scholarly journals Meniscal Root Repair

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110445
Author(s):  
John R. Matthews ◽  
Ryan W. Paul ◽  
Sommer Hammoud
Keyword(s):  
Knee Injury ◽  
Gap Formation ◽  
Axial Loads ◽  
Highly Active ◽  
Meniscal Root ◽  
Root Repair ◽  
Complete Tear ◽  
Meniscal Root Tear ◽  
Hoop Stresses ◽  
Tibia Plateau

Background: Meniscal root tears typically result from a hyperflexion/squatting injury or are in conjunction with ligamentous knee injury. Once a complete tear occurs, the meniscus is unable to convert axial loads to transverse hoop stresses which result in increased tibiofemoral contact pressure and osteoarthritis. The goal of a meniscal root repair is to anatomically reattach the meniscal root to the tibia plateau. Complete and partial healing occurs in over 93% of cases with retear rates ranging from 0% to 7%. Indications: We present a case of a highly active 21-year-old male collegiate soccer play that sustained a medial meniscal root tear after slipping on ice. Technique: An anatomic medial meniscal root repair was performed using a transtibial guide and 2 loop sutures tied over a button. Results: Full anatomic footprint coverage was able to be achieved intraoperatively and gentle range of motion from 0 to 90° of flexion did not result in gap formation. Discussion/Conclusion: Successful outcomes with full anatomic footprint coverage of the medial meniscal root can be achieved with 2-loop suture button configuration.

scholarly journals Arthroscopic Medial Meniscus Root Repair With Transtibial Ripstop Technique

2021 ◽  
Vol 1 (6) ◽  
pp. 263502542110336
Author(s):  
Navya Dandu ◽  
Steven F. DeFroda ◽  
Nicholas A. Trasolini ◽  
Reem Y. Darwish ◽  
Adam B. Yanke
Keyword(s):  
Meniscal Repair ◽  
Rapid Progression ◽  
Root Tear ◽  
Full Extension ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pull Out ◽  
Meniscal Root ◽  
Root Repair ◽  
Meniscal Root Tear

Background: Meniscal root tears are radial tears occurring at or within 1 cm of the meniscal root attachment. These injuries have been shown to be the biomechanical equivalent of a total meniscectomy and are thought to be responsible for a rapid progression of osteoarthritis if left untreated. Indications: Meniscal root repair is indicated if possible, with the exception of patients who have diffuse Outerbridge 3-4 osteoarthritis of the ipsilateral compartment, those who are poor surgical candidates due to age or medical comorbidity, or in whom nonsymptomatic tears are found incidentally. Technique Description: Standard 2-portal arthroscopy is performed. Once a medial root tear has been identified and concomitant pathology has been addressed, we typically begin the repair by trephinating the deep medial collateral ligament with an 18-gauge needle to enhance visualization and avoid iatrogenic cartilage injury. Arthroscopic shaver is used to debride the meniscal root as needed. A meniscal root guide is introduced into the joint and an incision is made on the anteromedial tibia for outside-in drilling of a transosseous tunnel. Drilling is performed with a 5-mm retroreaming device, and a 10-mm socket is created. Nonabsorbable suture is then passed through the meniscus using a self-capture device in an inverted mattress configuration, following by 2 cinch stitches. The sutures are then shuttled into the transosseous tunnel, and the meniscal root is reduced and tensioned in full extension, with the sutures being fixated into a suture anchor on the anteromedial tibia. Results: A recent large systematic review of 1086 patients undergoing treatment of meniscal root tear via either debridement or nonoperative management compared with meniscal repair found that conversion to total knee arthroplasty occurred in 11% to 54% of those managed via debridement or nonoperative care versus 0% to 1% for those with root repair. Discussion/Conclusion: Currently, meniscal root repair offers the greatest improvement and lowest risk of conversion to arthroplasty following meniscal root tear. The present technique offers a durable repair that we believe combines ease of execution with decreased risk of suture pull-out, by creating a ripstop-type construct. Long-term outcome studies are needed for this and other root repair techniques.

Loosening of Posteromedial Meniscal Root Repairs Affects Knee Mechanics: A Finite Element Study

2021 ◽  
Author(s):  
Brett Steineman ◽  
Robert LaPrade ◽  
Tammy Haut Donahue
Keyword(s):  
Finite Element ◽  
Mechanical Response ◽  
Compressive Force ◽  
Initial Position ◽  
Meniscal Root ◽  
Knee Mechanics ◽  
Root Repair ◽  
Intact Condition ◽  
Hoop Stresses ◽  
Better Than

Abstract Meniscal root repairs are susceptible to unrecoverable loosening that may displace the meniscus from the initial position reduced during surgery. Despite this, the effects of a loosened meniscal root repair on knee mechanics are unknown. We hypothesized that anatomic root repairs without loosening would restore knee mechanics to the intact condition better than loosened anatomic root repairs, but that loosened repairs would restore mechanics better than untreated meniscal root tears. Finite element knee models were used to evaluate changes in cartilage and meniscus mechanics due to repair loosening. The mechanical response from loosened anatomic root repairs was compared to anatomic repairs without loosening and untreated root tears. All conditions were evaluated at three flexion angles, 0°, 30°, and 60°, and a compressive force of 1,000 N to simulate return-to-activity loading. The two-simple-suture method was represented within the models to simulate posteromedial meniscal root repairs and repair loosening was derived from previous biomechanical experimental data. Loosening decreased hoop stresses throughout the meniscus, increased posterior extrusion, and shifted loading through the meniscus-cartilage region to the cartilage-cartilage region compared to the anatomic root repair without loosening. Despite differences between repairs and loosened repairs, the changes from loosened repairs more closely resembled the anatomic repair without loosening than the untreated root repair condition. Therefore, root repairs are susceptible to loosening that will prevent a successful initial repair from remaining in the intended position and will alter mechanics, although repairs that loosen appear better than leaving tears untreated.

