SURGICAL MANAGEMENT OF MENICOCAPSULAR SEPARATION OF THE KNEE JOINT

Abstract

Background: Meniscocapsular separations are longitudinal tears at the meniscocapsular junction of the posterior horn of the medial meniscus. They are commonly associated with the ACL-deficient knee, both in the acute and chronic setting, with their incidence increasing in time from injury. Meniscocapsular separations are difficult to diagnose preoperatively, and one must have a high index of suspicion in the setting of a chronic ACL tear. Objective: To highlighten a special entity of meniscal injuries “meniscocapsular separation”. Patients and Methods: This study included 10 patients with meniscocapsular separation treated between November 2014 and May 2019. All were involved in sporting trauma. Age was between 18 - 40 years. All cases had a minimum 6 months follow-up. All cases had an M.R.I. All patients had medial meniscal tears. During arthroscopy, complete separation of the meniscus at the capsular junction was reported. Reduction was done followed by using the shaver for edge abrasion. An all inside suture technique had been used to repair the meniscus. The Lysholm knee score and International Knee Documentation Committee (IKDC) were recorded to assess functional outcome, and had been recorded before surgery and 6 months after surgery. Results: Full range of motion was gradually restored. Minimal tenderness was noticed at site of sutures. Four patients had returned to pre-injury activity level. Lysholm knee score improved gradually from preoperatively to final follow-up 6 months later. Conclusion: Meniscocapsular separation presented as a bucket-handle tear. Vigorous twisting and locking should raise suspicion. M.R.I. may be misleading. Reduction and multiple suture placements from posterior to anterior allowed healing and prevented further displacement.