Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel

Abstract

According to our observation in ACL reconstruction, we find root tears of the posterior horn of the lateral meniscus as a common concomitant injury in ACL-deficient knees. This might be a consequence of initial trauma or of the increased anterior-posterior translation of the tibia and an overload impact on the posterior meniscus root in ACL-deficient knees. A tear of the posterior horn of the medial meniscus causes a 25% increase in peak pressure in the medial compartment compared with that found in the intact condition. The repair restores the peak contact pressure to normal (Allaire et al. in J Bone Joint Surg Am 90(9):1922-1931, [2008]). A tear of the posterior horn of the lateral meniscus might have similar consequences. We hypothesize the surgical anatomical reattachment of the root at the tibia helping to restore knee joint kinematics and helping to advance ACL-graft function. This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture.

Surgical Treatment of Combined Posterior Root Tears of the Lateral Meniscus and ACL Tears

“…The ACL reconstruction surgical technique has been described by Nebelung et al [ 17 ]. In case of a PLMR tears, a transtibial pullout suture was performed [ 4 ]. PLMR refixation and ACL reconstruction were carried out ( Figure 1 ).…”

“…Meniscus injuries are frequently reported concomitantly with ACL injury [ 1 – 3 ]. A recent study of Matheny et al [ 4 ] revealed 3.5% of posterior lateral meniscus root (PLMR) tear with concomitant ACL rupture. The meniscus roots are the insertions of the anterior and posterior meniscal horns on the tibial plateau [ 5 – 7 ].…”

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

“…In all 28 patients the diagnosis of an ACL rupture and the PLMRT (Type I according to Forkel and Petersen) [9] was confirmed.…”

“…According to the classification published by Forkel and Petersen, Type I is an avulsion of the root at the plateau of the tibia with intact MFL, Type II is a radial tear of the posterior horn of the lateral meniscus with an intact MFL, and Type III is a complete injury of the posterior horn of the lateral meniscus with rupture of the MFL [9].…”

“…Three different classification systems have been published to describe the pattern of the posterior lateral meniscal root tear (PLMRT) and adjacent structures [2,9,10] such as the meniscofemoral ligaments (MFLs).…”