Meniscal Root Repair

2020 ◽  
pp. 91-111
Author(s):  
Michael Alaia ◽  
David Klein
Keyword(s):  
Meniscal Root ◽  
Root Repair

scholarly journals Meniscus Root Repair

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0046
Author(s):  
Jafri Hasan
Keyword(s):  
Hoop Stress ◽  
Suture Anchor ◽  
Symptomatic Treatment ◽  
Normal Function ◽  
Suture Technique ◽  
High Rate ◽  
Meniscal Root ◽  
Root Repair ◽  
Meniscus Suture ◽  
Pullout Repair

Meniscal root tears defined as bony or soft tissue root avulsion injuries or radial tears within 1cm of the meniscal root attachment. If it is not treated properly can cause early development of osteoarthritis. The meniscal root tears leading to compromised hoop stress and decreased tibiofemoral contact area and increased contact pressures in the involved compartment. To confirm the diagnosis is through arthroscopic as a diagnostic and treatment and through magnetic resonance imaging. Not all meniscal root tears can be treated surgically, especially if they have multiple comorbidities or advanced age, severe osteoarthritis, non-symptomatic chronic meniscal root tears and significant mal-alignment of the affected compartment then the treatment of choice is to give a symptomatic treatment like non-steroid anti-inflammatory drug, and activity modification. Meniscectomy has been found to induce a high rate of arthritis progression postoperatively. There are two most common meniscal root repair techniques which are trans-tibial pullout repair and suture anchor repair that now preferred over meniscectomy. The most important thing to consider when repairing the meniscal root is the right anatomically repair. It has been proven that non-anatomical meniscal root repair will not able to restore to the normal function because the conversion of femorotibial loads into circumferential tension may be altered, with functional impairment of the knee. Anchor suture technique shows a greater degree of healing and better biomechanical outcome. The suture anchor technique uses “all-inside" fixation and avoids the need for a distal fixation which potentially places abrasive forces on the sutures used. The trans-tibial pullout repair can restore the attachment and contact pressure near normal value, also the tunnel drilling stimulating growth factors and progenitor cells from bone marrow and facilitate the ability of meniscus to convert axial load into hoop stress. The concern of trans-tibial pullout repair is its ‘bungee effect’ and repetitive loading resulted in the displacement of this repair complex and might compromise healing because of decreased stiffness and micromotion of the meniscus-suture complex.

Biomechanical evaluation of meniscal root repair: a porcine study

2013 ◽  
Vol 23 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Ekkehard F. Röpke ◽  
Sebastian Kopf ◽  
Steffen Drange ◽  
Roland Becker ◽  
Christoph H. Lohmann ◽  
...  
Keyword(s):  
Meniscal Root ◽  
Root Repair ◽  
Biomechanical Evaluation

scholarly journals Meniscal Root Tear: A Missed Epidemic?

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0046
Author(s):  
Nadia Nastassia Ifran
Keyword(s):  
Physical Examination ◽  
Shock Absorber ◽  
Lateral Meniscus ◽  
Meniscal Tears ◽  
Root Tear ◽  
Injury Patterns ◽  
Radiological Findings ◽  
Meniscal Root ◽  
Meniscus Tears ◽  
Meniscal Root Tear

Meniscal root tears often go unnoticed and represent unique injury patterns with unique biomechanical consequences. Meniscal root tear occurs about 10-21% of all meniscal tears. Almost 10% of ACL tears involving posterior lateral meniscus tears. Meniscal root tears interrupt the continuity of the circumferential fibers, hence meniscus will fail to function as a shock absorber and load distributor. The biomechanical implication is the accelerated degeneration of the joint comparable to total meniscectomy. Repair of meniscal root tear will reduce contact pressure and increase contact area biomechanically similar to the uninjured meniscus. However, the repair must be done as anatomic as possible. Otherwise, the goal of restoring the meniscus function may not be achieved. Sign and symptoms, physical examination and radiological findings that may suggest a meniscal root tear will be discussed in this paper. Moreover, an overview of the management will also be described.

Clinical and Radiologic Outcomes of Patients With Lax Healing After Medial Meniscal Root Repair: Comparison With Subtotal Meniscectomy

2019 ◽  
Vol 35 (11) ◽  
pp. 3079-3086 ◽  
Author(s):  
Chang-Wan Kim ◽  
Chang-Rack Lee ◽  
Heui-Chul Gwak ◽  
Jung-Han Kim ◽  
Dae-Hyun Park ◽  
...  
Keyword(s):  
Meniscal Root ◽  
Root Repair
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