Arthroscopic transtibial pullout repair for posterior meniscus root tears

Biomechanical evaluation of the effect of arthroscopic suture passing instruments on the posterior meniscal root

BACKGROUND

The study aimed to biomechanically evaluate the effect of arthroscopic suture passing instruments used in the treatment of meniscal root tears on the meniscal suture interface in the root region.

METHODS

A total of 40 intact lateral menisci, obtained during total knee arthroplasty, were procured for the purpose of conducting a biomechanical study. The menisci were randomly assigned to one of two distinct test groups: Group 1 using the Accu-Pass Suture Shuttle (cannulated) and Group 2 using the First-pass Mini Suture Passer (non-cannulated), with each group consisting of n = 20 samples. Maximum failure load, stiffness, and displacement values were obtained using a uniaxial universal tensile testing machine.

RESULTS

When the groups were compared in terms of average maximum failure load (Group 1: 152.5N ± 50.7, Group 2: 162.5N ± 54.4), no statistically significant difference was observed (P = 0.549). At the moment of maximum failure load, the displacement values of both groups were similar (P = 0.502). In the comparison conducted for both groups in terms of preconditioning and postconditioning stiffness, no significant difference was detected between groups (P-values were 0.252 and 0.210, respectively).

CONCLUSION

In our study, the tissue laceration size created by suture passers at the meniscus-suture interface within the root region was indirectly tested based on the influence of tensile forces. Both suture passers (cannulated and non-cannulated) are similar in terms of maximum failure load, stiffness, and displacement amounts. This study indicates that there is no difference between suture passers for root tears and supports the usability of both methods during surgery.

[Refixation of a posterior medial root lesion in combination with centralization by a meniscotibial suture]

OBJECTIVE

Refixation of a posterior root lesion of the medial meniscus via a tibial drill tunnel and prevention of extrusion using a meniscotibial suture (centralization).

INDICATIONS

Posterior root lesion of the medial meniscus.

CONTRAINDICATIONS

Grade 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region.

SURGICAL TECHNIQUE

Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of a targeting device and drilling of a targeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a 4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with a thread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the "outside in" technique and fixation of the inner meniscus base at the edge of the tibial plateau using a transosseous extraction suture or a suture anchor.

POSTOPERATIVE MANAGEMENT

Six weeks nonweight-bearing (0 kg), then gradually increased load. Range of motion: 4 weeks E/F 0-0-60°, 2 weeks 0-0-90°, optionally use of a valgus brace (varus of < 5°).

RESULTS

In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, a transosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.

Delta-Grip Stitch for Medial Meniscus Posterior Root Repair

Medial meniscus posterior root tear (MMPRT) is a common medial meniscus injury among elderly patients and often necessitates repair. Although the clinical outcomes of MMPRT repair have demonstrated improvements, subsequent second-look arthroscopy shows poor healing postrepair. Consequently, numerous repair techniques have been reported. Herein, we introduce a simple locking-suture method, the "delta-grip" stitch, for MMPRT repair. This technique exhibited sufficient pullout strength compared with conventional suturing methods, offering promising prospects for enhancing the outcomes of MMPRT repair.

Short-term results of tibial interference screw fixation for transtibial medial meniscus posterior root pull-out repair

Background

To evaluate the technique of transtibial pull-out repair with tibial interference screw fixation for medial meniscus posterior root (MMPR) tear by reporting on short-term outcomes and complications.

Methods

All MMPR repairs performed between January 2019 and August 2021 (n = 70) were retrospectively screened regarding demographic data and surgical parameters. The patients were questioned for performed revision surgery, symptoms and complications. The Numeric Rating Scale (NRS) for pain, Lysholm Knee Score and International Knee Documentation Committee Subjective Knee Form (IKDC) questionnaires were used to evaluate clinical outcome. In cases of revision surgery for re-tear the mode of failure was intraoperatively classified (patients with re-tear were excluded from the clinical follow-up examination). The influence of demographic and treatment parameters (surgical and rehabilitation) on the incidence and mode of re-tear and clinical scores was evaluated.

