Combined Rip-Stop and Transtibial Pull-out Technique for Lateral Meniscus Radial Repairs
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ABSTRACT:
SUBMITTER: Homan M
PROVIDER: S-EPMC10533934 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
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Project description:Radial tears increase tibiofemoral contact pressure and disrupt the ability of the meniscus to withstand hoop stress, leading to earlier-onset osteoarthritis. Repair of radial tears is problematic because they have a lower healing rate and lack a single gold standard technique. However, when a radial tear is proximal to the root, there is an opportunity to convert it into a root tear. This is ideal because root tears fixed through a transtibial tunnel technique have improved clinical outcomes and reduced rates of osteoarthritis. This Technical Note and accompanying video describe a method for repairing a radial tear near the meniscus root by converting a radial tear to a root tear followed by a pull-out root repair through a transtibial tunnel. This method restores the meniscus root, allowing it to withstand hoop stress. Our technique uses a disposable root repair kit that includes a FlipCutter, a Knee Scorpion Suture Passer, a 4.75-mm SwiveLock anchor tap, a SutureLasso, a PassPort Cannula, 0 FiberLink sutures, and TigerLink sutures.
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Project description:Medial meniscus posterior root tear is a disruptive injury causing significant sequelae. Several techniques to repair and maintain the native function of the medial meniscus have been introduced, but limitations have been reported in terms of their results. In this current note, the authors introduce the arthroscopic transtibial pull-out repair with whip running suture technique, which may not only avoid the potential risk of meniscus cut-through by the suture material but also optimize the reduction of the extruded meniscus. By suturing the posteromedial capsule and peripheral meniscus, more medialization force can be directly applied to the extruded part of the meniscus, and normal hoop tension can be restored.
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Project description:Radial tears of the lateral meniscus posterior horn are one of the most common lateral meniscal injuries accompanied by acute anterior cruciate ligament disruption. Meniscus-preserving therapy is recommended in the case of a radial lateral meniscal tear to preserve its dynamic behavior. We introduce an arthroscopic pull-out technique for repairing incomplete radial tears of the lateral meniscus posterior horn combined with anterior cruciate ligament reconstruction. In this technique, a ring hoop is made through which the tear ends of lateral meniscus on both sides are tightened by adjusting tension of stitches, providing annular and downward tension for lateral meniscus, both of which are critical to the stability of the lateral meniscus. The resident part of lateral meniscus adjacent to the posterior root is not subject to much tension in this technique because of the pull-out fixation of lateral meniscus posterior horn, thus providing support for healing and restoring the hoop action of the lateral meniscus.
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Project description:Medial meniscus posterior root tears (MMPRT) are a risk factor for knee osteoarthritis (KOA) because it involves disruption of the hoop structure of the meniscus. In recent years, MMPRT pullout repair has been performed to restore the native anatomy of the meniscus attachment. In addition, medial open-wedge high tibial osteotomy (MOWHTO) has been performed with MMPRT pullout repair to reduce the pressure on the medial compartment. However, it has been noted that when MMPRT pullout repair and HTO are performed simultaneously in a patient, the locking screws of the plate interfere with the tibial bone tunnel, which damages the suture. In this technical note, we developed a method to reduce the probability of interference by placing the plate further anteroinferior when digging the bone tunnel from the PM position. This technical note aimed to provide a comprehensive description of the safety of transtibial MMPRT repair with MOWHTO for medial KOA with MMPRT.
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Project description:The meniscal roots are critical in maintaining the normal shock absorbing function of the meniscus. If a meniscal root tear is left untreated, meniscal extrusion can occur rendering the meniscus nonfunctional resulting in degenerative arthritis. Two main repair techniques are described: (1) suture anchors (direct fixation) and (2) sutures pulled through a tibial tunnel (indirect fixation). Meniscal root repair using a suture anchor technique is technically challenging requiring a posterior portal and a curved suture passing device that can be difficult to manipulate within the knee. We present a technique for posterior medial meniscus root repair using 3 sutures (1 leader, 2 cinch), standard arthroscopy portals, and transtibial fixation. Overall, this technique simplifies a challenging procedure and allows for familiarity and efficiency.
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