Distal Fixation of Meniscal Root Repair by Transtibial Pullout Technique via Transtibial Tubercle Fixation Without Hardware

Abstract

The meniscal roots are critical in maintaining the normal shock-absorbing function of the meniscus. If a meniscal root tear is left untreated, meniscal extrusion can occur, rendering the meniscus nonfunctional, resulting in degenerative arthritis. Preservation of meniscal tissue with restoration of meniscal continuity is becoming the standard for meniscal root pathology. Not all patients are candidates for root repair; however, repair is indicated in active patients after acute or chronic injury with no significant osteoarthritis and malalignment. Two main repair techniques have been described: suture anchor (direct fixation) and transtibial pullout (indirect fixation). The most common root repair technique is a transtibial technique. In this technique, sutures are placed into the torn meniscal root and then shuttled down through the tunnel in the tibia to tie the repair distally. The option adopted in our technique is to fix the meniscal root distally by wrapping threads of FiberTape (Arthrex) around the tibial tubercle through a transverse tunnel posterior to the tibial tubercle with buried knots inside the transverse tunnel without the use of metal buttons or anchors. This technique provides secure tension for repair without loosening of knots and tension that occur when using metal buttons and avoiding irritation caused by metal buttons and knots in patients.