Arthroscopic side-to-side repair for complete radial posterior lateral meniscus root tears

Objectives: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. The anterior and posterior meniscus roots anchor the meniscus to bone. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and progressive degenerative articular wear. As a result of these deleterious effects, there has been increasing emphasis on repair of meniscus root injuries to restore structure and function. The purpose of this study is to describe meniscus root tears, associated injuries, and minimum 2-year treatment outcomes in a series of pediatric patients. Methods: A single-institution, IRB approved, retrospective review was performed of consecutive pediatric patients less than 19 years of age with a meniscus root tear treated with transosseous root repair over a 4-year period. All patients had minimum 24-month clinical follow-up. Partial root tears treated with partial meniscectomy or irreparable root tears were excluded. All meniscus root tears were classified arthroscopically based on the tear types described by LaPradeADDIN EN.CITE 9. The primary outcomes were revision meniscus surgery and patient reported outcome scores (PROs) (Lysholm, Patient Satisfaction, and Tegner activity). Results: Twenty-one patients, 11 males and 10 females with a mean age of 15 years (range 7 – 18 years), met inclusion criteria. There were 15 lateral meniscus root tears and 6 medial meniscus root tears. The tears occurred in the posterior root in 20 patients (95%). The most common injury pattern was a lateral meniscus posterior root tear (14 patients, 67%). 18 patients (86%) had an associated ligament tear: 13 ACL tears and 5 PCL tears. Two root tears occurred in isolation, and both were the posterior root of the medial meniscus. The majority of meniscus root tears (15 patients, 71%) were root avulsions (type 5). Mean follow-up was 42 months (range 25 – 71 months). Three patients had a second surgery on the affected knee. In two patients, one with revision ACL reconstruction and one treated with chondroplasty of the patella, the meniscus root repair was noted to be well healed. A third patient sustained a new injury to the knee 4 years following medial meniscus posterior root repair and underwent partial medial meniscectomy. At final follow-up, PROs were obtained for 17 patients (81%). Mean Lysholm score was 91 (range 51 – 100). Mean patient satisfaction score was 8.7 (range 5 – 10). Fourteen of 16 patients (88%) reported returning to the same or higher level of activity following surgery. Conclusions: Meniscus root tears occur in pediatric patients, most commonly as root avulsions of the posterior root of the lateral meniscus and in association with ACL tears. This is unique as compared to the adult population, in which the medial meniscus posterior root is often injured in isolation and radial tears adjacent the root are the most commonly described injury pattern. In our case series, transosseous root repair resulted in successful outcomes in the majority of patients with durable results at midterm follow-up.

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Arthroscopic Lateral Meniscus Root Repair With Soft Suture Anchor Technique

Arthroscopy Techniques ◽

10.1016/j.eats.2013.07.008 ◽

2013 ◽

Vol 2 (4) ◽

pp. e479-e482 ◽

Cited By ~ 4

Author(s):

Niti Prasathaporn ◽

Somsak Kuptniratsaikul ◽

Kitiphong Kongrukgreatiyos

Keyword(s):

Suture Anchor ◽

Lateral Meniscus ◽

Meniscus Root ◽

Root Repair ◽

Meniscus Root Repair

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Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-3280-2 ◽

2014 ◽

Vol 23 (1) ◽

pp. 140-145 ◽

Cited By ~ 30

Author(s):

Matthias J. Feucht ◽

Sebastian Bigdon ◽

Julian Mehl ◽

Gerrit Bode ◽

Catharina Müller-Lantzsch ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Lateral Meniscus ◽

Ligament Injuries ◽

Anterior Cruciate Ligament Injuries ◽

Meniscus Root ◽

Anterior Cruciate

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Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-3467-6 ◽

2014 ◽

Vol 23 (1) ◽

pp. 112-118 ◽

Cited By ~ 49

Author(s):

Philipp Forkel ◽

Sven Reuter ◽

Frederike Sprenker ◽

Andrea Achtnich ◽

Elmar Herbst ◽

...

Keyword(s):

Classification System ◽

Lateral Meniscus ◽

Acl Injuries ◽

Meniscus Root

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Transosseous Repair of Root Tears of the Lateral Meniscus: Operative Technique and Short-Term Clinical Follow-Up of 28 Patients

Advances in Orthopedic Surgery ◽

10.1155/2017/6514654 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Arne Driessen ◽

Maurice Balke ◽

William James White ◽

Markus Fink ◽

Marcel Betsch ◽

...

