Posterior knee arthroscopy facilitates the safe and effective all-inside repair of locked bucket-handle medial meniscal tear using a suture hook technique

Abstract

Purpose This study reported the outcomes of locked bucket-handle medial meniscal tear (BHMMT) repairs using an arthroscopic posterior approach during anterior cruciate ligament (ACL) reconstruction. Methods Between 2011 and 2014, 48 patients with BHMMTs and ACL tears who met the eligibility criteria were enrolled in the present study. BHMMTs were assessed using a posterolateral transseptal portal and repaired using a posteromedial portal. Transportal ACL reconstruction was performed using hamstrings autograft. Patients were assessed based on their IKDC and Lysholm scores and Tegner activity level. Meniscal healing was clinically evaluated based on the absence of swelling, joint line tenderness, locking, and catching; McMurray test results; and the need for meniscectomy. Results According to follow-up assessments, the average IKDC and Lysholm scores improved signiicantly after 3-5 years (P < 0.001) Conclusion Excellent clinical outcomes were obtained when locked BHMMTs were repaired using an all-inside suture technique that employed posteromedial and posterolateral transseptal portals. Level of evidence IV.

Overview of posterior knee arthroscopy in the medial meniscal repair: Technical note

“…By using anterior portals alone for rasping the synovial side of the posterior meniscus, vigorous MCL release might be necessary to open up the medial compartment and to prevent iatrogenic cartilage injury. This can easily be avoided by posterior arthroscopy 19 . We never reduce the BHMMT before completely rasping the meniscal borders, as the reduced meniscus itself will block our access to the synovial side.…”

“…We never reduce the BHMMT before completely rasping the meniscal borders, as the reduced meniscus itself will block our access to the synovial side. Furthermore, care must be taken not to over-release the MCL as it might cause postoperative pain or knee laxity 19 . To prevent it, we prefer to abrade the posterior synovium from the posteromedial portal while observing from a trans-notch or trans-septal view 19 .…”

“…Furthermore, care must be taken not to over-release the MCL as it might cause postoperative pain or knee laxity 19 . To prevent it, we prefer to abrade the posterior synovium from the posteromedial portal while observing from a trans-notch or trans-septal view 19 . In this manner, we will have a great view of the posteromedial compartment without any barriers and we can abrade the synovial and inner border of peripheral fragment freely irrespective of whether the meniscus is reduced or not.…”

“…The repair also can be performed from J o u r n a l P r e -p r o o f a working posteromedial portal under the view of anterolateral notch view or working anteromedial portal under view from the anterolateral portal with an all-inside or inside-out method depending upon the configuration of the meniscal tear or surgeon's preference. In certain cases, especially where there is sagging of the peripheral fragment (Figures 6C and 8), repair from the posteromedial portal helps us to correct the meniscal deformity by elevating the peripheral fragment and reach anatomical reduction, which will, in turn, increase the chances of meniscal healing 19 .…”

“…Most areas in the posterior compartment of the knee cannot be easily visualized or introduced with anterior portals 17 18 . Some surgeons release the medial collateral ligament (MCL) percutaneously to open the medial compartment and prevent chondral injury 19 . However, adequate rasping of the meniscosynovial junction and meniscal surface at the most posterior areas of a teared meniscus is still challenging [20][21][22] .…”