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Meniscal Root Tear Repair: Why, When and How?

Bonasia DE, Pellegrino P, D'Amelio A, Cottino U, Rossi R - Orthop Rev (Pavia) (2015)

Bottom Line: Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair.The goal of this review is to summarize the existing knowledge regarding meniscal root tears, including anatomy, biomechanics and imaging.In addition, the most common surgical techniques, together with the clinical outcomes, are described.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, CTO Hospital, University of Turin , Italy.

ABSTRACT
The integrity of the meniscal root insertions is fundamental to preserve correct knee kinematics and avoid degenerative changes of the knee. Injuries to the meniscal attachments can lead to meniscal extrusion, decreased contact surface, increased cartilage stress, and ultimately articular degeneration. Recent and well designed studies have clarified the anatomy and biomechanics of the medial and lateral meniscal roots. Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair. The goal of this review is to summarize the existing knowledge regarding meniscal root tears, including anatomy, biomechanics and imaging. In addition, the most common surgical techniques, together with the clinical outcomes, are described.

No MeSH data available.


Related in: MedlinePlus

Lateral meniscus posterior root repair (pull-out technique). A) Complete detachment of the lateral meniscus posterior root (above the probe). B,C) Armature of the posterior root with a spinal needle and a non-braided shuttle suture. D) After substitution of the shuttle suture with a non resorbable n°2 braided suture, the procedure is repeated in order to have 2 stitches arming the root. Suture. E) Anterior cruciate ligament giude used to drill a 2-mm tummel at the level of the lateral meniscus posterior horn attachment. F) The sutures are retrieved through the tunnel from the anterior tibia, with a Huson suture passer, and fixed with a pull-out button.
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fig005: Lateral meniscus posterior root repair (pull-out technique). A) Complete detachment of the lateral meniscus posterior root (above the probe). B,C) Armature of the posterior root with a spinal needle and a non-braided shuttle suture. D) After substitution of the shuttle suture with a non resorbable n°2 braided suture, the procedure is repeated in order to have 2 stitches arming the root. Suture. E) Anterior cruciate ligament giude used to drill a 2-mm tummel at the level of the lateral meniscus posterior horn attachment. F) The sutures are retrieved through the tunnel from the anterior tibia, with a Huson suture passer, and fixed with a pull-out button.

Mentions: The pull-out technique (Figure 4A and 5) is generally indicated when the root is avulsed from the tibial insertion and no multiligamentous reconstruction (with multiple tibial tunnels) is planned. With this technique, 1 or 2 small tunnels (2 mm) are drilled with an ACL guide at the level of the avulsed meniscal root. A curved suture passer is generally used to arm the meniscal root with 2 n°0 non absorbable sutures. The sutures are then retrieved through the tunnels from the anteromedial tibia. In case of LMPRT combined with ACL tear, the pull-out tunnel can be drilled from the anterolateral tibia, in order to avoid interference with the ACL tibial tunnel. The sutures are then tightened distally with different fixation options, including pull-out buttons,49 screws,50 or bone bridges.51 In case of inadequate visualization, additional posteromedial or posterolateral portals can be performed.52


Meniscal Root Tear Repair: Why, When and How?

Bonasia DE, Pellegrino P, D'Amelio A, Cottino U, Rossi R - Orthop Rev (Pavia) (2015)

Lateral meniscus posterior root repair (pull-out technique). A) Complete detachment of the lateral meniscus posterior root (above the probe). B,C) Armature of the posterior root with a spinal needle and a non-braided shuttle suture. D) After substitution of the shuttle suture with a non resorbable n°2 braided suture, the procedure is repeated in order to have 2 stitches arming the root. Suture. E) Anterior cruciate ligament giude used to drill a 2-mm tummel at the level of the lateral meniscus posterior horn attachment. F) The sutures are retrieved through the tunnel from the anterior tibia, with a Huson suture passer, and fixed with a pull-out button.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508558&req=5

fig005: Lateral meniscus posterior root repair (pull-out technique). A) Complete detachment of the lateral meniscus posterior root (above the probe). B,C) Armature of the posterior root with a spinal needle and a non-braided shuttle suture. D) After substitution of the shuttle suture with a non resorbable n°2 braided suture, the procedure is repeated in order to have 2 stitches arming the root. Suture. E) Anterior cruciate ligament giude used to drill a 2-mm tummel at the level of the lateral meniscus posterior horn attachment. F) The sutures are retrieved through the tunnel from the anterior tibia, with a Huson suture passer, and fixed with a pull-out button.
Mentions: The pull-out technique (Figure 4A and 5) is generally indicated when the root is avulsed from the tibial insertion and no multiligamentous reconstruction (with multiple tibial tunnels) is planned. With this technique, 1 or 2 small tunnels (2 mm) are drilled with an ACL guide at the level of the avulsed meniscal root. A curved suture passer is generally used to arm the meniscal root with 2 n°0 non absorbable sutures. The sutures are then retrieved through the tunnels from the anteromedial tibia. In case of LMPRT combined with ACL tear, the pull-out tunnel can be drilled from the anterolateral tibia, in order to avoid interference with the ACL tibial tunnel. The sutures are then tightened distally with different fixation options, including pull-out buttons,49 screws,50 or bone bridges.51 In case of inadequate visualization, additional posteromedial or posterolateral portals can be performed.52

Bottom Line: Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair.The goal of this review is to summarize the existing knowledge regarding meniscal root tears, including anatomy, biomechanics and imaging.In addition, the most common surgical techniques, together with the clinical outcomes, are described.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, CTO Hospital, University of Turin , Italy.

ABSTRACT
The integrity of the meniscal root insertions is fundamental to preserve correct knee kinematics and avoid degenerative changes of the knee. Injuries to the meniscal attachments can lead to meniscal extrusion, decreased contact surface, increased cartilage stress, and ultimately articular degeneration. Recent and well designed studies have clarified the anatomy and biomechanics of the medial and lateral meniscal roots. Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair. The goal of this review is to summarize the existing knowledge regarding meniscal root tears, including anatomy, biomechanics and imaging. In addition, the most common surgical techniques, together with the clinical outcomes, are described.

No MeSH data available.


Related in: MedlinePlus