Abstract
PurposePosterior root repair of the medial meniscus (MM) can prevent rapid progression of knee osteoarthritis in patients with a MM posterior root tear (MMPRT). The anatomic reattachment of the MM posterior root is considered to be critical in a transtibial pullout repair. However, tibial tunnel creation at the anatomic attachment is technically difficult. We hypothesized that a newly developed point-contact aiming guide [Unicorn Meniscal Root (UMR) guide] can create the tibial tunnel at a better position rather than a previously designed MMPRT guide. The aim of this study was to compare the position of the created tibial tunnel between the two meniscal root repair guides.Materials and methodsThirty-eight patients underwent transtibial pullout repairs. Tibial tunnel creation was performed using the UMR guide (19 cases) or MMPRT guide (19 cases). Three-dimensional computed tomography images of the tibial surface were evaluated using the Tsukada’s measurement method postoperatively. The expected anatomic center of the MM posterior root attachment was defined as the center of three tangential lines referring to three anatomic bony landmarks (anterior border of the posterior cruciate ligament, lateral margin of the medial tibial plateau, and retro-eminence ridge). The expected anatomic center and tibial tunnel center were evaluated using the percentage-based posterolateral location on the tibial surface. The distance between the anatomic center and tunnel center was calculated.ResultsThe anatomic center of the MM posterior root footprint was located at a position of 79.2% posterior and 39.5% lateral. The mean of the tunnel center in the UMR guide was similar to that in the MMPRT guide (posterior direction, P = 0.096; lateral direction, P = 0.280). The mean distances between the tunnel center and the anatomic center were 4.06 and 3.99 mm in the UMR and MMPRT guide group, respectively (P = 0.455).ConclusionsThe UMR guide, as well as the MMPRT guide, is a useful device to create favorable tibial tunnels at the MM posterior root attachment for pullout repairs in patients with MMPRTs.Level of evidenceIV
Highlights
A medial meniscus (MM) acts as a secondary stabilizer against the anterior tibial shift and external rotation of the tibia [1, 2]
No significant differences between the Unicorn Meniscal Root (UMR) and MM posterior root tear (MMPRT) guide groups were observed in preoperative age, height, body weight, body mass index, and femorotibial angle (Table 1)
No significant differences in tunnel center position and distance between the two centers were detected between the UMR and MMPRT guide groups (Table 2)
Summary
A medial meniscus (MM) acts as a secondary stabilizer against the anterior tibial shift and external rotation of the tibia [1, 2]. MM posterior root repair can reduce an excessive tibiofemoral contact pressure following the MMPRT by anchoring the MM posterior root and horn [4]. In arthroscopic MM posterior root repairs, an accurate positioning of the tibial tunnel aperture seems to be critical in restoring meniscal function following transtibial pullout repair [5]. A specially designed MMPRT aiming guide for transtibial pullout repair (Smith & Nephew, Andover, MA, USA) has an advantage in creating the tibial tunnel aperture at a more anatomic location compared with a conventional non-anatomically designed multi-use guide (Arthrex, Naples, FL, USA) [10]. We made a point-contact aiming guide [Unicorn Meniscal Root (UMR) guide, Arthrex] to achieve rigid positioning of the tibial tunnel center for the MM posterior root repair. The aim of this study was to compare the tibial tunnel position between two meniscal root repair guides
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