Results

After 2.3 ± 0.7 years, 62 patients (88.6 %) were available for follow-up. There were no direct intra- or postoperative complications. No revision was performed due to symptoms related to the tibial fixation material. The mean surgery time was 33.5 ± 10.8 min. The overall re-tear rate was 17.7 % (11 patients) of whom 10 were treated surgically and one conservatively. Primary mode of failure was suture cut-out from the meniscus (70 %). The NRS, Lysholm Knee Score and subjective IKDC were obtained in 38 patients and improved from 6.8 ± 2.4, 40.1 ± 23.9 and 32.8 ± 16.3 to 2.2 ± 2.2, 80.5 ± 16.3 and 63.0 ± 13.9, respectively (all p < 0.001). No influence was observed from demographic and treatment parameters on re-tear rates or clinical Scores.

Conclusions

Tibial interference screw fixation is a fast and promising technique for MMPR transtibial pull-out repair. In the presented technique, utilizing non-absorbable locking sutures alongside tibial interfenrence screw fixation, the primary mode of failure was suture cut-out from the meniscus.

Arthroscopic Lateral Meniscus Root Repair With Reverse Suture Anchor Technique

The stability of the knee joint is crucially dependent on the integrity of the lateral meniscus posterior root, which is often accompanied by anterior cruciate ligament injury. Anchor suture repair for lateral meniscus posterior root injury not only achieves better biomechanical effects but also ensures favorable prognosis. However, the placement of anchors often requires the establishment of a posterior approach, and the insertion of an anchor is a technical challenge. In light of this, we have applied the technique of reverse anchor fixation for repairing the lateral meniscus posterior root, which not only simplifies the procedure but also effectively reduces the "bungee effect."

Anterior Root Tear of the Meniscus: A Report of Two Cases

Menisci are crescent-shaped fibrocartilagenous structures that increase the tibiofemoral congruity, act as shock absorbers, and provide secondary anteroposterior stability. The root tears affect the biomechanical integrity of the whole meniscus, simulating a total meniscectomy, which can lead to early degeneration of the joint. Most of the root tears affect the posterior part rather than the anterior root. Very few reports have been described in the literature regarding anterior root tears and repairs. We present two such patients with anterior meniscal root tears, one of the lateral meniscus and one of the medial meniscus.

Evaluation of the All-Inside Technique for the Repair of Lateral Meniscus Root Tears at 1 Year After ACL Reconstruction

Background

The presence of a lateral meniscus root tear (LMRT) in patients with an anterior cruciate ligament (ACL) tear makes the knee more unstable and increases the risk of osteoarthritis and osteonecrosis. An all-inside suture repair technique without bone tunnels has been proposed to treat LMRT.

Purpose

To compare the 1-year postoperative findings between patients who underwent ACL reconstruction combined with LMRT repair (LMRT group) and patients who underwent isolated ACL reconstruction (control group).

Study Design

Cohort study; Level of evidence, 3.

Methods

The LMRT group consisted of 19 patients, and the control group consisted of 56 patients. In this study, the authors compared the postoperative magnetic resonance imaging (MRI) findings (meniscal extrusion, ghost sign, and hyperintensity in the tibial plateau beneath the LMRT), functional outcomes (International Knee Documentation Committee [IKDC], Lysholm, and Tegner scores), and reoperation rate between groups. The primary endpoint was analyzed by comparing, in the LMRT group, the 1-sided 97.5% confidence interval (CI) of the mean lateral meniscal extrusion at 1 year to the limit of noninferiority (fixed at 0.51). To take into account imbalanced baseline characteristics between groups, adjusted mean meniscal extrusion (with 1-sided 97.5% CI) was assessed using a linear regression model.

Results

The mean follow-up was 12.2 months (range, 7.7-14.7 months) in the control group and 11.5 months (range, 7.1-13.0 months) in the LMRT group (P = .06). For meniscal extrusion, the LMRT group was noninferior to the control group. The mean meniscal extrusion was 2.19 mm (97.5% CI, -infinity to 2.68 mm) in the LMRT group and 2.03 mm (97.5% CI,-infinity to 2.27 mm) in the control group, indicating that the upper boundary of the 1-sided 97.5% CI in the LMRT group was less than the noninferiority threshold of 2.78 (ie, 2.27 mm + 0.51 mm = 2.78 mm). There was a statistically significant difference in the IKDC score between the LMRT and control groups (77.2 ± 8.1 vs 80.3 ± 7.3, respectively; P = .04). There was no between-group difference in the other MRI parameters, the Lysholm and Tegner scores, or the reoperation rate.

