Abstract
The medial meniscus (MM) posterior root has important functions in preventing an excessive loading stress during knee motion and degeneration of the articular cartilage. Although the transtibial pullout repair has become the gold standard for MM posterior root tears (MMPRTs), MM extrusion remains. In addition, during knee extension to deep flexion, the MM posterior segment in the MMPRT knee has been shown to translate toward the posteromedial direction, causing a notable MM posterior extrusion. Thus, the reduction in the MM posteromedial extrusion is one of the important postoperative outcomes to restore the meniscal function and eventually prevent the progression of knee osteoarthritis. The present technical note describes an arthroscopic technique addition to the pullout repair, in which an all-inside suture is inserted into the posteromedial part of the MM to reduce the MM posteromedial extrusion.
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LaPrade CM, Ellman MB, Rasmussen MT, James EW, Wijdicks CA, Engebretsen L, LaPrade RF (2014) Anatomy of the anterior root attachments of the medial and lateral menisci: a quantitative analysis. Am J Sports Med 42:2386–2392. https://doi.org/10.1177/0363546514544678
Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931. https://doi.org/10.2106/JBJS.G.00748
Kim JG, Lee YS, Bae TS, Ha JK, Lee DH, Kim YJ, Ra HJ (2013) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21:2121–2125. https://doi.org/10.1007/s00167-012-2182-4
Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol 183(1):17–23. https://doi.org/10.2214/ajr.183.1.1830017
Masuda S, Furumatsu T, Okazaki Y, Kodama Y, Hino T, Kamatsuki Y, Miyazawa S, Ozaki T (2018) Medial meniscus posterior root tear induces pathological posterior extrusion of the meniscus in the knee-flexed position: an open magnetic resonance imaging analysis. Orthop Traumatol Surg Res 104:485–489. https://doi.org/10.1016/j.otsr.2018.02.012
Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH (2007) 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 15:1510–1513. https://doi.org/10.1007/s00167-007-0310-3
Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ (2006) Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy 22:795.e1–795.e4
Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T (2016) Pullout repair of a medial meniscus posterior root tear using a FasT-Fix all-inside suture technique. Orthop Traumatol Surg Res 102:951–954. https://doi.org/10.1016/j.otsr.2016.06.013
Fujii M, Furumatsu T, Kodama Y, Miyazawa S, Hino T, Kamatsuki Y, Yamada K, Ozaki T (2017) A novel suture technique using the FasT-Fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear. Eur J Orthop Surg Traumatol 27:559–562. https://doi.org/10.1007/s00590-017-1930-z
Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc 24:1455–1468. https://doi.org/10.1007/s00167-015-3832-0
Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG (2017) Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 45:42–49. https://doi.org/10.1177/0363546516662445
Okazaki Y, Furumatsu T, Kodama Y, Kamatsuki Y, Masuda S, Ozaki T (2019) Description of a surgical technique of medial meniscus root repair: a fixation technique with two simple stitches under an expected initial tension. Eur J Orthop Surg Traumatol 29:705–709. https://doi.org/10.1007/s00590-018-2347-z
Todor A, Caterev S, Nistor DV (2016) Outside-in deep medial collateral ligament release during arthroscopic medial meniscus surgery. Arthrosc Tech 5:e.781–e.785. https://doi.org/10.1016/j.eats.2016.03.004
Okazaki Y, Furumatsu T, Yamaguchi T, Kodama Y, Kamatsuki Y, Masuda S, Okazaki Y, Hiranaka T, Zhang X, Ozaki T (2019) Medial meniscus posterior root tear causes swelling of the medial meniscus and expansion of the extruded meniscus: a comparative analysis between 2D and 3D MRI. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05580-6(Published online ahead of print)
Furumatsu T, Kodama Y, Fujii M, Tanaka T, Hino T, Kamatsuki Y, Yamada K, Miyazawa S, Ozaki T (2017) A new aiming guide can create the tibial tunnel at favorable position in transtibial pullout repair for the medial meniscus posterior root tear. Orthop Traumatol Surg Res 103:367–371. https://doi.org/10.1016/j.otsr.2017.01.005
Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Kodama Y, Ozaki T (2019) Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair. Int Orthop 43:1239–1245. https://doi.org/10.1007/s00264-018-4071-z
LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43:912–920. https://doi.org/10.1177/0363546514566191
Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, Alaia MJ (2018) Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc 26(9):2826–2834. https://doi.org/10.1007/s00167-017-4755-8
Park DY, Min BH, Choi BH, Kim YJ, Kim M, Suh-Kim H, Kim JH (2015) The degeneration of meniscus roots is accompanied by fibrocartilage formation, which may precede meniscus root tears in osteoarthritic knees. Am J Sports Med 43:3034–3044. https://doi.org/10.1177/0363546515605086
Koga H, Watanabe T, Horie M, Katagiri H, Otabe K, Ohara T, Katakura M, Sekiya I, Muneta T (2017) Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Arthrosc Tech 6:e1335–e1339. https://doi.org/10.1016/j.eats.2017.05.014
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Okazaki, Y., Furumatsu, T., Miyazawa, S. et al. A novel suture technique to reduce the meniscus extrusion in the pullout repair for medial meniscus posterior root tears. Eur J Orthop Surg Traumatol 29, 1805–1809 (2019). https://doi.org/10.1007/s00590-019-02513-4
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DOI: https://doi.org/10.1007/s00590-019-02513-4