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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2021

01-04-2021 | Magnetic Resonance Imaging | KNEE

Placement of an anatomic tibial tunnel significantly improves the medial meniscus posterior extrusion at 90° of knee flexion following medial meniscus posterior root pullout repair

Authors: Yusuke Kamatsuki, Takayuki Furumatsu, Takaaki Hiranaka, Yoshiki Okazaki, Yuki Okazaki, Yuya Kodama, Tomohito Hino, Shin Masuda, Shinichi Miyazawa, Toshifumi Ozaki

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2021

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Abstract

Purpose

The purpose of this study was to evaluate the influence of tibial tunnel position in pullout repair for a medial meniscus (MM) posterior root tear (MMPRT) on postoperative MM extrusion.

Methods

Thirty patients (median age 63 years, range 35–72 years) who underwent transtibial pullout repairs for MMPRTs were included. Three-dimensional computed tomography images of the tibial surface were evaluated using a rectangular measurement grid for assessment of tibial tunnel position and MM posterior root attachment. Preoperative and postoperative MM medial extrusion (MMME) and posterior extrusion (MMPE) at 10° and 90° knee flexion were measured using open magnetic resonance imaging.

Results

Tibial tunnel centers were located more anteriorly and more medially than the anatomic center (median distance 5.8 mm, range 0–9.3 mm). The postoperative MMPE at 90° knee flexion was significantly reduced after pullout repair, although there was no significant reduction in MMME or MMPE at 10° knee flexion after surgery. In the correlation analysis of the displacement between the anatomic center to the tibial tunnel center and improvements in MMME, and MMPE at 10° and 90° knee flexion, there was a significant positive correlation between percentage distance and improvement of MMPE at 90° knee flexion.

Conclusion

This study demonstrated that the nearer the tibial tunnel position to the anatomic attachment of the MM posterior root, the more effective the reduction in MMPE at 90° knee flexion. Our results emphasize that an anatomic tibial tunnel should be created in the MM posterior root to improve the postoperative MMPE and protect the articular cartilage in a knee flexion position. Placement of an anatomic tibial tunnel significantly improves the MMPE at 90° of knee flexion after MM posterior root pullout repair.

