The Popliteus Tendon Provides a Safe and Reliable Location for Anchor Placement in Posterior Horn Lateral Meniscal Repairs

Purpose All-inside posterior horn lateral meniscal (PHLM) repair puts the popliteal neurovascular bundle (PVNB) at risk of injury by meniscal repair devices. The purpose of this study was to establish a safe zone of all-inside meniscal fixation in pediatric patients using MRI measurements between the popliteus tendon (PT) and popliteal neurovascular bundle (PNVB). We hypothesize that males and older age groups will have a larger distance between PT and PNVB. Methods Axial MRIs of 250 pediatric (5-16 yrs.) patients were retrospectively reviewed. Patients were grouped by age: group I (5-7yrs.): 61; II (8-10yrs.): 59; III (11-13yrs.): 60; IV (14-16yrs.): 70. At the level of the lateral meniscus, two lines starting at the lateral patella tendon border ending at the medial edge of the PT (D1) and the lateral edge of the PNVB (D2) were made on an axial knee MRI. D3 connected D1 to D2 at the meniscocapsular junction of the PHLM. D4 was derived geometrically, parallel and 8 mm anterior to D3 simulating the anterior edge of the PHLM. Results Analysis showed significant correlation between age and sex for D3 (p<0.0001). For D3, there were significant differences among all age groups, except between groups III and IV. Average (STD) D3 for age groups was: 14.1mm(3.1), 15.8(2.5), 17.0(3.3), 17.2(3.1). For D4, the average (STD) was: 11.9 mm(2.9); 13.9(2.5); 15.4(3.0); 15.2(2.9). There was significant difference in D3 and D4 in males versus females (17.6 vs 15.7 mm; p <0.001; 14.9 vs 13.2; p <0.001), particularly in III and IV (17.0 vs 13.8 and 16.8 vs 13.9). Conclusions This study provides normative data of the distance between popliteal neurovascular bundle and popliteus tendon at the meniscocapsular junction (D3) and anterior edge of the posterior horn lateral meniscus (D4) with the knee in full extension. Combined with previous studies showing the addition of knee flexion increases the distance between the meniscus and the neurovascular bundle, surgeons can use this data to improve safety of posterior horn lateral meniscus repair in pediatric patients.

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Unstable Type III Wrisberg-type Lateral Discoid Meniscus: All-inside Arthroscopic Repair

Video Journal of Sports Medicine ◽

10.1177/26350254211006717 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110067

Author(s):

Alberto Grassi ◽

Nicola Pizza ◽

Luca Macchiarola ◽

Stefano Zaffagnini

Keyword(s):

Effective Treatment ◽

Knee Pain ◽

Return To Sport ◽

Posterior Horn ◽

Arthroscopic Repair ◽

Popliteus Tendon ◽

Clinical Scenario ◽

Discoid Meniscus ◽

Type Iii ◽

Unstable Type

Background: The Type III Wrisberg-type represents the rarest subtype of discoid meniscus. It exhibits a normal non-discoid “C”-shape with possible posterior horn hypertrophy, but meniscotibial ligaments and capsular restraints are lacking, leading to a clinical scenario of knee pain, popping, and catching due to meniscal hypermobility. Moreover, concomitant tears can be present due to repeated meniscal traumas. Indications: Type III Wrisberg-type lateral discoid meniscus with hypermobility, dislocation, or tear. Technique Description: Through standard arthroscopic portals, the meniscus is reduced in its anatomical position (if displaced). Abnormal mobility and anatomy should be noted. All-inside sutures are used in the posterior horn and body to stabilize the meniscus to the capsule and popliteus tendon. In the case of radial tears, horizontal stitches are used. Results: Patients are expected to return to sport approximately 4 to 5 months after the procedure with relief of pain, popping sensation, and knee locking. Conclusion: Arthroscopic all-inside repair is an effective treatment for unstable and displaced Type III Wrisberg-type lateral discoid meniscus. However, the diagnosis can be challenging, especially without frank meniscal dislocation.

