Skip to main content

Advertisement

SpringerLink
Log in

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

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

According to our observation in ACL reconstruction, we find root tears of the posterior horn of the lateral meniscus as a common concomitant injury in ACL-deficient knees. This might be a consequence of initial trauma or of the increased anterior–posterior translation of the tibia and an overload impact on the posterior meniscus root in ACL-deficient knees. A tear of the posterior horn of the medial meniscus causes a 25% increase in peak pressure in the medial compartment compared with that found in the intact condition. The repair restores the peak contact pressure to normal (Allaire et al. in J Bone Joint Surg Am 90(9):1922–1931, [2008]). A tear of the posterior horn of the lateral meniscus might have similar consequences. We hypothesize the surgical anatomical reattachment of the root at the tibia helping to restore knee joint kinematics and helping to advance ACL-graft function. This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture.

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
Fig. 5
Fig. 6

References

  1. Ahn JH, Lee YS, Chang JY, Chang MJ, Eun SS, Kim SM (2009) Arthroscopic all inside repair of the lateral meniscus root tear. Knee 16(1):77–80

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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 Jt Surg Am 90(9):1922–1931

    Article  Google Scholar 

  4. Arnoczky SP, Warren RF (1982) Microvasculature of the human meniscus. Am J Sports Med 10:90–95

    Article  PubMed  CAS  Google Scholar 

  5. Brody JM, Lin HM, Hulstyn MJ, Tung GA (2006) Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology 239:805–810

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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 Jt Surg Am 91(Suppl 2):257–270

    Article  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38(8):1591–1597

    Article  PubMed  Google Scholar 

  12. Petersen W, Tillmann B (1999) Structure and vascularization of the knee joint menisci. Z Orthop Ihre Grenzgeb 137(1):31–37 German

    Article  PubMed  CAS  Google Scholar 

  13. Petersen W, Zantop T (2006) Arthroscopic meniscal suture. Oper Orthop Traumatol 18(5–6):393–410

    Article  PubMed  Google Scholar 

  14. Petersen W, Zantop T (2006) Avulsion injury to the posterior horn of the lateral meniscus. Technique for arthroscopic refixation. Unfallchirurg 109(11):984–987

    Article  PubMed  CAS  Google Scholar 

  15. Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47

    Article  PubMed  Google Scholar 

  16. Petersen W, Pufe T, Stärke C, Fuchs T, Kopf S, Raschke M, Becker R, Tillmann B (2005) Locally applied angiogenic factors—a new therapeutic tool for meniscal repair. Ann Anat 187(5–6):509–519

    Article  PubMed  CAS  Google Scholar 

  17. Petersen W, Pufe T, Stärke C, Fuchs T, Kopf S, Neumann W, Zantop T, Paletta J, Raschke M, Becker R (2007) The effect of locally applied vascular endothelial growth factor on meniscus healing: gross and histological findings. Arch Orthop Trauma Surg 127(4):235–240

    Article  PubMed  Google Scholar 

  18. Rattner JB, Matyas JR, Barclay L, Holowaychuk S, Sciore P, Lo IK, Shrive NG, Frank CB, Achari Y, Hart DA (2010) New understanding of the complex structure of knee menisci: implications for injury risk and repair potential for athletes. Scand J Med Sci Sports

  19. 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 Jt Surg Br 91(2):190–195

    Article  CAS  Google Scholar 

  20. 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

  21. Stärke C, Kopf S, Gröbel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26(3):358–365

    Article  PubMed  Google Scholar 

  22. Thompson WO, Fu FH (1993) The meniscus in the cruciate-deficient knee. Clin Sports Med 12(4):771–796

    PubMed  CAS  Google Scholar 

  23. West RV, Kim JG, Armfield D, Harner CD (2004) Lateral meniscal root tears associated with anterior cruciate ligament injury: classification and management. Arthroscopy 20:e32–e33

    Google Scholar 

  24. Ziegler CG, Pietrini SD, Westerhaus BD, Anderson CJ, Wijdicks CA, Johansen S, Engebretsen L, LaPrade RF (2011) Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39(4):743–752

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic for Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar-Theyß-Str. 27-31, 14193, Berlin, Germany

    Philipp Forkel & Wolf Petersen

Authors
  1. Philipp Forkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wolf Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp Forkel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Forkel, P., Petersen, W. 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, 387–391 (2012). https://doi.org/10.1007/s00402-011-1429-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-011-1429-8

Keywords

Search

Navigation