Hidden Lesions and Root Tears

Abstract

Up to two thirds of patients with anterior cruciate ligament (ACL) rupture have combined medial meniscus posterior horn (MMPH) tears [20, 22, 33, 42]. Repairing this torn meniscus anatomically allows the reconstructed ACL knee to be more stable than those with a meniscectomy [1, 4, 31]. However, many surgeons overlook this combined tear because of its concealing location and benign-looking appearance from the anterior portals [41]. Previous studies have shown that magnetic resonance imaging (MRI) has a sensitivity of only 69–89 % for detecting meniscal tears in patients with acute or chronic ACL tears [10, 38, 39]. The development of all-inside meniscus repair devices has been a turning point in the advance of arthroscopic technique due to simplicity of implant insertion and the reduction in surgery time [23, 27, 28]. Although these devices are easy to use, there have been several complications reported with their use. The all-inside suture for peripheral longitudinal tear of MMPH using a posteromedial (PM) portal is a very efficient and safe technique that provides anatomic coaptation of the torn meniscal fragment, an easy placement of vertically oriented suture, and a strong fixation while minimizing the risk of neurovascular or chondral injuries. We previously reported an arthroscopic modified all-inside suture technique of Morgan using 2 PM portals for repair of MMPH tears [2]. However, recently we began performing arthroscopic all-inside suture for MMPH tear through a single PM portal [4, 6]. Our suturing technique allows greater freedom in suture hook maneuvering by creating a single posterior portal without using a cannula. This technique allows excellent visualization of the posterior compartment, anatomic coaptation of the torn meniscus, and strong knot tying while avoiding inadvertent injury to the remnant meniscus and articular cartilage.