Widening of the popliteal hiatus on magnetic resonance imaging leads to recurrent subluxation of the lateral meniscus
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This study was undertaken to elucidate the clinical significance of widening of the popliteal hiatus on magnetic resonance imaging (MRI), and to document the clinical results and technical aspects of arthroscopic repair of this finding.
Included are 82 knees after arthroscopic surgery, divided according to arthroscopic diagnosis into group A, hypermobility of lateral meniscus, 8 knees; group B, tear of the anterior horn of the lateral meniscus, 32 knees; and group C, no abnormality of the lateral meniscus, 36 knees with medial meniscal tears and 6 with other conditions. Popliteal hiatus diameter was measured and the popliteal hiatus/lateral tibial plateau (LTP) ratio was calculated on preoperative sagittal and coronal MRI. At arthroscopy, the widened popliteal hiatus in group A was tightened anteriorly by outside-in or all-inside suture and posteriorly with all-inside suture. Outcomes were evaluated with MRI, Lysholm, Tegner and VAS scores.
The preoperative diameter of the popliteal hiatus and the popliteal hiatus/LTP ratio were significantly larger in group A than in groups B and C (p < 0.05) on both views. Threshold popliteal hiatus/LTP values of 0.16 and 0.18 on the sagittal and coronal views demonstrated diagnostic discrimination, and these values were significantly reduced after arthroscopy in Group A. Lysholm and Tegner scores were improved after tightening of the popliteal hiatus, while VAS scores reduced (all p < 0.05).
Widening of the popliteal hiatus on MRI may lead to recurrent subluxation of the lateral meniscus. Arthroscopic anterior and posterior tightening of the popliteal hiatus was a safe and effective treatment.
Level of evidence
KeywordsKnee Popliteal hiatus Lateral meniscus MRI Arthroscopy
We thank Dr. Zhengwu Tang for assistance in the statistical analysis of our data and preparation of figures of this article.
Compliance with ethical standards
Conflict of interest
Zhou Li, Heng Zhao, Zhu Dai, Zhiwei Chen, Ying Liao, Dehong Fu, Yunliang Lei, Tao Luo, and Quanhui Liu declare that they have no conflict of interest.
This work was supported by grants from the National Natural Science Foundation of China (81501886).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval for this study was obtained from the ethics committee of the First Affiliated Hospital of University of South China.
Informed consent forms were signed by each patient included in this study.
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