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Suture Repair of Full Radial Posterior Lateral Meniscus Tears Using a Central Midline Portal.

ABSTRACT: Full radial posterior lateral meniscus root tears are frequently associated with injuries to the anterior cruciate ligament. Left unrepaired, they result in loss of the meniscus hoop stress function and can lead to overload of the lateral compartment and early degenerative changes. Arthroscopic suture repairs show successful results with long-term follow-up. However, previously described suture repair techniques have often required special instrumentation and can be technically demanding. This Technical Note describes the use of an accessory portal through the patellar tendon as a safe and easy method for repairing full posterior radial tears of the lateral meniscus.

SUBMITTER: Ouanezar H

PROVIDER: S-EPMC5796884 | biostudies-other | 2017 Oct

REPOSITORIES: biostudies-other

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Suture Repair of Full Radial Posterior Lateral Meniscus Tears Using a Central Midline Portal.

Ouanezar Hervé H Thaunat Mathieu M Saithna Adnan A Fernandes Levi Reina LR Sonnery-Cottet Bertrand B

Arthroscopy techniques 20171009 5

Full radial posterior lateral meniscus root tears are frequently associated with injuries to the anterior cruciate ligament. Left unrepaired, they result in loss of the meniscus hoop stress function and can lead to overload of the lateral compartment and early degenerative changes. Arthroscopic suture repairs show successful results with long-term follow-up. However, previously described suture repair techniques have often required special instrumentation and can be technically demanding. This T ...[more]

PMID: 29416968

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An All-Inside Repair for Full Radial Posterior Lateral Meniscus Tears.

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Project description:Medial meniscal root injury is known to cause an increase in tibiofemoral contact pressure and results in early osteoarthritis. There have been many reports on meniscal root repairing techniques, which can be categorized into 2 groups. One is transosseous suture, and the other is anchor suture repair. Both techniques show improvement in not only clinical performance, but also radiographic finding. However, the meniscal root repair procedure must be performed by experienced physicians. Most techniques require a posteromedial portal, which takes time and may even complicate the procedure. The technique proposed in this study provides a simple procedure in which no posteromedial portal is required and a soft anchor suture, a commonly used suture in glenolabral repair, is used. The use of this suture, instead of the conventional anchor suture, is believed to lessen possible injury to the cartilage and results in easier revision surgery.

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Easy and Safe All-Inside Suture Technique for Posterior Horn Tears of Lateral Meniscus Using Standard Anteromedial and Anterolateral Portals.

Project description:The importance of the lateral meniscus in weight bearing, distribution of force, shock absorption, articular cartilage protection, proprioception, stabilization of the joint, and joint lubrication is well known. Surgeons currently agree on the importance of preserving the menisci. Different suture techniques have been standardized. These include outside-in, inside-out, and all-inside techniques. The all-inside technique can be used to repair lesions of the posterior horn of the lateral meniscus. However, this technique presents important disadvantages, such as the necessity for an accessory portal and a high risk of neurovascular damage. For these reasons, we have developed a technique in which a suture hook and a shuttle relay are used to pass the suture wire through the meniscal lesion of the posterior horn of the lateral meniscus with an all-inside technique, without the use of accessory portals and cannulas, with a standard 30° arthroscopic camera.

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

Project description: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.

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Use of an Accessory Anteromedial Portal to Facilitate Repair of Mid-Body Radial Tears of the Lateral Meniscus in Children and Adolescents.

Project description:Meniscal tears in adolescent patients are commonly treated with repair to preserve meniscal tissue and prevent future degenerative changes. Historically, meniscal tears best suited for repair are acute vertical tears in patients aged <40 years with a normal mechanical axis, >1 cm and <4 cm in size, within the red-red zone, and concurrent with anterior cruciate ligament reconstruction. However, with continued advancements in technology and the development of new techniques, the possibilities and indications for meniscal repair have broadened. This paper presents the use of an accessory medial portal to facilitate the repair of radial tears of the mid-body of the lateral meniscus. Previous techniques described include all-inside, outside-in, and inside-out repairs, but these techniques can be challenging to achieve optimal simultaneous meniscus reduction, visualization, and suture trajectory. In this Technical Note, we describe the use of an inside-out technique, with emphasis on an accessory anteromedial portal to improve visualization and suture trajectory.

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