Clin Orthop Surg.  2011 Dec;3(4):332-335. 10.4055/cios.2011.3.4.332.

Arthroscopic Direct Repair for a Complete Radial Tear of the Posterior Root of the Medial Meniscus

• Wang KH
• Hwang DH
• Cho JH
• Changale S
• Woo SJ
• Nha KW

• KMID: 1097172
• DOI: http://doi.org/10.4055/cios.2011.3.4.332

Abstract

We report here on a new arthroscopic direct repair technique for a radial tear of the posterior root of the medial meniscus (PRMM) using a posterior trans-septal portal. Radial tears of the PRMM are commonly observed in the elderly population of Korea and Japan, and the life style of these people requires squatting and kneeling down in daily life. A radial tear of the PRMM results in the loss of hoop tension and this accelerates degenerative changes in the knee joint and causes early osteoarthritis. Several reports in the medical literature have focused on various repair techniques for these tears by using pull out sutures. These techniques result in nonanatomic fixation of the meniscus, which may lead to disturbed meniscal excursion and failure to restore hoop tension. Arthroscopic direct repair may contribute to restoring hoop tension and preventing accelerated degenerative changes in the knee joint of these patients.

Keyword

Radial tear; Medial meniscus posterior root; Direct repair; Arthroscopy

MeSH Terms

Arthroscopy/methods
Humans
Menisci, Tibial/*injuries/*surgery
Middle Aged
Rupture/surgery

Figure

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  Fig. 1 The suture hook penetrated the remnants of the medial meniscus (inner side of the posterior root site) from inside to outside. LM: lateral meniscus, MM: medial meniscus.

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  Fig. 2 Sutures are passed through both ends of the tear with the arthroscope in the trans-septal portal. PDS: polydioxanone suture, LM: lateral meniscus, MM: medial meniscus.

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  Fig. 3 (A) Arthroscopic view of the suture connecting the root and body portion of the torn meniscus. (B) The torn edges of the meniscus are secured with two SMC knots. MFC: medial femoral condyle, MM: medial meniscus.

Reference

1. Seo JH, Li G, Shetty GM, et al. Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy. 2009. 25(11):1281–1287.

2. Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH. A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc. 2007. 15(12):1510–1513.

3. Ahn JH, Chung YS, Oh I. Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal. Arthroscopy. 2003. 19(1):101–107.

4. Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982. 10(2):90–95.

5. Ahn JH, Kim SH, Yoo JC, Wang JH. All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy. 2004. 20(1):101–108.

6. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Joint Surg Am. 2008. 90(9):1922–1931.

7. Tuckman GA, Miller WJ, Remo JW, Fritts HM, Rozansky MI. Radial tears of the menisci: MR findings. AJR Am J Roentgenol. 1994. 163(2):395–400.

8. Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM. Meniscal movement: an in-vivo study using dynamic MRI. J Bone Joint Surg Br. 1999. 81(1):37–41.

9. van Trommel MF, Simonian PT, Potter HG, Wickiewicz TL. Arthroscopic meniscal repair with fibrin clot of complete radial tears of the lateral meniscus in the avascular zone. Arthroscopy. 1998. 14(4):360–365.

10. Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR. Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy. 2010. 26(1):67–75.