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Popliteomeniscal fascicle tear: diagnosis and operative technique.

ABSTRACT: The occurrence and the consistency of the popliteomeniscal fascicle between the popliteus tendon and the lateral meniscus have been the subject of debate. It is difficult to diagnose and treat popliteomeniscal fascicle tears. Furthermore, popliteomeniscal fascicle tears are difficult to identify with arthroscopy. This article describes the diagnostic factors for popliteomeniscal fascicle tears and the safe, effective operative techniques that can be used for their treatment. We suggest that popliteomeniscal fascicle tears are diagnosed when the following 3 conditions are confirmed: (1) existence of mechanical symptoms such as pain, locking, and giving way in the lateral compartment of the knee; (2) identification of hypermobility of the lateral meniscus through arthroscopic probing; and (3) occurrence of an osteochondral lesion in the posterior area of the lateral femoral condyle. In the case of popliteomeniscal fascicle tears, the tear area can be repaired with a suture hook and polydioxanone with an all-inside technique. If the joint space is narrowing because of soft-tissue tightness, it can be repaired with a zone-specific cannula through an inside-out technique.

SUBMITTER: Shin HK

PROVIDER: S-EPMC3678649 | biostudies-other | 2012 Sep

REPOSITORIES: biostudies-other

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Popliteomeniscal fascicle tear: diagnosis and operative technique.

Shin Hong-Kwan HK Lee Hee-Sung HS Lee Young-Kuk YK Bae Ki-Cheor KC Cho Chul-Hyun CH Lee Kyung-Jae KJ

Arthroscopy techniques 20120623 1

The occurrence and the consistency of the popliteomeniscal fascicle between the popliteus tendon and the lateral meniscus have been the subject of debate. It is difficult to diagnose and treat popliteomeniscal fascicle tears. Furthermore, popliteomeniscal fascicle tears are difficult to identify with arthroscopy. This article describes the diagnostic factors for popliteomeniscal fascicle tears and the safe, effective operative techniques that can be used for their treatment. We suggest that popl ...[more]

PMID: 23766962

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Project description:Radial meniscus tears occur commonly as traumatic tears in younger patients, as well as in association with concomitant degenerative changes. Traditional management of these tears has centered around partial meniscectomy; however, there has been a more recent trend toward preserving the meniscus and attempting repair. Because of the gapping and displacement that frequently occurs with these tears, repair is often challenging and is done under high amounts of tension. The following article describes a technique using a traction suture to aid in maintaining reduction throughout repair. This is followed by the use of a combination of techniques to form a “super-hashtag” configuration of both vertical and horizontal mattress sutures, leading to a secure repair under little tension. Technique Video Video 1 Video demonstrating technique for repair of anterolateral radial meniscus tears using a traction suture and super-hashtag orientation. This video shows arthroscopic view from the anterolateral portal with the lateral femoral condyle at the top of the view, and the lateral tibial plateau at the bottom. A standard diagnostic arthroscopy is then performed. The video first demonstrates the identification of the tear at the junction of anterior and middle thirds of the lateral meniscus, which includes a large amount of gapping. A rasp is then used to abrade the synovium and tear to generate the best biologic healing response. The traction suture is then placed in the posterior limb of the tear with the use of the NovoStitch Pro Meniscal Repair System (Smith & Nephew, Andover, MA). This is performed by making one bite in the periphery of this limb, followed by another more centrally. Suture limbs are then brought out through the lateral portal to be used to pull traction and maintain reduction of the tear throughout the remainder of the repair. The anterior and posterior limbs are then secured to the capsule in reduced position with the use of vertical mattress sutures via a combination of all-inside, inside-out, and outside-in techniques. The same sutures are then used for tie-grip or rip-stop sutures for the horizontal mattress. The sutures are tied under the iliotibial band and directly at the capsule, while keeping the meniscus reduced with the traction suture. This is followed by placement of various horizontal mattress sutures over the tie-grip or rip-stop sutures, creating a “super-hashtag” repair. Our postoperative protocol includes keeping the patient non-weightbearing for 6 weeks following surgery with hinged knee brace locked in extension for the first 2 weeks. Range of motion will be strictly 0-90° for the first 4 weeks. Deep vein thrombosis prophylaxis is continued for 6 weeks postoperatively.

Dataset Information

Popliteomeniscal fascicle tear: diagnosis and operative technique.

Publications

Popliteomeniscal fascicle tear: diagnosis and operative technique.

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