Conclusion

There was no significant difference in extrusion on MRI or clinical outcomes at 1-year follow-up in patients who underwent ACL reconstruction with all-inside LMRT repair compared with patients who did not have an LMRT.

Coronal extrusion of the lateral meniscus does not increase after pullout repair of the posterior root of the lateral meniscus at short-term follow-up

PURPOSE

Posterior lateral meniscus root (PLMR) tears are injuries that commonly occur together with anterior cruciate ligament (ACL) tears. The aim of this study was to evaluate the clinical and radiological outcome of PLMR repair accompanying ACL reconstruction. Specifically, PLMR healing rates, meniscal extrusion behavior and their influence on patient-reported outcome measures (PROMs) were analyzed. It was hypothesized that PLMR repair shows satisfactory healing rates and coronal meniscal extrusion does not increase significantly following PLMR repair.

METHODS

Patients that underwent PLMR repair between 2014 and 2019 were evaluated at least 12 months postoperatively. At follow-up, magnetic resonance imaging (MRI) was performed in order to evaluate the PLMR healing behavior (complete vs. partial vs. no healing) as well as the coronal and sagittal meniscal extrusion in comparison with the preoperative MRI. Additionally, patient-reported outcome measures (PROMs; Lysholm score, International Knee Documentation Committee subjective knee form [IKDC]) were compiled. Pre- and postoperative meniscal extrusion were tested for statistical significance using the paired t test. The Kruskal-Wallis test was used to compare extrusion values and PROMs in relation to different healing states. A correlation analysis was conducted using the Pearson correlation coefficient between differences in meniscal extrusion and PROMs.

RESULTS

Out of 25 patients, 18 patients (72.0%; 11 male and seven female) were available for final assessment at a mean follow-up of 40.8 ± SD 17.5 months. One revision PLMR repair was performed five months after the initial repair. In 14 cases (77.8%), healing of the lateral meniscus was observed (6 × complete, 8 × partial). Coronal extrusion of the lateral meniscus did not increase significantly following PLMR repair (2.0 ± 1.5 mm vs. 2.1 ± 1.3 mm; p = 0.645). Sagittal extrusion increased significantly (25.7 ± 2.4 mm vs. 27.0 ± 1.4 mm; p < 0.001). The healing status of the PLMR showed no significant association with meniscal extrusion or PROMs (p > 0.05). But a higher increase in coronal meniscal extrusion negatively affected PROMs (Lysholm score: p = 0.046, r = - 0.475; IKDC: p = 0.003, r = - 0.651).

CONCLUSION

High healing rates of the PLMR and no significant increase in coronal extrusion may be expected following combined PLMR repair and ACL reconstruction. But a greater increase in postoperative coronal meniscal extrusion correlates with less favorable clinical results. A greater increase in sagittal extrusion was observed, but this did not influence the clinical outcome.

LEVEL OF EVIDENCE

Retrospective Case Series; IV.

Kindliche vordere Kreuzbandruptur mit komplexer Außenmeniskusverletzung und Knorpelfragmentablösung der posterolateralen Tibia

Ein 11-jähriger Junge erleidet ein Distorsionstrauma des Kniegelenks mit einer Ruptur des vorderen Kreuzbands (VKB), Läsion des Außenmeniskus und Ablösung eines Knorpelfragments am posterolateralen Tibiaplateau. Aufgrund der konträren Nachbehandlungsschemata dieser schwerwiegenden Kombinationsverletzung erfolgt eine zweizeitige operative Versorgung. In einem ersten arthroskopischen Eingriff werden die Meniskus- und Knorpelverletzung behandelt. Nach stattgefundener Knorpeleinheilung erfolgt eine epiphysenschonende Rekonstruktion des vorderen Kreuzbands.