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Is the present classification of discoid meniscus sufficient?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00049 ◽

2017 ◽

Vol 5 (2_suppl2) ◽

pp. 2325967117S0004

Author(s):

Hasan Bombaci ◽

Fatma Gökel ◽

Emrah Geçgel ◽

Suavi Aydoğmuş

Keyword(s):

Lateral Meniscus ◽

Partial Meniscectomy ◽

Posterior Horn ◽

Anterior Horn ◽

Meniscus Tear ◽

Discoid Lateral Meniscus ◽

Popliteus Tendon ◽

Discoid Meniscus ◽

The Stability

Introduction: Although uncommon, the discoid meniscus is quite prone to injury due to its abnormal shape and abnormal histology. The weak or absent peripheral attachment of the discoid meniscus causes instability even after partial meniscectomy. Therefore, recently, after resection of the central part of the meniscus, in which tears develop most frequently, the remnant of the meniscus is preferred to repair. In that time, the Watanabe classification, which classifies the discoid meniscuses in three groups, is used to plan treatment. However, discoid meniscus can develop in the different forms from these three main shapes. In the present study we aimed to analyse the discoid meniscuses, which we encountered during arthroscopic procedures in the knee, according to Watanabe classification. Patients and methods: The lateral discoid meniscuses in the 36 knees of 35 patients, who were operated on because of meniscus tear of either the discoid lateral meniscus itself or the normal medial meniscus, were classified according to Watanabe classification. Results: While the lateral discoid meniscuses were classified as “complete” in 13, “incomplete” in 15 knees, the meniscuses were very thin or absent in the central (one knee) or in the postero-lateral regions (seven knees) of discoid meniscus ( Figure 1 ). In this series this opening was next to the popliteus tendon except in one case. In these cases, the continuity of the meniscus between middle and posterior horn frequently was not possible after central partial meniscectomy (CPM). On the other hand, posterior horn has stable peripheral attachment unlike the Wrisberg type discoid meniscus. Of the 36 discoid meniscuses, CPM was performed in 21 knees, CPM with anterior horn repair in three, CPM with posterior horn repair in one and anterior horn repair without meniscectomy in two patients. In nine patients the lateral discoid meniscus was left alone. [Figure: see text] Discussion and conclusion: When meniscus sparing methods are intended to perform, both to decide the amount of resection and repair of the remnant, besides the shape of meniscus tear, the stability of discoid meniscus is crucial. This study shows that the Watanabe classification cannot be sufficient to include some specific type of lateral discoid meniscus. We believe that to add the discoid meniscuses, with opening in postero-lateral region next to the popliteus tendon, to the Watanabe classification might be useful to decide the amount of resection or repair of the discoid lateral meniscus.

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Topographical histology of the posterolateral corner of the knee, with special reference to laminar configurations around the popliteus tendon: a study of elderly Japanese and late-stage fetuses

Journal of Orthopaedic Science ◽

10.1007/s00776-004-0848-6 ◽

2005 ◽

Vol 10 (1) ◽

pp. 48-55 ◽

Cited By ~ 5

Author(s):

Takeshi Minowa ◽

Gen Murakami ◽

Daisuke Suzuki ◽

Eiichi Uchiyama ◽

Hideji Kura ◽

...

Keyword(s):

Special Reference ◽

Late Stage ◽

Posterolateral Corner ◽

Popliteus Tendon ◽

Elderly Japanese

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Meniscus delivery: a maneuver for easy arthroscopic access to the posterior horn of the medial meniscus

SICOT-J ◽

10.1051/sicotj/2016007 ◽

2016 ◽

Vol 2 ◽

pp. 10 ◽

Cited By ~ 2

Author(s):

Hatem Galal Said ◽

Saumitra Goyal ◽

Tarek Nabil Fetih

Keyword(s):

Medial Meniscus ◽

Posterior Horn

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Nonanatomic Location of the Posterior Horn of a Medial Meniscal Autograft Implanted in a Cadaveric Knee Adversely Affects the Pressure Distribution on the Tibial Plateau

The American Journal of Sports Medicine ◽

10.1177/03635465020300012601 ◽

2002 ◽

Vol 30 (1) ◽

pp. 74-82 ◽

Cited By ~ 100

Author(s):

S. Vijay Sekaran ◽

Maury L. Hull ◽

Stephen M. Howell

Keyword(s):