Level of evidence

IV.
Literature
1.
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 Jt Surg Am 90:1922–1931CrossRef
2.
3.
Chung KS, Ha JK, Ra HJ, Lee HS, Lee DW, Park JH et al (2019) Pullout fixation for medial meniscus posterior root tears: clinical results were not age-dependent, but osteoarthritis progressed. Knee Surg Sports Traumatol Arthrosc 27:189–196CrossRefPubMed
4.
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 45:42–49CrossRefPubMed
5.
Daney BT, Aman ZS, Krob JJ, Storaci HW, Brady AW, Nakama G et al (2019) Utilization of transtibial centralization suture best minimizes extrusion and restores tibiofemoral contact mechanics for anatomic medial meniscal root repairs in a cadaveric model. Am J Sports Med 47:1591–1600CrossRefPubMed
6.
Fujii M, Furumatsu T, Kodama Y, Miyazawa S, Hino T, Kamatsuki Y et al (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 27:559–562CrossRefPubMed
7.
Fujii M, Furumatsu T, Miyazawa S, Okada Y, Tanaka T, Ozaki T et al (2015) Intercondylar notch size influences cyclops formation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:1092–1099CrossRefPubMed
8.
Furumatsu T, Kodama Y, Fujii M, Tanaka T, Hino T, Kamatsuki Y et al (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 103:367–371CrossRefPubMed
9.
10.
11.
Inoue H, Furumatsu T, Miyazawa S, Fujii M, Kodama Y, Ozaki T (2018) Improvement in the medial meniscus posterior shift following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:434–441CrossRefPubMed
12.
Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF (2012) Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med 40:2342–2347CrossRefPubMed
13.
Kamatsuki Y, Furumatsu T, Fujii M, Kodama Y, Miyazawa S, Hino T et al (2018) Complete tear of the lateral meniscus posterior root is associated with meniscal extrusion in anterior cruciate ligament deficient knees. J Orthop Res 36:1894CrossRefPubMed
14.
Kamatsuki Y, Furumatsu T, Miyazawa S, Kodama Y, Hino T, Okazaki Y et al (2019) The early arthroscopic pullout repair of medial meniscus posterior root tear is more effective for reducing medial meniscus extrusion. Acta Med Okayama 73:503–510PubMed
15.
16.
Kim NK, Bin SI, Kim JM, Lee BS, Lee CR (2019) Meniscal extrusion is positively correlated with the anatomical position changes of the meniscal anterior and posterior horns, following medial meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc 27:2389–2399CrossRefPubMed
17.
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((R)) all-inside suture technique. Orthop Traumatol Surg Res 102:951–954CrossRefPubMed
18.
19.
Koga H, Watanabe T, Horie M, Katagiri H, Otabe K, Ohara T et al (2017) Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Arthrosc Tech 6:e1335–e1339CrossRefPubMedPubMedCentral
20.
LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L et al (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43:912–920CrossRefPubMed
21.
Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37:124–129CrossRefPubMed
22.
Masuda S, Furumatsu T, Okazaki Y, Kamatsuki Y, Okazaki Y, Kodama Y et al (2019) Transtibial pullout repair reduces posterior extrusion of the medial meniscus. Acta Med Okayama 73:495–501PubMed
23.
Masuda S, Furumatsu T, Okazaki Y, Kodama Y, Hino T, Kamatsuki Y et al (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 104:485–489CrossRefPubMed
24.
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 stiches under an expected initial tension. Eur J Orthop Surg Traumatol 29:705–709CrossRefPubMed
25.
Okazaki Y, Furumatsu T, Okazaki Y, Masuda S, Hiranaka T, Kodama Y et al (2020) Medial meniscus posterior root repair decreases posteromedial extrusion of the medial meniscus during knee flexion. Knee 27:132–139CrossRefPubMed
26.
Okazaki Y, Furumatsu T, Shimamura Y, Saiga K, Ohashi H, Uchino T et al (2019) Time-dependent increase in medial meniscus extrusion after medial meniscus posterior root tear analyzed by using magnetic resonance imaging. Knee Surg Relat Res 31:120–125PubMedPubMedCentral
27.
28.
Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA et al (2014) Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med 42:699–707CrossRefPubMed
29.
Park JY, Kim BH, Ro DH, Lee MC, Han HS (2019) Characteristic location and rapid progression of medial femoral condylar chondral lesions accompanying medial meniscus posterior root tear. Knee 26:673–678CrossRefPubMed
30.
Todor A, Caterev S, Nistor DV (2016) Outside-in deep medial collateral ligament release during arthroscopic medial meniscus surgery. Arthrosc Tech 5:e781–e785CrossRefPubMedPubMedCentral
31.
Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Toh S (2008) Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 13:122–129CrossRefPubMed
32.
Walker PS, Arno S, Bell C, Salvadore G, Borukhov I, Oh C (2015) Function of the medial meniscus in force transmission and stability. J Biomech 48:1383–1388CrossRefPubMed
33.
Ziegler CG, Pietrini SD, Westerhaus BD, Anderson CJ, Wijdicks CA, Johansen S et al (2011) Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39:743–752CrossRefPubMed
Metadata
Title
Placement of an anatomic tibial tunnel significantly improves the medial meniscus posterior extrusion at 90° of knee flexion following medial meniscus posterior root pullout repair
Authors
Yusuke Kamatsuki
Takayuki Furumatsu
Takaaki Hiranaka
Yoshiki Okazaki
Yuki Okazaki
Yuya Kodama
Tomohito Hino
Shin Masuda
Shinichi Miyazawa
Toshifumi Ozaki
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06070-w

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