Keyword(s):

Cruciate Ligament ◽

Lateral Meniscus ◽

International Knee Documentation Committee ◽

Short Term ◽

Meniscus Root ◽

Transosseous Repair ◽

Anterior Cruciate ◽

Semitendinosus Graft ◽

Repair Group

An avulsion of the posterior tibial insertion of the lateral meniscus occurs during rotational distortion of the knee and can be associated with a tear of the anterior cruciate ligament (ACL). We performed a follow-up of 28 patients who, following anatomical ACL reconstruction using the ipsilateral semitendinosus graft, underwent either transosseous repair of the posterior lateral meniscus root (n=14) or no intervention (n=14). The meniscus root tears were classified as Forkel I lesions. All patients were examined 6 months after surgery and undertook scoring using International Knee Documentation Committee Score (IKDC). Comparing the repair group with the no repair group the subjective IKDC 6 months after surgery was 75,72% (±1,019) and 75,56 (±1,058). Regarding the objective IKDC 8 × A (57,1%) and 6 × B (42,9%) could be ascertained in the repair group whereas 6 × A (42,9%), 6 × B (42,9%), and 2 × C (14,3%) scoring could be ascertained in the no repair group. It remains unclear if surgery on type Forkel I PLMRT provides benefits compared to the nonsurgical procedures as in both groups stability might occur. The purpose of this article was to report the outcome of surgical repair of lateral meniscus root tears.

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A Surgical Algorithm According to Pivot-Shift Grade in Patients With ACL Injury: A Prospective Clinical and Radiological Evaluation

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211025494 ◽

2021 ◽

Vol 9 (8) ◽

pp. 232596712110254

Author(s):

Ramazan Akmese ◽

Sancar Alp Ovali ◽

Mehmet Mesut Celebi ◽

Batu Malatyali ◽

Hakan Kocaoglu

Keyword(s):

Pivot Shift ◽

Root Function ◽

Lateral Meniscus ◽

Meniscal Repair ◽

Anterolateral Ligament ◽

Rotational Instability ◽

Meniscus Root ◽

The Mean ◽

Grade 3

Background: Some patients have a positive pivot-shift finding and rotational instability after anterior cruciate ligament (ACL) reconstruction (ACLR). Three major pathologies known to affect the pivot-shift examination include ACL tear, anterolateral ligament injury, and loss of posterior lateral meniscus root function. Purpose: To describe a surgical algorithm determining indications for lateral extra-articular tenodesis (LET) based on intraoperative pivot-shift examination to prevent postoperative pivot shift and rotational instability and to evaluate the 2-year clinical and functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: The study included 47 consecutive patients (39 men and 8 women) who underwent operative treatment for ACL injury between 2016 and 2017. Pivot-shift examination was performed under anesthesia, and the pivot shift was graded as grade 1 (glide), grade 2 (clunk), or grade 3 (gross). According to the surgical algorithm, single-bundle ACLR was performed in patients with grade 1 pivot shift. In patients with grade 2 with loss of posterior lateral meniscus root function, concurrent lateral meniscal repair was performed, and in patients with grade 2 with an intact lateral meniscus posterior root, concurrent extra-articular iliotibial band tenodesis was performed. Patients with grade 3 underwent ACLR, lateral meniscal repair, and LET. Clinical and radiographic evaluations were performed. Results: The mean age was 27.2 years (range, 16-56 years). In total, 26 (55.3%) patients were evaluated as having pivot-shift grade 1; 16 (34%) patients, grade 2; and 5 (10.6%) patients, grade 3. A total of 7 (14.9%) patients underwent LET in addition to ACLR. Two of these patients had pivot-shift grade 2, and LET was performed since the lateral meniscus posterior root was intact. In 14 of 16 patients with grade 2, lateral meniscus root disruption was detected, and lateral meniscal repair was performed. One patient was excluded from the further follow-up because of graft failure. At a mean postoperative follow-up of 29 months in 46 patients, the pivot-shift examination was negative in all patients. The mean Lysholm and International Knee Documentation Committee subjective scores were 95.35 ± 4.40 and 82.87 ± 9.36, respectively. Radiographic evidence of osteoarthritis was not detected. Conclusion: Only 14.9% of patients needed LET. With proper ACL, lateral meniscal, and anterolateral ligament surgery, it was possible to prevent positive pivot-shift findings postoperatively.

