Meniscal root tears: from basic science to ultimate surgery

Abstract

Biomechanical and clinical studies demonstrate that surgical repair of acute, traumatic meniscal root injuries fully restores the biomechanical features of the menisci, leading to pain relief and functional improvement. The current available surgical techniques for the meniscal root repair (suture anchors and pullout repair) are comparable. Level of evidence IV.

Structural Properties of the Meniscal Roots

“…5,19,20 After posterior root tears of the medial and lateral menisci, there is a significant increase in tibiofemoral contact pressure concomitant with decreased contact areas, 2,13,19,20,22 with one study reporting that posterior root tears simulate a state of total meniscectomy.2 Therefore, the current treatment of choice for meniscal root injuries is primary repair by use of either a transtibial bone tunnel or a suture anchor for fixation of the root to bone. 7,14,16,21 The literature suggests that existing surgical techniques for meniscal root repair fail to restore the biomechanical properties of repaired meniscus tissue to its native state at time zero. 6,7,8,18 Feucht et al 7 reported that neither the transtibial pullout nor suture anchor technique was able to adequately restore biomechanical properties of the native posterior medial (PM) meniscal root.…”

Transosseous Repair of Root Tears of the Lateral Meniscus: Operative Technique and Short-Term Clinical Follow-Up of 28 Patients

“…As different surgical techniques such as side-to-side suture, suture anchors, and transtibial pull-out suture have been described in literature, the most common for PLMRT with avulsion of the tibial insertion (the transtibial repair with a pull-out suture transosseous technique) was recommended [6,29,30]. Therefore, this technique was used in our patients.…”

Easy and Safe All-Inside Suture Technique for Posterior Horn Tears of Lateral Meniscus Using Standard Anteromedial and Anterolateral Portals

“…These include outside-in, inside-out, and all-inside techniques. 6,7 The outside-in technique results are optimal for lesions of the body of the medial and lateral meniscus, whereas it is not appropriate for suture of the posterior horn of the lateral meniscus and medial meniscus. 6,7 The inside-out technique can be used to repair these lesions of the posterior horn of the lateral meniscus.…”

“…6,7 The outside-in technique results are optimal for lesions of the body of the medial and lateral meniscus, whereas it is not appropriate for suture of the posterior horn of the lateral meniscus and medial meniscus. 6,7 The inside-out technique can be used to repair these lesions of the posterior horn of the lateral meniscus. However, this technique presents important disadvantages, such as the necessity for an accessory portal and a high risk of neurovascular damage.…”

“…Every technique in use has different disadvantages. 6 More challenging is the repair of a lesion of the posterior horn of the lateral meniscus. 7 The anatomic relation among the popliteus tendon, popliteal artery, and tibial nerve within the popliteal space must always be kept in mind when one is performing meniscal repair of the posterior horn of the lateral meniscus.…”