Pressure Distribution ◽

Tibial Plateau ◽

Posterior Horn ◽

Cadaveric Knee

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Effect of Meniscocapsular and Meniscotibial Lesions in ACL-Deficient and ACL-Reconstructed Knees: A Biomechanical Study

The American Journal of Sports Medicine ◽

10.1177/0363546518774315 ◽

2018 ◽

Vol 46 (10) ◽

pp. 2422-2431 ◽

Cited By ~ 35

Author(s):

Nicholas N. DePhillipo ◽

Gilbert Moatshe ◽

Alex Brady ◽

Jorge Chahla ◽

Zachary S. Aman ◽

...

Keyword(s):

Internal Rotation ◽

Medial Meniscus ◽

Pivot Shift ◽

External Rotation ◽

Posterior Horn ◽

Pivot Shift Test ◽

Anterior Tibial Translation ◽

Anterior Tibial ◽

Tibial Translation ◽

Acl Deficient

Background: Ramp lesions were initially defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction. The separate biomechanical roles of the meniscocapsular and meniscotibial attachments of the posterior medial meniscus have not been fully delineated. Purpose: To evaluate the biomechanical effects of meniscocapsular and meniscotibial lesions of the posterior medial meniscus in anterior cruciate ligament (ACL)–deficient and ACL-reconstructed knees and the effect of repair of ramp lesions. Study Design: Controlled laboratory study. Methods: Twelve matched pairs of human cadaveric knees were evaluated with a 6 degrees of freedom robotic system. All knees were subjected to an 88-N anterior tibial load, internal and external rotation torques of 5 N·m, and a simulated pivot-shift test of 10-N valgus force coupled with 5-N·m internal rotation. The paired knees were randomized to the cutting of either the meniscocapsular or the meniscotibial attachments after ACL reconstruction (ACLR). Eight comparisons of interest were chosen before data analysis was conducted. Data from the intact state were compared with data from the subsequent states. The following states were tested: intact (n = 24), ACL deficient (n = 24), ACL deficient with a meniscocapsular lesion (n = 12), ACL deficient with a meniscotibial lesion (n = 12), ACL deficient with both meniscocapsular and meniscotibial lesions (n = 24), ACLR with both meniscocapsular and meniscotibial lesions (n = 16), and ACLR with repair of both meniscocapsular and meniscotibial lesions (n = 16). All states were compared with the previous states. For the repair and reconstruction states, only the specimens that underwent repair were compared with their intact and sectioned states, thus excluding the specimens that did not undergo repair. Results: Cutting the meniscocapsular and meniscotibial attachments of the posterior horn of the medial meniscus significantly increased anterior tibial translation in ACL-deficient knees at 30° ( P ≤ .020) and 90° ( P < .005). Cutting both the meniscocapsular and meniscotibial attachments increased tibial internal (all P > .004) and external (all P < .001) rotation at all flexion angles in ACL-reconstructed knees. Reconstruction of the ACL in the presence of meniscocapsular and meniscotibial tears restored anterior tibial translation ( P > .053) but did not restore internal rotation ( P < .002), external rotation ( P < .002), and the pivot shift ( P < .05). To restore the pivot shift, an ACLR and a concurrent repair of the meniscocapsular and meniscotibial lesions were both necessary. Repairing the meniscocapsular and meniscotibial lesions after ACLR did not restore internal rotation and external rotation at angles >30°. Conclusion: Meniscocapsular and meniscotibial lesions of the posterior horn of the medial meniscus increased knee anterior tibial translation, internal and external rotation, and the pivot shift in ACL-deficient knees. The pivot shift was not restored with an isolated ACLR but was restored when performed concomitantly with a meniscocapsular and meniscotibial repair. However, the effect of this change was minimal; although statistical significance was found, the overall clinical significance remains unclear. The ramp lesion repair used in this study failed to restore internal rotation and external rotation at higher knee flexion angles. Further studies should examine improved meniscus repair techniques for root tears combined with ACLRs. Clinical Relevance: Meniscal ramp lesions should be repaired at the time of ACLR to avoid continued knee instability (anterior tibial translation) and to eliminate the pivot-shift phenomenon.

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