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Anatomic all-epiphysial tibial tunnels for anterior cruciate ligament reconstruction in skeletally immature knees may be placed without damaging the anterior meniscus root

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000177 ◽

2018 ◽

Vol 3 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Kevin G Shea ◽

Peter C Cannamela ◽

Peter D Fabricant ◽

Allen F Anderson ◽

John D Polousky ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Lateral Meniscus ◽

Spatial Relationship ◽

Anterior Horn ◽

Joint Surface ◽

Skeletally Immature ◽

Meniscus Root ◽

Anterior Cruciate

ObjectivesThe purpose of this study was to evaluate the spatial relationship of the anterior horns of the menisci and the tibial tunnel during all-epiphysial drilling of skeletally immature specimens and identify any iatrogenic damage or destabilisation to the meniscus and meniscal root.MethodsFour skeletally immature cadaveric knee specimens (aged 9–11 years) were used to create three-dimensional models from CT images. All-epiphysial anterior cruciate ligament (ACL) tibial tunnel drilling was performed in 14 specimens (aged 7–11 years), entering the joint surface at the ACL footprint and avoided the proximal tibial physis. The anterior meniscal roots and horns were closely inspected visually and probed for stability, prior to drilling. After drilling, the meniscus and attachment points were re-evaluated for damage to the meniscus, meniscus root and probed to evaluate for destabilisation.ResultsAll-epiphysial tunnels entered the joint at the anatomic ACL tibial footprint. Direct visual inspection of the menisci demonstrated an absence of damage to either meniscus or anterior horn regions in all specimens. Probing and traction of the medial and lateral meniscal tissue did not demonstrate evidence of instability or destabilisation of the anterior horn or meniscus root before or after drilling. All tunnels were circumferentially intact at the joint surface, with no evidence of superior tunnel perforation due to shallow tunnel angle.ConclusionIn this study, tunnel placement did not produce damage to either meniscus, nor noticeably destabilise the meniscal roots. This study also demonstrated that drill holes can be placed within the ACL footprint without entering the joint on the proximal tibia surface anterior to the ACL attachment, although the ‘safe zone’ for drill hole placement is limited. All-epiphysial ACL tibial tunnels can create a large aperture at the tibial joint surface, but these tunnels can be placed at the anatomic footprint of the ACL, without causing gross anterior medial or lateral meniscus horn or root injury.

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MENISCUS ROOT TEARS IN CHILDREN AND ADOLESCENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00032 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0003

Author(s):

S. Clifton Willimon ◽

Melissa Christino ◽

Michael Busch ◽

Crystal Perkins

Keyword(s):

Pediatric Patients ◽

Medial Meniscus ◽

Lateral Meniscus ◽

Posterior Root ◽

Associated Injuries ◽

Inclusion Criteria ◽

Root Tear ◽

Meniscus Root ◽

Meniscus Root Tear

Background: The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and degenerative articular wear. The purpose of this study is to describe meniscus root tears, associated injuries, and treatment in a series of pediatric patients Methods: A single-institution retrospective review was performed of consecutive pediatric patients treated for meniscus root tears from 2013 – 2017. Inclusion criteria were patients less than 19 years of age, arthroscopic evidence of a meniscus root tear, and minimum 6 months clinical follow-up. The primary outcome was surgery for revision of the meniscus repair. Results: Twenty-seven patients were identified to fit inclusion criteria. There were 15 males and 12 females with a mean age of 15.2 years (range 7 – 18 years). Basketball, soccer, and football accounted for the majority (56%) of injuries. The lateral meniscus was involved in 21 patients (78%) and the medial meniscus in 6 patients (22%). The posterior meniscus root was torn in 25 patients (93%) and anterior meniscus root in 2 patients (7%). The most common injury pattern was a lateral meniscus posterior root tear (19 patients, 70%). Associated injuries included an ACL tear (19 patients, 70%), PCL tear (6 patients, 22%), and a tear of the opposite meniscus (7 patients, 26%). Two root tears occurred in isolation, and both were of the posterior root of the medial meniscus. All patients were treated surgically with an arthroscopic transosseous root repair in addition to simultaneous treatment for their associated injuries. Mean follow-up was 14 months (range 6 – 37 months). No patients required additional surgery for their meniscus root tear. Two patients had a second surgery on the affected knee: one for revision ACL reconstruction 2 years following the primary procedure and the other for chondroplasty of the patella 2.5 years following the primary procedure. Conclusions: Meniscus root tears occur in pediatric and adolescent patients, most commonly affecting the posterior root of the lateral meniscus and occurring in association with ACL tears. The adolescent meniscus root injury pattern is unique compared to the adult population in which the medial meniscus posterior root is often injured in isolation. Inspection of the meniscus root attachments with deliberate probing to assess the meniscus roots should be a routine part of every knee arthroscopy. In our case series, transosseous root repair resulted in successful outcomes in all patients without need for any additional meniscus treatment.

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