Arthroscopic Transtibial Repair of Acute Traumatic Posterior Medial Meniscus Root Tear

Abstract

Background: The posteromedial meniscal root is a critical structure in maintaining balanced tibiofemoral contact stresses and joint stability. Studies have shown that posterior root tears are biomechanically equivalent to total meniscectomy and can lead to the rapid development of osteoarthritis. Our presentation focuses on the less common, acute, traumatic posteromedial meniscal root avulsion, although our technique is also applicable to the more common degenerative posteromedial meniscal root tears. Indications: Surgical indications include acute tears, as well as chronic or degenerative tears in patients without advanced osteoarthritis. Absolute surgical contraindications include subchondral bone collapse, substantial concurrent meniscal pathology, malalignment of >5°, and advanced knee osteoarthritis. Technique Description: Once the tear is identified, the bone at the root insertion is prepared with a meniscal rasp. Two looped sutures are passed through the meniscal root in a cinch-type fashion using a knee scorpion. A tunnel is drilled at the root insertion using a specialized meniscal root repair guide. Approximately, 10 mm of bone are drilled in a retrograde fashion with a flip cutter deployed to 7 mm to decorticate the bone and enhance healing. The drill is then removed and a rubber tube with a retrieval suture is advanced through the drill guide into the joint. The loop suture is retrieved through the anteromedial portal and the repair sutures are passed through the retrieval loop. Under arthroscopic visualization, the root is then reduced to its anatomic insertion and the sutures secured to the tibia using a knotless suture anchor placed 1 cm distal to the transtibial tunnel. Results: Several recent studies have shown that meniscal root repair decreases rapid knee degeneration as gauged by meniscal extrusion, progression of Kellgren-Lawrence grade and rate of conversion to total knee arthroplasty (TKA). Discussion/Conclusion: Posteromedial meniscal root tears are increasingly being recognized as a distinct meniscal pathology that can lead to rapid arthritis if left unrepaired. Arthroscopic repair techniques continue to improve allowing orthopedic surgeons to more readily address this significant, but treatable pathology. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.