Magnetic Resonance Imaging of Lateral Meniscus Root Tears in the Pediatric and Adolescent Knee: Is the Diagnosis Missed, Mentioned, or Made?

Background

Failure to address meniscus root tears may place undue loads on anterior cruciate ligament (ACL) reconstructive surgery in the adult population. Because the intraoperative management of lateral meniscus posterior root tears (LMPRTs) may diverge from standard meniscal work and requires specialty items, preoperative diagnosis may be advantageous.

Purpose

To evaluate the reliability of radiologist interpretations of preoperative knee magnetic resonance imaging (MRI) scans of lateral meniscus root pathology in a mixed pediatric and adolescent population.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

A retrospective review of medical records was performed to identify patients younger than 18 years with an arthroscopically confirmed LMPRT who underwent knee arthroscopy between March 1, 2010, and April 1, 2020. Arthroscopic findings were compared with the reading radiologist's preoperative MRI interpretations, and patients were stratified into 2 groups: (1) LMPRT diagnosis made preoperatively or (2) diagnosis missed or only mentioned to describe pathology nonspecific to the root. Variables such as body mass index (BMI), open physes, time from injury to MRI, time from MRI to surgery, MRI magnet field strength, musculoskeletal radiologist designation, insurance type, and tear grade were assessed between groups.

Results

Overall, 1116 knee arthroscopies were performed, with 49 LMPRTs found; all 49 LMRPTs were found concomitantly with ACL tears (49/535; 9.2%). The average patient age was 15.97 years (range, 11.52-17.97 years). There were 50 MRI scans for 49 patients. An LMPRT was diagnosed based on preoperative MRI scans in 12 of these 50 scans (24%) and mentioned or missed in 38 of the 50 scans (76%). No significant difference was seen between the diagnosis-made versus diagnosis-mentioned/missed groups in BMI, skeletal maturity, time from injury to MRI, time from MRI to surgery, MRI magnet strength, fellowship training of the reading radiologist, tear grade, or insurance type.

Conclusion

In 76% of patients, a definitive diagnosis of LMPRT was not made on preoperative MRI scans. Notably, all LMPRTs found intraoperatively were found concomitantly with ACL tears.

Arthroscopic Repair of Posterior Root Tears of the Lateral Meniscus with All-Suture Anchor

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.

Large lateral tibial slope and lateral-to-medial slope difference are risk factors for poorer clinical outcomes after posterolateral meniscus root tear repair in anterior cruciate ligament reconstruction

BACKGROUND

Meniscus root tear is an uncommon but detrimental injury of the knee. Hoop stress is lost during meniscus root tear, which can lead to excessive tibiofemoral contact pressure and early development of osteoarthritis. Posterolateral meniscus root tears (PLRT) are more commonly associated with anterior cruciate ligament (ACL) tears. As the lateral compartment is less congruent than the medial compartment, it is more susceptible to a shearing force, which is increased in the ACL-deficient knee. In accordance with the compressive axial load, the increase in the tibial slope would generate a greater shearing force. The additional lateral compartment mobility caused by ACL tear should be reduced after ACL reconstruction (ACLR). However, there is a lack of evidence to conclude that ACLR can sufficiently limit the effect of large tibial slope (LTS) on the healing after PLRT repair. This study aimed to evaluate whether a steep LTS would be a risk factor for poorer clinical outcomes after PLRT repair concomitant with ACLR.

METHODS

In this retrospective study, a chart review was conducted to identify patients with concomitant unilateral primary ACLR and PLRT repair. Patients with a partial tear or healed tear were excluded. Postoperative MRI and clinical assessments were performed at a mean follow up of 35 months. MRI data was used to measure the LTS, medial tibial slope (MTS), coronal tibial slope (CTS), the lateral-to-medial slope difference (LTS-MTS) and meniscus healing and extrusion. Functional outcomes were evaluated by patient-reported outcomes (International Knee Documentation Committee [IKDC], Lysholm and Tegner scores) and KT-1000 arthrometer assessment. Interobserver reproducibility was assessed by two reviewers.

