual ALLx (odds ratios, 10.24-23.57).ConclusionFor younger patients who underwent both ACLR and lateral meniscal repair, higher MRI SI of the repaired LM was associated with a higher prevalence of residual ALLx.

Dataset Information

Reconstruction of the Popliteomeniscal Fascicles for Treatment of Recurrent Subluxation of the Lateral Meniscus.

Publications

Reconstruction of the Popliteomeniscal Fascicles for Treatment of Recurrent Subluxation of the Lateral Meniscus.

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