Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus



This study was undertaken to diagnose and to document the clinical results and technical aspects of arthroscopic meniscus repair for recurrent subluxation with peripheral tears around the popliteal hiatus of the lateral meniscus.


Twenty-three patients (24 knees) with symptomatic recurrent subluxation of the lateral meniscus treated by arthroscopic meniscus repair were included. The inclusion criteria were: (1) patients with knee pain, locking or snapping symptoms despite 3 months of conservative treatment; (2) non-discoid lateral meniscus; (3) stable knee, and (4) tears involving the red–white or red–red zone. All tears were repaired by either the modified all-inside suture technique only or a combination of the modified all-inside and modified outside-in suture techniques. Clinical results were evaluated preoperatively and at final follow-up according to Tegner activity level, Lysholm knee, and Hospital for Special Surgery (HSS) scores.


No reoperations were required after a median follow-up of 41 months (range 24–124). Although recurrence of a locking episode was documented in one knee and catching sensations were experienced in three knees, those patients did not require reoperation. At the last follow-up, the median Tegner activity level had improved significantly from 4 (range 2–6) to 7 (range 3–10, p < 0.0001), the median Lysholm knee score improved from 76 (range 25–90) preoperatively to 94 (range 76–100) at final follow-up (p < 0.0001), and the median preoperative HSS score improved from 86 to 95 at final follow-up (p < 0.0001).


The described arthroscopic meniscus suture technique is effective for treating symptomatic recurrent subluxation of the lateral meniscus without any complications or recurrence. Clinical suspicion and understanding of recurrent subluxation with lateral meniscus are important to diagnose the disease especially when definite meniscal tear signs are absent on magnetic resonance imaging.

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  1. 1.

    Ahn JH, Kim KI, Wang JH, Jeon JW, Cho YC, Lee SH (2015) Long-term results of arthroscopic reshaping for symptomatic discoid lateral meniscus in children. Arthroscopy 31(5):867–873

  2. 2.

    Ahn JH, Kim KI, Wang JH, Kyung BS, Seo MC, Lee SH (2015) Arthroscopic repair of bucket-handle tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 23(1):205–210

  3. 3.

    Ahn JH, Oh I (2006) Arthroscopic all-inside lateral meniscus suture using posterolateral portal. Arthroscopy 22(5):572 e571–574

  4. 4.

    Ahn JH, Wang JH, Yoo JC, Kim SK, Park JH, Park JW (2006) The modified outside-in suture: vertical repair of the anterior horn of the meniscus after decompression of a large meniscal cyst. Knee Surg Sports Traumatol Arthrosc 14(12):1288–1291

  5. 5.

    Ahn JH, Yim SJ, Seo YS, Ko TS, Lee JH (2014) The double flipped meniscus sign: unusual MRI findings in bucket-handle tear of the lateral meniscus. Knee 21(1):129–132

  6. 6.

    Ahn JH, Yoo JC, Lee SH (2012) Posterior horn tears: all-inside suture repair. Clin Sports Med 31(1):113–134

  7. 7.

    Ahn JY, Kim TH, Jung BS, Ha SH, Lee BS, Chung JW, Kim JM, Bin SI (2012) Clinical results and prognostic factors of arthroscopic surgeries for discoid lateral menisci tear: analysis of 179 Cases with minimum 2 years follow-up. Knee Surg Relat Res 24(2):108–112

  8. 8.

    Austin KS, Sherman OH (1993) Complications of arthroscopic meniscal repair. Am J Sports Med 21(6):864–868

  9. 9.

    Barber FA, Bava ED (2012) Meniscal repair: the newest fixators. Sports Med Arthrosc 20(2):95–100

  10. 10.

    Breitenseher MJ, Trattnig S, Dobrocky I, Kukla C, Nehrer S, Steiner E, Imhof H (1997) MR imaging of meniscal subluxation in the knee. Acta Radiol 38(5):876–879

  11. 11.

    Demange MK, Von Keudell A, Gomoll AH (2013) Iatrogenic instability of the lateral meniscus after partial meniscectomy. Knee 20(5):360–363

  12. 12.

    Diamantopoulos A, Tokis A, Tzurbakis M, Patsopoulos I, Georgoulis A (2005) The posterolateral corner of the knee: evaluation under microsurgical dissection. Arthroscopy 21(7):826–833

  13. 13.

    Garofalo R, Kombot C, Borens O, Djahangiri A, Mouhsine E (2005) Locking knee caused by subluxation of the posterior horn of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 13(7):569–571

  14. 14.

    George M, Wall EJ (2003) Locked knee caused by meniscal subluxation: magnetic resonance imaging and arthroscopic verification. Arthroscopy 19(8):885–888

  15. 15.

    Hagino T, Ochiai S, Watanabe Y, Senga S, Wako M, Ando T, Sato E, Haro H (2012) Clinical results of arthroscopic all-inside lateral meniscal repair using the Meniscal Viper Repair System. Eur J Orthop Surg Traumatol. doi:10.1007/s00590-012-1138-1

  16. 16.

    Han JH, Song JG, Kwon JH, Kang KW, Shah D, Nha KW (2015) Spontaneous healing of a displaced bucket-handle tear of the lateral meniscus in a child. Knee Surg Relat Res 27(1):65–67

  17. 17.

