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Avulsion of the anterior medial meniscus root: case report and surgical technique

Knee Surgery, Sports Traumatology, Arthroscopy volume 23, pages 146–151 (2015)Cite this article

Abstract

Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau.

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References

  1. Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR (2010) Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 26(1):67–75

    PubMed  Article  Google Scholar 

  2. Ahn JH, Wang JH, Lim HC, Bae JH, Park JS, Yoo JC, Shyam AK (2009) Double transosseous pull out suture technique for transection of posterior horn of medial meniscus. Arch Orthop Trauma Surg 129(3):387–392

    PubMed  Article  Google Scholar 

  3. 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(12):1510–1513

    PubMed  Article  Google Scholar 

  4. 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(9):1922–1931

    PubMed  Article  Google Scholar 

  5. Berlet GC, Fowler PJ (1998) The anterior horn of the medical meniscus. An anatomic study of its insertion. Am J Sports Med 26(4):540–543

    CAS  PubMed  Google Scholar 

  6. Brand J Jr, Weiler A, Caborn DN, Brown CH Jr, Johnson DL (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28(5):761–774

    PubMed  Google Scholar 

  7. Cho JH (2012) Modified pull-out suture in posterior root tear of the medial meniscus: using a posteromedial portal. Knee Surg Relat Res 24(2):124–127

    PubMed Central  PubMed  Article  Google Scholar 

  8. Choi CJ, Choi YJ, Lee JJ, Choi CH (2010) Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy 26(12):1602–1606

    PubMed  Article  Google Scholar 

  9. Choi NH, Son KM, Victoroff BN (2008) Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc 16(9):891–893

    PubMed  Article  Google Scholar 

  10. Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20(10):2098–2103

    PubMed  Article  Google Scholar 

  11. Forkel P, Petersen W (2012) Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg 132(3):387–391

    PubMed  Article  Google Scholar 

  12. Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26(10):1326–1332

    PubMed  Article  Google Scholar 

  13. Harner CD, Mauro CS, Lesniak BP, Romanowski JR (2009) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Joint Surg Am 91(Suppl 2):257–270

    PubMed  Google Scholar 

  14. Hein CN, Deperio JG, Ehrensberger MT, Marzo JM (2011) Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee 18(3):189–192

    PubMed  Article  Google Scholar 

  15. Henry S, Mascarenhas R, Kowalchuk D, Forsythe B, Irrgang JJ, Harner CD (2012) Medial meniscus tear morphology and chondral degeneration of the knee: is there a relationship? Arthroscopy 28(8):1124–1134

    PubMed  Article  Google Scholar 

  16. Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ, Jung KA (2012) Risk factors for medial meniscus posterior root tear. Am J Sports Med 40(7):1606–1610

    PubMed  Article  Google Scholar 

  17. Iversen JV, Krogsgaard MR (2012) Tibial avulsion fracture of the posterior root of the medial meniscus in children. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2295-9

    PubMed  Google Scholar 

  18. Jones AO, Houang MT, Low RS, Wood DG (2006) Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol 50(4):306–313

    CAS  PubMed  Article  Google Scholar 

  19. Jung WH, Kim DH, Chun CW, Lee JH, Ha JH, Jeong JH (2012) Arthroscopic, suture anchor repair through a novel medial quadriceptal portal for medial meniscal root tear. Knee Surg Sports Traumatol Arthrosc 20(12):2391–2394

    PubMed  Article  Google Scholar 

  20. Jung YH, Choi NH, Oh JS, Victoroff BN (2012) All-inside repair for a root tear of the medial meniscus using a suture anchor. Am J Sports Med 40(6):1406–1411

    PubMed  Article  Google Scholar 

  21. Kale A, Kopuz C, Dikici F, Demir MT, Corumlu U, Ince Y (2010) Anatomic and arthroscopic study of the medial meniscal horns’ insertions. Knee Surg Sports Traumatol Arthrosc 18(6):754–759

    PubMed  Article  Google Scholar 

  22. Kenny C (2009) Arthroscopic repair of avulsion of the posterior root and body of the lateral meniscus: a twenty-year follow-up. A case report. J Bone Joint Surg Am 91(12):2932–2936

    PubMed  Article  Google Scholar 

  23. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27(12):1644–1653

    PubMed  Article  Google Scholar 

  24. Kim JH, Shin DE, Dan JM, Nam KS, Ahn TK, Lee DH (2009) Arthroscopic suture anchor repair of posterior root attachment injury in medial meniscus: technical note. Arch Orthop Trauma Surg 129(8):1085–1088

    PubMed  Article  Google Scholar 

  25. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, Lee MY (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27(3):346–354

    PubMed  Article  Google Scholar 

  26. Kim YJ, Kim JG, Chang SH, Shim JC, Kim SB, Lee MY (2010) Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee 17(5):324–328

    PubMed  Article  Google Scholar 

  27. Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25(9):1025–1032

    PubMed  Article  Google Scholar 

  28. Kohn D, Moreno B (1995) Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy 11(1):96–103

    CAS  PubMed  Article  Google Scholar 

  29. Kopf S, Colvin AC, Muriuki M, Zhang X, Harner CD (2011) Meniscal root suturing techniques: implications for root fixation. Am J Sports Med 39(10):2141–2146

