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Posterior Lateral Meniscus Root Reattachment With Suture Anchors: An Arthroscopic Technique.

ABSTRACT: The posterior lateral meniscus root (PLMR) provides the circumferential tension required to stabilize the lateral meniscus. Thus, preservation of the PLMR is important to prevent an increase in tibiofemoral contact pressure, which could result in osteoarthritis. We describe an all-arthroscopic approach to the fixation of PLMR using suture anchors through associated posterolateral arthroscopic portals that result in a more favorable inclination of the anchors. Initially, the anatomical insertion site of the root on the tibial plateau is debrided, 1 to 2 anchors are placed through the posterolateral portals into the root's footprint area, and the meniscus is finally sutured from the posterolateral portals. Compression of the meniscus is achieved with bone contact. This technique achieves lateral meniscus root fixation, reducing the risk of subluxation of the meniscus and subsequent osteoarthritis.

SUBMITTER: Cuellar A

PROVIDER: S-EPMC5797299 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Posterior Lateral Meniscus Root Reattachment With Suture Anchors: An Arthroscopic Technique.

Cuéllar Adrián A Cuéllar Asier A Sánchez Alberto A Cuéllar Ricardo R

Arthroscopy techniques 20171016 5

The posterior lateral meniscus root (PLMR) provides the circumferential tension required to stabilize the lateral meniscus. Thus, preservation of the PLMR is important to prevent an increase in tibiofemoral contact pressure, which could result in osteoarthritis. We describe an all-arthroscopic approach to the fixation of PLMR using suture anchors through associated posterolateral arthroscopic portals that result in a more favorable inclination of the anchors. Initially, the anatomical insertion ...[more]

PMID: 29416979

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Project description:Meniscus root tears are increasingly being recognized and treated because of improved awareness and diagnostics. These injuries commonly occur in combination with knee ligament injuries. Untreated posterior meniscus root teats have been demonstrated to increase contact pressure and decrease contact area, ultimately leading to unfavorable joint loading and development of early osteoarthritis. Posterior lateral meniscus root tears (PLMRTs) also have been reported to increase anterior tibial translation and pivot shift in anterior cruciate ligament–deficient knees. Therefore, it is crucial to repair meniscal root tears when possible to restore knee joint loading and kinematics. Several techniques for repair of the PLMRT have been described. In this Technical Note, we describe our preferred technique for repair of PLMRT using an all-suture anchor. This technique is reproducible, does not need a tunnel, mitigates bungee effect of transtibial technique, and the anchor can easily be inserted on the footprint without a need for a guide. Technique Video Video 1 We present our arthroscopic repair of posterior root tears of the lateral meniscus with all-suture anchor. The surgical procedure is performed with the patient under epidural anesthesia in the supine position. A padded, nonsterile tourniquet is placed high on the operative thigh, and the patient is positioned with lateral support at the level of the tourniquet and a foot post to allow the knee to be maintained at 90° of flexion when required. The operative leg is prepared and draped in standard fashion. Standard anterolateral and anteromedial portals are created for routine diagnostic arthroscopy. The torn meniscal root should be probed to assess for severity and tear pattern. First with a burr and then with a curved curette, the tibial attachment site of the torn lateral meniscus root is debrided of soft tissues and overlying cartilage down to a bleeding bone bed to improve healing of the repair. Appropriate knee flexion is key to achieve a correct anchor placement. Therefore, an accessory high anteromedial portal is created with the knee hyperflexed. A curved guide is inserted through the high anteromedial portal and the guide is placed at the prepared insertion site of the footprint. A pilot hole is created at an appropriate angle using a 1.8-mm flexible drill. Afterwards, a 1.8 mm all-suture anchor loaded with a FiberWire no. 2 is placed. We recommend to set the anchor and test its stability by pulling on the sutures. The leg is then brought into the figure-of-4 position. The sutures are retrieved through the standard anteromedial portal. A direct suture passer and retriever is loaded into the bottom jaw, and it is then introduced through the standard anteromedial portal. Once the suture passer and retriever has been positioned at the desired location on the meniscus, the top jaw is closed and the back trigger is squeezed to advance suture through the tissue bottom up. With the suture captured in the top jaw, the Knee Scorpion is retracted from the tissue. The same procedure is then repeated in the posterior part of the meniscus with the second, free-end of the suture. A simple arthroscopic knot is then tightened under direct arthroscopic visualization aiming for the correct amount of tension. Finally, with a FiberTape Cutter, the FiberWire is cut and the strength of the suture fixation is tested with a probe.

Project description:Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique. Technique Video Video 1 The arthroscopic view from the anterolateral portal shows a decreased volume of the lateral meniscus due to a previous surgical resection. The posterior lateral meniscus (LM) is pulled anteriorly over the center of the lateral compartment by probing. The posterior LM is repaired under the guidance of the ultrasound by having the assistant surgeon place the ultrasound probe, covered with a sterile sleeve, horizontally on the popliteal fossa to allow confirmation of the posterior portion of the LM and the popliteal artery. An all-inside suture device, the JuggerStitch, is introduced from an anterolateral portal, and the tip of the needle is observed in the ultrasound image. While penetrating the posterior LM, the direction of the needle is confirmed not to injure the neurovascular structures. The anchor of the JuggerStich is introduced at the posterior side of the LM and can be observed as a high echoic region. After introduction of two anchors, the sutures are pulled anteriorly through the anterolateral portal, and the knot is tightened. The ultrasound image shows that the two anchors are positioned on the capsule behind the posterior LM. The same procedures are then repeated. The location of the popliteal artery and the direction of the needle are confirmed by ultrasound every time. If the needle is directed toward the artery, it should be extracted and inserted again. A total of 4 sutures are performed to obtain stability of the LM under the assistance of ultrasound. The final arthroscopic examination shows the properly secured repair and the stabilized posterior LM by probing.

Dataset Information

Posterior Lateral Meniscus Root Reattachment With Suture Anchors: An Arthroscopic Technique.

Publications

Posterior Lateral Meniscus Root Reattachment With Suture Anchors: An Arthroscopic Technique.

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