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Quantifying the differential functional behavior between the medial and lateral meniscus after posterior meniscus root tears

ABSTRACT: Meniscus tears of the knee are among the most common orthopedic knee injury. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. Despite contemporary surgical treatments of posterior meniscus root tears, there is a low rate of healing and an incidence of residual meniscus extrusion approaching 30%, illustrating an inability to recapitulate native meniscus function. Here, we characterized the differential functional behavior of the medial and lateral meniscus during axial compression load and dynamic knee motion using a cadaveric model. We hypothesized essential differences in extrusion between the medial and lateral meniscus in response to axial compression and knee range of motion. We found no differences in the amount of meniscus extrusion between the medial and lateral meniscus with a competent posterior root (0.338mm vs. 0.235mm; p-value = 0.181). However, posterior root detachment resulted in a consistently increased meniscus extrusion for the medial meniscus compared to the lateral meniscus (2.233mm vs. 0.4705mm; p-value < 0.0001). Moreover, detachment of the posterior root of the medial meniscus resulted in an increase in extrusion at all angles of knee flexion and was most pronounced (4.00mm ± 1.26mm) at 30-degrees of knee flexion. In contrast, the maximum mean extrusion of the lateral meniscus was 1.65mm ± 0.97mm, occurring in full extension. Furthermore, only the medial meniscus extruded during dynamic knee flexion after posterior root detachment. Given the differential functional behaviors between the medial and lateral meniscus, these findings suggest that posterior root repair requires reducing overall meniscus extrusion and recapitulating the native functional responses specific to each meniscus.

SUBMITTER: Walczak B

PROVIDER: S-EPMC8580232 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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: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.

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Quantifying the differential functional behavior between the medial and lateral meniscus after posterior meniscus root tears

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