Skip to main content

Advertisement

SpringerLink
Log in

Repair of a complete radial tear in the midbody of the medial meniscus using a novel crisscross suture transtibial tunnel surgical technique: a case report

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Complete radial meniscus tears have been reported to result in deleterious effects in the knee joint if left unrepaired. An emphasis on meniscal preservation is important in order to restore native meniscal function. In this case report, a complete radial tear of the medial meniscus midbody was repaired using a novel crisscross suture transtibial technique. This technique secured the anterior and posterior meniscal horns, which were released from their extruded and scarred position along the capsule, using crisscrossing sutures passed through two transtibial tunnels and secured over a bone bridge on the anterolateral tibia. In addition, the repair was supplemented with the injection of platelet-rich plasma and bone marrow aspirate concentrate to promote the healing of the meniscal tissue. Complete healing on second-look arthroscopy is presented, including in the previously unreported white–white meniscal zone.

Level of evidence

Case Report, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  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 Joint Surg Am 90:1922–1931

    Article  PubMed  Google Scholar 

  2. Arnoczky SP, Warren RF (1983) The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med 11:131–141

    Article  CAS  PubMed  Google Scholar 

  3. Badlani JT, Borrero C, Golla S, Harner CD, Irrgang JJ (2013) The effects of meniscus injury on the development of knee osteoarthritis: data from the osteoarthritis initiative. Am J Sports Med 41:1238–1244

    Article  PubMed  Google Scholar 

  4. Barber-Westin SD, Noyes FR (2014) Clinical healing rates of meniscus repairs of tears in the central-third (red–white) zone. Arthroscopy 30:134–146

    Article  PubMed  Google Scholar 

  5. Beaufils P, Hulet C, Dhénain M, Nizard R, Nourissat G, Pujol N (2009) Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthop Traumatol Surg Res 17:437–442

    Article  Google Scholar 

  6. Campbell KJ, Boykin RE, Wijdicks CA, Erik Giphart J, LaPrade RF, Philippon MJ (2013) Treatment of a hip capsular injury in a professional soccer player with platelet-rich plasma and bone marrow aspirate concentrate therapy. Knee Surg Sports Traumatol Arthrosc 21:1684–1687

    Article  PubMed  Google Scholar 

  7. Choi NH, Kim TH, Son KM, Victoroff BN (2010) Meniscal repair for radial tears of the midbody of the lateral meniscus. Am J Sports Med 38:2472–2476

    Article  PubMed  Google Scholar 

  8. de Girolamo L, Galliera E, Volpi P, Denti M, Dogliotti G, Quaglia A, Cabitza P, Corsi Romanelli MM, Randelli P (2013) Why menisci show higher healing rate when repaired during ACL reconstruction? Growth factors release can be the explanation. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2712-8

    PubMed  Google Scholar 

  9. Driscoll MD, Robin BN, Horie M, Hubert ZT, Sampson HW, Jupiter DC, Tharakan B, Reeve RE (2013) Marrow stimulation improves meniscal healing at early endpoints in a rabbit meniscal model. Arthroscopy 29:113–121

    Article  PubMed  Google Scholar 

  10. Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB, Braun S (2014) Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears. Am J Sports Med 42:187–193

    Article  PubMed  Google Scholar 

  11. Foad A (2012) Self-limited healing of a radial tear of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 20:933–936

    Article  PubMed  Google Scholar 

  12. Freedman KB, Nho SJ, Cole BJ (2003) Marrow stimulating technique to augment meniscus repair. Arthroscopy 19:794–798

    Article  PubMed  Google Scholar 

  13. Goedecke A, Wobus M, Krech M, Munch N, Richter K, Holig K, Bornhauser M (2011) Differential effect of platelet-rich plasma and fetal calf serum on bone marrow-derived human mesenchymal stromal cells expanded in vitro. J Tissue Eng Regen Med 5:648–654

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  15. 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 40:2342–2347

    Article  PubMed  Google Scholar 

  16. Krüger JP, Hondke S, Endres M, Pruss A, Siclari A, Kaps C (2012) Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells. J Orthop Res 30:845–852

    Article  PubMed  Google Scholar 

  17. LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 96:471–479

    Article  PubMed  Google Scholar 

  18. Magee T, Shapiro M, Williams D (2002) MR accuracy and arthroscopic incidence of meniscal radial tears. Skeletal Radiol 31:686–689

    Article  PubMed  Google Scholar 

  19. Matsubara H, Okazaki K, Izawa T, Tashiro Y, Matsuda S, Nishimura T, Nakanishi Y, Kawamura H, Iwamoto Y (2012) New suture method for radial tears of the meniscus: biomechanical analysis of cross-suture and double horizontal suture techniques using cyclic load testing. Am J Sports Med 40:414–418

    Article  PubMed  Google Scholar 

  20. McDermott I (2011) Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee. Br J Sports Med 45:292–297

    Article  PubMed  Google Scholar 

  21. Melton JT, Murray JR, Karim A, Pandit H, Wandless F, Thomas NP (2011) Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study. Knee Surg Sports Traumatol Arthrosc 19:1729–1734

    Article  CAS  PubMed  Google Scholar 

  22. Mishra A, Tummala P, King A, Lee B, Kraus M, Tse V, Jacobs CR (2009) Buffered platelet-rich plasma enhances mesenchymal stem cell proliferation and chondrogenic differentiation. Tissue Eng Part C Methods 15:431–435

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Muriuki MG, Tuason DA, Tucker BG, Harner CD (2011) Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. J Bone Joint Surg Am 93:1089–1095

    Article  CAS  PubMed  Google Scholar 

  24. Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, LaPrade RF (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 42:699–707

    Article  PubMed  Google Scholar 

  25. Ra HJ, Ha JK, Jang SH, Lee DW, Kim JG (2013) Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot. Knee Surg Sports Traumatol Arthrosc 21:2126–2130

    Article  PubMed  Google Scholar 

  26. Stärke C, Kopf S, Grobel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26:358–365

    Article  PubMed  Google Scholar 

  27. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jäger A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal repairs. Am J Sports Med 38:1542–1548

    Article  PubMed  Google Scholar 

  28. Thompson WO, Thaete FL, Fu FH, Dye SF (1991) Tibial meniscal dynamics using three dimensional reconstruction of magnetic resonance images. Am J Sports Med 19:210–216

    Article  CAS  PubMed  Google Scholar 

  29. Vangsness CT Jr, Farr J II, Boyd J, Dellaero DT, Mills CR, Leroux-Williams M (2014) Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. J Bone Joint Surg Am 96:90–98

    Article  PubMed  Google Scholar 

  30. Wei LC, Gao SG, Xu M, Jiang W, Tian J, Lei GH (2012) A novel hypothesis: the application of platelet-rich plasma can promote the clinical healing of white–white meniscal tears. Med Sci Monit 18:HY47–HY50

    PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Steadman Philippon Research Institute, Vail, CO, USA

    Evan W. James, Christopher M. LaPrade, John A. Feagin & Robert F. LaPrade

  2. The Steadman Clinic, Vail, CO, USA

    Robert F. LaPrade

Authors
  1. Evan W. James
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher M. LaPrade
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John A. Feagin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert F. LaPrade
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert F. LaPrade.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

James, E.W., LaPrade, C.M., Feagin, J.A. et al. Repair of a complete radial tear in the midbody of the medial meniscus using a novel crisscross suture transtibial tunnel surgical technique: a case report. Knee Surg Sports Traumatol Arthrosc 23, 2750–2755 (2015). https://doi.org/10.1007/s00167-014-3089-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3089-z

Keywords

Search

Navigation