RESULTS

Twenty-five patients were identified for the analysis. Patients with larger LTS and larger LTS-MTS differences were shown to be correlated with poorer IKDC scores after surgery (R = -0.472, p = 0.017 and R = -0.429, p = 0.032, respectively). Herein, patients with LTS ≥ 6° or LTS-MTS ≥ 3° demonstrated poorer IKDC scores.

CONCLUSION

A large LTS (≥ 6°) and a large difference of LTS-MTS (≥ 3°) were shown to be risk factors for poorer functional and radiological outcomes for PLRT repair in patients after ACLR. Clinically, closer monitoring and a more stringent rehabilitation plan for patients with LTS ≥ 6° or LTS-MTS ≥ 3° would be recommended.

Non-Anatomical Arthroscopic All-Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment

OBJECTIVE

To describe a non-anatomical arthroscopic all-inside repair of medial meniscus posterior root tear (MMPRT) to posterior cruciate ligament (PCL) technique for patients with normal lower limb alignment and to evaluate the short-term clinical and radiologic outcomes.

METHODS

MMPRT directly to PCL was repaired with all-inside horizontal mattress suturing technique rather than by the transtibial pullout suture technique or anchor suturing repair technique in 20 Laparade Type II MMPRT patients with normal lower limb alignment during 2018-2019. The clinical and radiological outcomes were evaluated retrospectively for at least 2 years follow-up. The VAS score, Lysholm score, Tegner activity score were evaluated preoperatively and at the final follow-up. The status of the medial meniscus posterior root were assessed on magnetic resonance imaging (MRI) preoperatively and at the final follow-up.

RESULTS

Twenty patients (mean age 54.5 ± 19.5 years) were included in the present study. The mean follow-up duration was 32.5 ± 5.8 months. The VAS score was significantly decreased from preoperative 6.5 ± 1.5 to 2.1 ± 1.4 at the final follow-up (P < 0.01). The mean Lysholm score was significantly improved from 43.7 ± 10.9 preoperatively to 85.7 ± 10.8 (P < 0.01). The median Tegner activity score was improved from 1.0 (range 1-4) to 3.0 (range 2-4, P < 0.01). On MRI, a total of 12 cases (60%) had complete healing, while eight cases (40%) had partial healing.

CONCLUSION

Non-anatomical arthroscopic all-inside repair of MMPRT to PCL may yield beneficial clinical outcomes and a higher rate of clinical healing in Type II MMPRT patients with normal lower limb alignment. It is an easy and reliable alternative technique to the transtibial pullout suture or anchor suture repair technique.

Lateral meniscal posterior root tears experience acceptable healing status after transtibial repair technique

PURPOSE

To evaluate patient MRI results, demography and clinical outcome following transtibial repair of lateral and medial meniscal posterior root tears.

METHODS

Patients treated with transtibial repairs of posterior meniscal root tears from 2015 through 2018 performed pre- and postoperative MRI scans. Outcome measures were continuity/discontinuity of the meniscal root and change in meniscal extrusion on MRI. Other outcomes were KOOS, Lysholm score, Tegner activity scale and the Global Rate of Change (GRoC) score for function and pain at follow-up.

STUDY DESIGN

Retrospective case-series.

RESULTS

Of 41 patients, 36 attended follow-up at mean 26 (12-38) months postoperatively. At follow-up, 11 out of 18 lateral meniscus posterior root tear (LMPRT) versus 5 out of 18 medial meniscus posterior root tear (MMPRT) repairs were classified as healed. Meniscal extrusion decreased in LMPRTs from of 2.3 ± 1.5 mm to 1.4 ± 1.09 mm (p = 0.080) and increased in MMPRTs from 3.1 ± 1.6 mm to 4.8 ± 1.9 mm (p = 0.005) at FU (between-group difference, p < 0.001). LMPRT repairs were associated with ACL injury and additional meniscal injury and were younger and with lower BMI. No between-group differences were found for KOOS, Lysholm or GRoC Function scores. Tegner scale was higher and GRoC Pain score lower in the LMPRT group compared to the MMPRTs.

CONCLUSION

Following transtibial repair for meniscal posterior root repairs, the LMPRTs had a higher frequency of healing, whereas most MMPRTs continued to extrude, despite surgical intervention. The study confirmed that LMPRTs and MMPRTs differ in demography and associated injuries.

