Minimum 1 Year Results of Arthroscopic Pull-out Repair for Posterior Root Tear of Medial Meniscus

Chul-hyung Lee; In-soo Song; Hyun-yoon Jeong; Chang-soo Lee; Bong-ju Lee

doi:10.5763/kjsm.2011.29.1.1

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Lee, Song, Jeong, Lee, and Lee: Minimum 1 Year Results of Arthroscopic Pull-out Repair for Posterior Root Tear of Medial Meniscus

Clinical Article

Korean J Sports Med 2011;29(1):1-8.

Published online: 20 January 2011

DOI: https://doi.org/10.5763/kjsm.2011.29.1.1

Minimum 1 Year Results of Arthroscopic Pull-out Repair for Posterior Root Tear of Medial Meniscus

Chul-hyung Lee, MD, In-soo Song, MD, Hyun-yoon Jeong, MD, Chang-soo Lee, MD, Bong-ju Lee, MD

Department of Orthopaedic Surgery, Daejeon Sun General Hospital, Daejeon, Korea

Received 28 July 2010 Revised 1 September 2010 Accepted 22 November 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study is to evaluate clinical and arthroscopic second-look results of arthroscopic repairs of posterior root tears of medial meniscus which may cause loss of circumferential hoop tension and extrusion of meniscus. From October 2006 to May 2009, fifty-eight patients (59 knees) underwent arthroscopic pull-out repairs. Clinical results were evaluated using Hospital for Special Surgery (HSS) score and International Knee Documentation Committee (IKDC) score for 12-month follow-up. Second-look arthroscopy was done to evaluate meniscal healing in 21 cases. Magnetic resonance imaging (MRI) was performed to assess status of repaired meniscus and tibial tunnel position in 9 patients. Average preoperative HSS score and IKDC score of 59 cases were 69.5 and 36.0, respectively. Average postoperative HSS score and IKDC score of 59 cases had been changed into 90.3 (p＜0.001) and 66.8 (p＜0.001), respectively. Second-look arthroscopies revealed complete or incomplete healing except one case. Two patients showed increased one grade according to the Kellgren-Lawrence radiologic classification system and others showed no change. Of 9 patients who performed MRI, six patients showed complete healing. The average position of tibial tunnel was 4.8 mm anterior and 5.7 mm medial to center of posterior cruciate ligament. Arthroscopic pull-out repair technique using transtibial tunnel seems to be simple and effective procedure for posterior root tear of medial meniscus. Further evaluation of arthroscopic repair of posterior root tear of medial meniscus should be needed to prove the effectiveness on the prevention of osteoarthritis of knee.

Keywords: Medial meniscus, Posterior root tear, Pull-out repair

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Fig. 1.

Theses MRI findings demonstrated root tears of posterior horn of the medial meniscus on sagittal (ghost sign), coronal (cleft sign), and axial (cleavage sign, white arrow) section.

Fig. 2.

(A) Polydioxanone No. 1 was advanced through the suture hook that penetrated the torn edge of the posterior horn of medial meniscus from supe-rior to inferior and changed to Ethibond No. 2 using shuttle relay technique. (B) Arthrosco-pic finding showed posterior horn of medial meniscus on the tibial foot print was well-re-attached.

Fig. 3.

The transosseous tibial tunnel was drilled from the anterolateral cortex of the proximal tibia to the insertion site of the posterior horn of medial meniscus using the anterior cruciate ligament tibial drilling guide.

Fig. 4.

All Ethibonds were brought out the tibial tunnel using advanced wire loop.

Fig. 5.

Arthroscopy showed root of posterior horn of the me-niscus was reduced and well- reattached to the tibial insertion site.

Fig. 6.

Postoperative 6-month second-look arthroscopy re-vealed tear site was healed and reattached to the foot print of posterior horn of medial menis-cus.

Fig. 7.

(A) Postoperative MRI demonstrated intermediate signal density of healed meniscus tissue on foot print of posterior root of medial meniscus in coronal section (black arrow) and sagittal section (white arrow). (B) Second-look arthroscopy showed healing failure of medial meniscus and postoperative MRI demonstrated remained cleft sign on coronal section.

Fig. 8.

Postoperative MRI showed entry point of transosseous tibial tunnel was located 4.8 mm anteriorly and 5.7 mm medially to center of posterior cruciate ligament insertion site. (A) axial section, (B) sagittal section, and (C) coronal section.

Fig. 9.

Typical degenerative chondral lesion of medial femoral condyle due to root tear of posterior horn of me-dial meniscus showed irregular and moth-eaten appear-ance.

Table 1.

Preoperative and final follow-up scores of HSS

	HSS score	IKDC score
Preoperative	69.5 (11–91)	36.0 (4–72)
Final follow-up	90.3 (7–100)	66.8 (12–92)

HSS: Hospital for Special Surgery, IKDC: International Knee Documentation Committee.

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