Abstract
The medial meniscus (MM) posterior root has an important role in the maintenance of knee kinematics and articular cartilage. Although transtibial pullout repair of the MM posterior root tear (MMPRT) has become the gold standard, it is associated with several suturing difficulties. The present technical note describes a simple fixation technique using two simple stiches under an expected initial tension. After the degree of knee flexion (20°) and an expected tension (30 N) are checked, tibial fixation is performed using a bioabsorbable interference screw with a spring tensioner. After that, a suture knot is made just below the screw in case the sutures are pulled toward the joint direction. Furthermore, a cancellous screw is inserted at a position 1-cm distal from the tibial tunnel for augmentation and is tightened. MMPRT usually occurs in middle-aged females who often have decreased bone quality. However, there is no risk of tibial fracture with our new technique because the bone does not need to be hit. Adopting the advances of fixation with a spring tensioner and Biosure RG instead of Double Spike Plate, we can determine an expected tension easily and safely. The present fixation technique allows reproducibility for many operators to determine an initial tension and might be a good candidate for arthroscopic repair of the MMPRT. Further follow-up studies including second-look arthroscopy and scoring will be necessary to show the clinical benefits of this technique.
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References
Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. J Bone Joint Surg Am 90:1922–1931
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 27:346–354
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 15:1510–1513
Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ (2006) Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy 22:1–4
Kodama Y, Furumatsu T, Fujii M, Tanaka T, Miyazawa S, Ozaki T (2016) Pullout repair of a medial meniscus posterior root tear using a FasT-Fix all-inside suture technique. Orthop Traumatol Surg Res 102:951–954
Fujii M, Furumatsu T, Kodama Y, Miyazawa S, Hino T, Kamatsuki Y, Yamada K, Ozaki T (2017) A novel suture technique using the FasT-Fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear. Eur J Orthop Surg Traumatol 27:559–562
Todor A, Caterev S, Nistor DV (2016) Outside-in deep medial collateral ligament release during arthroscopic medial meniscus surgery. Arthrosc Tech 5:781–785
Furumatsu T, Kodama Y, Fujii M, Tanaka T, Hino T, Kamatsuki Y, Yamada K, Miyazawa S, Ozaki T (2017) A new aiming guide can create the tibial tunnel at favorable position in transtibial pullout repair for the medial meniscus posterior root tear. Orthop Traumatol Surg Res 103:367–371
West RV, Kim JG, Armfield D, Harner CD (2004) Lateral meniscal root tears associated with anterior cruciate ligament injury: classification and management (SS-70). Arthroscopy 20:32–33 (abstract)
Lavender CD, Hanzlik SR, Caldwell PE, Pearson SE (2015) Transosseous medial meniscal root repair using a modified Mason-Allen suture configuration. Arthrosc Tech 4:781–784
Apivatgaroon A, Chernchujit B (2016) A medial meniscal root pullout repair with the use of a tibial tunnel suturing technique. Arthrosc Tech 5:595–599
Chung KS, Ha JK, Ra HJ, Kim JG (2016) Arthroscopic medial meniscus posterior root fixation using a modified Mason-Allen stitch. Arthrosc Tech 5:63–66
Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Kodama Y, Ozaki T (2018) Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair. Int Orthop. https://doi.org/10.1007/s00264-018-4071-z
Fuji M, Furumatsu T, Xue H, Miyazawa S, Kodama Y, Hino T, Kamatsuki Y, Ozaki T (2017) Tensile strength of the pullout repair technique for the medial meniscus posterior root tear: a porcine study. Int Orthop. https://doi.org/10.1007/s00264-017-3561-8
Mrakolf KL, Jackson SR, McAllister DR (2012) Force measurements in the medial meniscus posterior horn attachment. Am J Sports Med 40:332–338
Starke C, Kopf S, Lippisch R, Lohmann CH, Becker R (2013) Tensile forces on repaired medial meniscus root tears. Arthroscopy 29:205–212
Feucht M, Grande E, Brunhuber J, Burgkart R, Imhoff A, Braun S (2013) Biomechanical evaluation of different suture techniques for arthroscopic transtibial pull-out repair of posterior medial meniscus root tears. Am J Sports Med 41:2784–2790
Lee DW, Kim MK, Jang HS, Ha JK, Kim JG (2014) Clinical and radiologic evaluation of arthroscopic medial meniscus root tear refixation: comparison of the modified Mason-Allen stitch and simple stitches. Arthroscopy 30:1439–1446
Chung KS, Noh JM, Ha JK, Ra HJ, Park SB, Kim HK, Kim JG (2018) Survivorship analysis and clinical outcomes of transtibial pullout repair for medial meniscus posterior root tears: a 5- to 10-year follow-up study. Arthroscopy 34:530–535
Okazaki Y, Furumatsu T, Masuda S, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2018) Pullout repair of the medial meniscus posterior root tear reduces proton density-weighted imaging signal intensity of the medial meniscus. Acta Med Okayama 72:493–498
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Okazaki, Y., Furumatsu, T., Kodama, Y. et al. Description of a surgical technique of medial meniscus root repair: a fixation technique with two simple stiches under an expected initial tension. Eur J Orthop Surg Traumatol 29, 705–709 (2019). https://doi.org/10.1007/s00590-018-2347-z
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DOI: https://doi.org/10.1007/s00590-018-2347-z