Non-anatomic repair of medial meniscus posterior root tears to the posterior capsule provided favourable outcomes in middle-aged and older patients

PURPOSE

To describe a non-anatomic arthroscopic all-inside repair technique for middle-aged and older patients with medial meniscus posterior root tears (MMPRTs) and to evaluate the short- to mid-term clinical and radiologic results. The hypothesis was that this procedure would yield good clinical outcome results and structural healing in middle- and older-aged patients.

METHODS

This was a retrospective study evaluating patients who had undergone MMPRT repair by suturing the meniscal root directly to the capsule, rather than by the transtibial technique, between 2013 and 2016. This all-inside repair technique was performed for patients with type II MMPRTs who were over 40 years old. Exclusion criteria included tibial osteotomy due to malalignment, concomitant multiple-ligament injuries and follow-up time less than 2 years. The Lysholm score, Tegner activity score and International Knee Documentation Committee (IKDC) score were evaluated preoperatively and at the final follow-up. Medial meniscal extrusion, the International Cartilage Repair Society (ICRS) grades of the medial compartment, and the healing status of the medial meniscus root were assessed on magnetic resonance imaging preoperatively and at the final follow-up.

RESULTS

Twenty-nine patients (mean age 61.7 ± 7.9) were included; the mean follow-up duration was 46.2 ± 7.9 months. The mean Lysholm score significantly improved from 33.7 ± 20.9 preoperatively to 81.7 ± 19.9 at the final follow-up (p < 0.001), the median Tegner activity score improved from 1.0 (range 1-4) to 3.0 (range 2-4, p < 0.001), and the mean IKDC score improved from 20.1 ± 16.4 to 69.6 ± 16.2 (p < 0.001). On MRI, 9 (31%) cases had complete healing; 17 (59%) had partial healing; and 3 (10%) had failed healing (ICCs ≥ 0.92). Mean meniscal extrusion significantly increased from 2.3 ± 1.7 mm preoperatively to 3.5 ± 1.5 mm postoperatively (p < 0.001, ICCs ≥ 0.92).

CONCLUSION

Non-anatomic arthroscopic all-inside repair of MMPRTs to the posterior capsule yielded good to excellent clinical results and a high rate of healing in the medial meniscus root on MRI in middle-aged and older patients at short- to mid-term follow-up, despite increased meniscal extrusion. This method is an alternative to the transtibial pullout repair technique for treating MMPRTs in middle- and older-aged patients.

LEVEL OF EVIDENCE

Level IV.

The role of MRI in evaluation of arthroscopic transtibial pullout repair for medial meniscus posterior root tears

Medial meniscus posterior root tears (MMPRT) can lead to meniscal extrusion, loss of hoop tension, loss of load-sharing ability and increased contact pressure. Currently, the most commonly used technique for root repair is arthroscopic transtibial pullout repair (ATPR). This article aims to illustrate both normal and abnormal postoperative imaging findings of the MMPRT repair performed with ATPR, with emphasis on MRI. The radiologist must highlight the tunnel position, the reduction of the medial meniscus posterior root to its anatomical attachment, the signs of root healing (continuity and lower signal intensity), and eventual meniscal extrusion or signs of osteoarthritis.

Arthroscopic Medial Meniscal Posterior Root Repair With Transtibial Luggage-Tag and Horizontal Mattress Sutures

Medial meniscal posterior root repair techniques have shown positive yet varied results in the literature. The decision to perform repair has improved clinical outcomes in many situations, although the healing rate is approximately 64% and the repair strength is roughly one-third of the native root strength, with meniscal extrusion being common. We present a technique based on biomechanical evidence to obtain a strong anatomic posterior root repair to restore nearly normal knee mechanics, combining an increased size of footprint under the lateral aspect of the medial meniscal horn for healing and a luggage-tag suture with a posteriorly placed horizontal mattress suture. The horizontal mattress suture is passed to capture the circumferential fibers of the meniscus and the luggage-tag suture is passed to capture the radial fibers of the meniscal body, through a single transtibial tunnel. The aim of this repair is to restore the normal meniscal function.