    PubMed  Article  Google Scholar 

  30. Lee CK, Cho HL, Park JW, Ku JH (2011) Displaced avulsion fracture of medial meniscus posterior horn through the intercondylar notch in the patient without combined ligamentous injuries. Knee Surg Sports Traumatol Arthrosc 19(2):165–167

    PubMed  Article  Google Scholar 

  31. Lee DW, Jang SH, Ha JK, Kim JG, Ahn JH (2012) Meniscus root refixation technique using a modified Mason-Allen stitch. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1992-8

    PubMed Central  Google Scholar 

  32. Lee JH, Lim YJ, Kim KB, Kim KH, Song JH (2009) Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy 25(9):951–958

    PubMed  Article  Google Scholar 

  33. Lee YG, Shim JC, Choi YS, Kim JG, Lee GJ, Kim HK (2008) Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. J Comput Assist Tomogr 32(3):452–457

    PubMed  Article  Google Scholar 

  34. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK (2010) Non-operative treatment of degenerative posterior root tear of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 18(4):535–539

    PubMed  Article  Google Scholar 

  35. Magee T (2008) MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging 28(2):466–470

    PubMed  Article  Google Scholar 

  36. Marzo JM (2012) Meniscus root avulsion. Clin Sports Med 31(1):101–111

    PubMed  Article  Google Scholar 

  37. 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(1):124–129

    PubMed  Article  Google Scholar 

  38. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK (2012) Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med 40(5):1138–1143

    PubMed  Article  Google Scholar 

  39. Navarro-Holgado P, Cuevas-Perez A, Aguayo-Galeote MA, Carpintero-Benitez P (2007) Anterior medial meniscus detachment and anterior cruciate ligament tear. Knee Surg Sports Traumatol Arthrosc 15(5):587–590

    PubMed  Article  Google Scholar 

  40. Nicholas SJ, Golant A, Schachter AK, Lee SJ (2009) A new surgical technique for arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arthrosc 17(12):1433–1436

    PubMed  Article  Google Scholar 

  41. Ohkoshi Y, Takeuchi T, Inoue C, Hashimoto T, Shigenobu K, Yamane S (1997) Arthroscopic studies of variants of the anterior horn of the medical meniscus. Arthroscopy 13(6):725–730

    CAS  PubMed  Article  Google Scholar 

  42. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN (2008) Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 16(9):849–854

    PubMed  Article  Google Scholar 

  43. Park YS, Moon HK, Koh YG, Kim YC, Sim DS, Jo SB, Kwon SK (2011) Arthroscopic pullout repair of posterior root tear of the medial meniscus: the anterior approach using medial collateral ligament pie-crusting release. Knee Surg Sports Traumatol Arthrosc 19(8):1334–1336

    PubMed  Article  Google Scholar 

  44. Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD (2009) Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Joint Surg Br 91(2):190–195

    CAS  PubMed  Article  Google Scholar 

  45. Rosslenbroich SB, Borgmann J, Herbort M, Raschke MJ, Petersen W, Zantop T (2013) Root tear of the meniscus: biomechanical evaluation of an arthroscopic refixation technique. Arch Orthop Trauma Surg 133(1):111–115

    PubMed  Article  Google Scholar 

  46. Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP (2012) Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med 40(11):2604–2609

    PubMed  Article  Google Scholar 

  47. Seil R, Duck K, Pape D (2011) A clinical sign to detect root avulsions of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 19(12):2072–2075

    PubMed  Article  Google Scholar 

  48. Seo HS, Lee SC, Jung KA (2011) Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med 39(1):99–107

    PubMed  Article  Google Scholar 

  49. Shelbourne KD, Roberson TA, Gray T (2011) Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med 39(7):1439–1443

    PubMed  Article  Google Scholar 

  50. Toy JO, Feeley BT, Gulotta LV, Warren RF (2011) Arthroscopic avulsion repair of a pediatric ACL with an Anomalous Primary Insertion into the Lateral Meniscus. Hss J 7(2):190–193

    PubMed Central  PubMed  Article  Google Scholar 

  51. Vyas D, Harner CD (2012) Meniscus root repair. Sports Med Arthrosc 20(2):86–94

    PubMed  Article  Google Scholar 

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Affiliations

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

    Matthias J. Feucht, Philipp Minzlaff, Tim Saier, Andreas Lenich, Andreas B. Imhoff & Stefan Hinterwimmer

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  1. Matthias J. Feucht
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  2. Philipp Minzlaff
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Correspondence to Matthias J. Feucht.

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Feucht, M.J., Minzlaff, P., Saier, T. et al. Avulsion of the anterior medial meniscus root: case report and surgical technique. Knee Surg Sports Traumatol Arthrosc 23, 146–151 (2015). https://doi.org/10.1007/s00167-013-2462-7

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  • DOI: https://doi.org/10.1007/s00167-013-2462-7

Keywords

  • Meniscus
  • Meniscus avulsion
  • Meniscus detachment
  • Meniscal repair
  • Root tear
  • Knotless suture anchor