Displacement of the posterior horn of the lateral meniscus into posterolateral compartment: an unusual injury pattern.
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ABSTRACT:
SUBMITTER: Marx RG
PROVIDER: S-EPMC2642554 | biostudies-other | 2009 Feb
REPOSITORIES: biostudies-other
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Project description:Large posterolateral corner loss type of discoid lateral meniscus tear is unsalvageable. Therefore, subtotal meniscectomy has been the only treatment option in this case. However, long-term results of subtotal or total meniscectomy have shown a high prevalence of early degenerative changes. Persistent symptoms, such as increased pain, snapping, giving way, locking, and limited extension, can be attributed to progressive loss of posterior tibial meniscal attachment and meniscal degeneration, especially in the posterior horn. The purpose of this technique-based article is to describe a partial repair, posterior horn repair augmented with the central portion of the discoid lateral meniscus that would have been removed if a subtotal meniscectomy were performed and bone marrow stimulation in the intercondylar notch to improve meniscal healing.
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Project description:BackgroundWe describe a special, interesting phenomenon found in the anterior horn of the lateral meniscus (AHLM): most tear patterns in the AHLM are distinctive, with loose fibers in injured region and circumferential fiber bundles were separated. We name it as macerated tear. The goal of this study was to bring forward a new type of meniscal tear in the AHLM and investigate its clinical value.Materials and methodsAHLM tears underwent arthroscopic surgery from January 2012 to December 2014 were included. Data regarding the integrity of AHLM were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos.ResultsA total of 60 AHLM tears in 60 patients (mean age 27.1 years) were grouped into horizontal tears (n = 15, 25%), vertical tears (n = 14, 23%), complex tears (n = 6, 10%), and macerated tears (n = 25, 42%). There were 6 patients with AHLM cysts in macerated tear group and one patient in vertical tear group. 60 patients were performed arthroscopic meniscus repairs and were followed-up with averaged 18.7 months. Each group had significant postoperative improvement in Lysholm and IKDC scores (p < 0.05). However, the macerated tear group showed least functional recovery of Lysholm and IKDC scores compared to other groups (p < 0.05). In addition, there were no differences in postoperative range of motion, return to work, or return to sport/other baseline activities between the four groups (p > 0.05).ConclusionsThis study demonstrated that the macerated tear is common in the tear pattern of AHLM. However, feasibility of the treatment of this type of meniscal tear, especially the meniscus repairs still requires further study.
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Project description:Lateral meniscus lesions result in loss of meniscus hoop stresses and can lead to lateral compartment overload and early degenerative changes. Arthroscopic suture repair provides good long-term results. However, posterior vertical tears in the peripheral area of the meniscus can be technically challenging to resolve. This Technical Note describes the suture hook technique using an accessory posterolateral portal. We believe it is a safe, effective method for repairing full vertical tears of the lateral meniscus.
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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.
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Project description:Arthroscopic suture repair for a radial tear at the posterior horn of the lateral meniscus poses a technical procedure for surgeons. We describe an all-inside repair technique using all-inside meniscal repair devices without adding any accessory portals. This simple technique provides precise reduction and stabilization of the meniscus by pinching 2 all-inside vertical sutures consecutively across the tear site.
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Project description:Pathology of posterior horn of medial meniscus is common and often presents a difficult approach during arthroscopy for various reasons. We describe an easy maneuver to facilitate "delivery of the medial meniscus" during arthroscopy.
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Project description:ObjectiveTo develop and perform ex vivo 3D imaging of meniscus posterior horn microstructure using micro-computed tomography (μCT), and to compare specimens from healthy references against end-stage osteoarthritis (OA) using conventional section-based histology and qualitative μCT.DesignWe retrieved human medial and lateral menisci from 10 deceased donors without knee OA (healthy references) and medial and lateral menisci from 10 patients having total knee replacement for medial compartment OA. Meniscal posterior horns were dissected and fixed in formalin. One subsection underwent hexamethyldisilazane (HMDS) treatment and μCT imaging. Pauli's histopathological scoring was performed for 3 other subsections. The differences in histopathological scores were estimated using mixed linear regression, resulting in fixed effects estimates for within-knee comparisons and adjusted for age and body mass index for between-subjects comparisons.Results3D visualization with μCT qualitatively revealed similar microstructural changes in the posterior horns as conventional histology. The mean histopathological score was higher for medial menisci from OA knees vs both medial reference menisci (mean difference [95% CI], 3.9 [2.6,5.3]), and lateral menisci from OA knees (3.9 [2.9,5.0]). The scores were similar between lateral menisci from OA knees and lateral reference menisci (0.8 [-0.6,2.2]), and between medial and lateral reference menisci (0.8 [-0.3,1.9]).ConclusionsHMDS-based μCT protocol allows unique 3D visualization of meniscus microstructures. Posterior horns of medial menisci from medial compartment OA knees had higher histopathological scores than both the lateral posterior horns from the same OA knees and medial reference menisci, suggesting a strong association between meniscus degradation and unicompartmental knee OA.
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Project description:We present a convenient and safe arthroscopic technique for suturing the lateral meniscus. In this technique, the clinician establishes a conventional posteromedial approach in the figure-of-four position of the knee by using the anterolateral and anteromedial observation approaches. Behind the posterior cruciate ligament, an operational approach is formed through the posterior mediastinum of the knee joint. Through this approach, suture hook can be brought to the posterior horn and body of the lateral meniscus, thus simplifying the suture of the lateral meniscus. We have used this technique to finish all-inside suture using suture hooks in a variety of types of lateral meniscal injuries, including longitudinal posterior horn tears, bucket handle meniscus tears, and tears around the popliteal hiatus area. Compared with traditional lateral meniscal all-inside suture technology through anteromedial or anterolateral approaches, this technology can suture more accurately, safely, and conveniently, avoid the involvement of the popliteal tendon suture, and the lower risk of complications such as popliteal vascular and nerve injury occur. Technique Video Video 1 Introduction of the posteromedial-transseptal portal for arthroscopic suture hook repair. The key steps of the repair of posterior horn tears and popliteomeniscal fascicles tears of lateral meniscus with modified technique were illustrated.
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