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Arthroscopic transtibial pullout repair for posterior meniscus root tears

Arthroskopische transtibiale Auszugsnaht von posterioren Meniskuswurzelrissen

  • Surgical Techniques
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Abstract

Objective

Anatomic repair of the torn meniscal root using transosseous sutures through the proximal tibia.

Indications

Nontraumatic meniscal root tears without severe degenerative changes (Kellgren–Lawrence grade ≤ 2), good quality meniscal tissue, traumatic root tears with or without concomitant anterior cruciate ligament tears or multiligament injuries.

Contraindications

Uncorrected varus or valgus malalignment (>3°), osteoarthritis Kellgren–Lawrence grades III and IV, and diffuse articular cartilage changes International Cartilage Regeneration and Joint Preservation Society (ICRS) grades III and IV of the effected compartment, noncompliance.

Surgical technique

Root tear confirmed by probing; location for the planned root refixation on the tibial plateau is identified. A tibial socket or full transtibial tunnel created with an aiming drill guide. Using a self-retrieving suture passing device or a curved suture passer, the torn meniscus root sutured with no. 0 non-absorbable braided suture. Meniscal sutures passed through the tibial tunnel and the meniscus root reduced into the socket or tunnel by tensioning the free ends of the sutures, followed by fixation on the tibial cortex.

Follow-up

Toe touch weight-bearing for 6 weeks, restricted range of motion (0–60° of flexion) for 6 weeks, no axial loading at flexion angles >90° until 6 months postoperatively.

Results

For medial root tears, pullout repair significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in the short-term. Complete healing observed in only 60% of patients. Negative prognostic factors: varus malalignment > 5°, cartilage degeneration Outerbridge grade III and IV, and older age. Outcomes after lateral root repair are encouraging with apparent prevention of progression of osteoarthritis.

Zusammenfassung

Operationsziel

Wiederherstellung der Meniskusfunktion durch transtibiale Auszugsnaht der gerissenen Meniskuswurzel.

Indikationen

Atraumatische Meniskuswurzelrisse ohne fortgeschrittene degenerative Veränderungen (Kellgren-Lawrence Grad ≤ II), gute Qualität des Meniskusgewebes, isolierte traumatische Wurzelrisse, traumatische Wurzelrisse in Kombination mit Verletzungen des vorderen Kreuzbandes oder Multiligamentverletzungen.

Kontraindikationen

Nichtkorrigierte Varus- oder Valgusfehlstellung (>3°), Arthrose Kellgren-Lawrence Grad III und IV oder diffuse Knorpelschädigung im betroffenen Kompartiment vom ICRS-Grad III und IV (International Cartilage Regeneration and Joint Preservation Society), Non-Compliance.

Operationstechnik

Bestätigung eines Wurzelrisses mit Tasthaken; Anlegen eines Sacklochs oder eines transtibialen Tunnels mit einem Zielgerät im Bereich der Insertion am Tibiaplateau. Mit einer speziellen Nahtzange oder einem Fadenlasso wird die Meniskuswurzel mit einem nichtresorbierbaren Faden angeschlungen. Die freien Fadenenden werden durch den tibialen Tunnel ausgeleitet und die Meniskuswurzel durch Spannen der Fäden reponiert. Die Fixation der Fäden erfolgt an der Tibia.

Weiterbehandlung

Sohlenkontakt und limitierter Bewegungsumfang für 6 Wochen (–60°-Flexion). Keine axiale Last bei Flexion >90° für 6 Monate.

Ergebnisse

Bei medialen Wurzelrissen verbessert die transtibiale Auszugsnaht die Kniefunktion signifikant und reduziert die Arthroseprogression. Eine komplette Einheilung wurde allerdings nur bei ca. 60 % beobachtet. Prognostisch ungünstig sind: Varusfehlstellung > 5°, Knorpeldegeneration Outerbridge-Grad III und IV sowie fortgeschrittenes Alter. Ergebnisse nach Refixation lateraler Wurzelrisse sind vielversprechend und scheinen das Fortschreiten der Arthrose zu verhindern.

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Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany

    M. J. Feucht, L. Lacheta, A. B. Imhoff & P. Forkel

  2. Clinic for Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Freiburg, Germany

    M. J. Feucht, K. Izadpanah & N. P. Südkamp

Authors
  1. M. J. Feucht
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  2. K. Izadpanah
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  3. L. Lacheta
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  4. N. P. Südkamp
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  5. A. B. Imhoff
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  6. P. Forkel
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Correspondence to M. J. Feucht.

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Conflict of interest

A.B. Imhoff is a consultant for Arthrex. M.J. Feucht, K. Izadpanah, L. Lacheta, N.P. Südkamp and P. Forkel declare that they haves no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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W. Petersen, Berlin

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R. Himmelhan, Mannheim

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Feucht, M.J., Izadpanah, K., Lacheta, L. et al. Arthroscopic transtibial pullout repair for posterior meniscus root tears. Oper Orthop Traumatol 31, 248–260 (2019). https://doi.org/10.1007/s00064-018-0574-4

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  • DOI: https://doi.org/10.1007/s00064-018-0574-4

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