Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction

Abstract

Background: Lateral meniscus posterior root tears (LMPRTs) almost always occur in association with anterior cruciate ligament (ACL) tears. Their repair is advocated to restore the stabilizing and load-sharing functions of the meniscus. Purpose: To study the functional outcomes of combined arthroscopic repair of LMPRTs and ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: The authors evaluated patients who underwent simultaneous arthroscopic ACLR and LMPRT repair. All patients had chronic injuries, with a mean time since ACL rupture of 7.9 months. Patient characteristics, Lachman and pivot-shift test results, type of LMPRT, associated injuries, and surgery details were documented. Pre- and postoperative functional status was assessed using the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. An independent single-tunnel transtibial repair using 2 SutureTapes was performed for Forkel type 1 and 3 tear root avulsions, while side-to-side suture repair was performed for type 2 radial/oblique tears. The Wilcoxon signed rank test and minimal clinically important difference (MCID) of the IKDC score were used for statistical analysis. Results: Included were 25 patients with a mean age of 29.6 ± 6.5 years. Of these, 22 patients (88%; 95% CI, 73.1%-100%) had a high-grade (grade 2 or 3) preoperative pivot shift. Diagnosis of the LMPRT on magnetic resonance imaging (MRI) scans was possible only in 5 patients (20%). At final evaluation, performed at 37.4 ± 7.1 months postoperatively, all functional scores had improved significantly from preoperatively: IKDC score, from 47.6 ± 9.5 to 81.8 ± 11.5; KOOS, from 45.5 ± 10.9 to 86.5 ± 10.3, and Lysholm score, from 49.0 ± 11.5 to 88.8 ± 7.6 ( P < .001 for all). Twenty-four patients (96%) achieved the MCID for the IKDC score. All knees had a negative pivot shift at final analysis, and no patient underwent revision ACLR or LMPRT repair. Conclusion: LMPRT repair combined with ACLR led to good short-term clinical outcomes in this study. An LMPRT may frequently go undetected on preoperative MRI scans, but a high-grade pivot shift is present in a large majority of these patients.

Concomitant Medial and Lateral Meniscus Posterior Horn Root Repair With ACL Reconstruction Using Trans-Tibial Tunnel Technique

“…recommended drilling independent tunnels for the LMPHR and the ACL graft, with the emphasis on keeping an adequate bony bridge between the two tunnels. 9 …”

Patients with meniscus posterolateral root tears repair during ACL reconstruction achieve comparable post-operative outcome than patients with isolated ACL reconstruction

“…Qian et al [29] reported MRI could detect only 33% of LMPRTs in a series of 45 arthroscopically confirmed tears. Furthermore, Shekhar et al [34] series demonstrated only 13 patients (52%) of the group with LMPRT confirmed by arthroscopy had a preoperative MRI reporting a tear in the posterior lateral meniscus, 5 of which were diagnosed as definitive root tears and 8 of which were diagnosed as a posterior horn tear.…”

Transtibial Pullout Repair of Lateral Meniscus Posterior Root Tear with Tissue Loss: A Case with Anterior Cruciate Ligament Injury and Medial Meniscus Tear

“…The anatomical repair of the meniscal root is important for its function in converting femorotibial loads into circumferential tension [ 19 ]. We, therefore, drilled the additional tunnel aiming at the posteromedial direction from the lateral tibial eminence and anterior from the PCL, as previously described [ 8 , 20 ]. One concern regarding the additional tunnel was tunnel convergence with ACL tunnels [ 21 ]; however, in our case, only a 2.4 mm tunnel was needed to pass the suture, and enough margin had been confirmed ( Figure 2(f) ).…”