    Higuchi H, Kimura M, Kobayashi A, Hatayama K, Takagishi K (2004) A novel treatment of hypermobile lateral meniscus with monopolar radiofrequency energy. Arthroscopy 20(Suppl 2):1–5

  18. 18.

    Kim JG, Han SW, Lee DH (2016) Diagnosis and treatment of discoid meniscus. Knee Surg Relat Res 28(4):255–262

  19. 19.

    Kimura M, Shirakura K, Hasegawa A, Kobayashi Y, Udagawa E (1992) Anatomy and pathophysiology of the popliteal tendon area in the lateral meniscus: 2. Clinical investigation. Arthroscopy 8(4):424–427

  20. 20.

    LaPrade RF, Konowalchuk BK (2005) Popliteomeniscal fascicle tears causing symptomatic lateral compartment knee pain: diagnosis by the figure-4 test and treatment by open repair. Am J Sports Med 33(8):1231–1236

  21. 21.

    Lee KW, Yang DS, Choy WS (2013) Dislocated double-layered lateral meniscus mimicking the bucket-handle tear. Orthopedics 36(10):e1333–e1335

  22. 22.

    Lim HC, Bae JH, Kim TS, Yang JH, Park SC, Yoon JR (2012) Intra-articular patterns of bucket handle meniscal tears and its relation to reducibility. Clin Orthop Surg 4(2):129–133

  23. 23.

    Makdissi M, Eriksson KO, Morris HG, Young DA (2006) MRI-negative bucket-handle tears of the lateral meniscus in athletes: a case series. Knee Surg Sports Traumatol Arthrosc 14(10):1012–1016

  24. 24.

    Ohtoshi K, Kimura M, Kobayashi Y, Higuchi H, Kikuchi S (2004) Arthroscopic thermal shrinkage for hypermobile lateral meniscus. Am J Sports Med 32(5):1297–1301

  25. 25.

    Park JH, Ro KH, Lee DH (2012) Snapping knee caused by a popliteomeniscal fascicle tear of the lateral meniscus in a professional Taekwondo athlete. Orthopedics 35(7):e1104–e1107

  26. 26.

    Pujol N, Tardy N, Boisrenoult P, Beaufils P (2015) Long-term outcomes of all-inside meniscal repair. Knee Surg Sports Traumatol Arthrosc 23(1):219–224

  27. 27.

    Sakai H, Sasho T, Wada Y, Sano S, Iwasaki J, Morita F, Moriya H (2006) MRI of the popliteomeniscal fasciculi. AJR Am J Roentgenol 186(2):460–466

  28. 28.

    Servien E, Acquitter Y, Hulet C, Seil R (2009) Lateral meniscus lesions on stable knee: a prospective multicenter study. Orthop Traumatol Surg Res 95(8 Suppl 1):S60–S64

  29. 29.

    Simonian PT, Sussmann PS, van Trommel M, Wickiewicz TL, Warren RF (1997) Popliteomeniscal fasciculi and lateral meniscal stability. Am J Sports Med 25(6):849–853

  30. 30.

    Simonian PT, Sussmann PS, Wickiewicz TL, Potter HG, van Trommel M, Weiland-Holland S, Warren RF (1997) Popliteomeniscal fasciculi and the unstable lateral meniscus: clinical correlation and magnetic resonance diagnosis. Arthroscopy 13(5):590–596

  31. 31.

    Small NC (1988) Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 4(3):215–221

  32. 32.

    Suganuma J, Mochizuki R, Inoue Y, Yamabe E, Ueda Y, Kanauchi T (2012) Magnetic resonance imaging and arthroscopic findings of the popliteomeniscal fascicles with and without recurrent subluxation of the lateral meniscus. Arthroscopy 28(4):507–516

  33. 33.

    Suganuma J, Ohkoshi T (2011) Association of internal rotation of the knee joint with recurrent subluxation of the lateral meniscus. Arthroscopy 27(8):1071–1078

  34. 34.

    Van Steyn MO, Mariscalco MW, Pedroza AD, Smerek J, Kaeding CC, Flanigan DC (2016) The hypermobile lateral meniscus: a retrospective review of presentation, imaging, treatment, and results. Knee Surg Sports Traumatol Arthrosc 24(5):1555–1559

  35. 35.

    Yue BW, Gupta AK, Moorman CT 3rd, Garrett WE, Helms CA (2011) Wrisberg variant of the discoid lateral meniscus with flipped meniscal fragments simulating bucket-handle tear: MRI and arthroscopic correlation. Skeletal Radiol 40(8):1089–1094

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This work was supported by Sports Scientification of Convergent R&D Program. Through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2014M3C1B1033320).

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Correspondence to Sang Hak Lee.

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The authors declare that they have no conflict of interest.


This study received no funding to complete.

Ethical approval

The study was reviewed and approved by the institutional review board of Kyung-Hee University Hospital at Gangdong, Seoul, Korea (No. 2013-01-047).

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All patients signed informed consent forms prior to study inclusion.

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Ahn, J.H., Lee, S.H., Kim, K.I. et al. Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 26, 787–792 (2018).

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  • Knee
  • Lateral meniscus
  • Posterior horn
  • Popliteal hiatus
  • Meniscus repair
  • All-inside suture