Tears of the Popliteomeniscal Fascicles of the Lateral Meniscus: An Arthroscopic Classification

Abstract

Objective To bring forward an arthroscopic classification of the popliteomeniscal fascicles of the lateral meniscus (PFLM) tears. Design Six fresh frozen knee joint samples of adult males were chosen, and the lateral meniscus at the popliteal hiatus region were measured to analyze their anatomic relationship. Patients who had received magnetic resonance imaging scan at knee joint before the surgery and diagnosed as PFLM tears by arthroscopy from April 2014 to October 2017 were selected. Data regarding the integrity of PFLM were prospectively recorded in a data registry. Tear morphology and treatment received were subsequently extracted by 2 independent reviewers from operative notes and arthroscopic surgical photos. Results The average length and thickness of the popliteal hiatus of the lateral meniscus were 2.09 ± 0.21 cm and 0.43 ± 0.08 cm, respectively. The average length of anterosuperior popliteomeniscal fascicle (APF) was 0.87 ± 0.18 cm, and the posterosuperior popliteomeniscal fascicle (PPF) was 0.72 ± 0.15 cm. A total of 36 PFLM tears in 36 patients were divided as type I (APF tear; n = 5, 13.9%), type II (PPF tear; n = 20, 55.6%), and type III (both APF and PPF tears; n = 11, 30.6%). All patients were treated with arthroscopic all-inside repair using a suture hook for the PFLM tears and follow-up for 21.1 months. All patients have done well with significantly improved Lysholm and International Knee Documentation Committee scores at the last follow-up relative to preoperative scores ( P < 0.01). Conclusion This study suggests to possibly classify the PFLM tears for clinical practice.

Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine

“…Both arthroscopic and open repair approaches have been used to repair isolated popliteal tears in different case series. 101 , 121 , 196 , 248 All clinical evidence at final follow-up demonstrated complete resolution of preoperative symptoms, including pain and knee locking. Only LaPrade et al 121 recorded a negative figure-4 test result for all patients at the conclusion of the observation period.…”

“…The mechanical symptoms caused by popliteomeniscal fascicle lesions were reviewed and discussed. Zheng et al 248 proposed an arthroscopic classification for tears of the popliteomeniscal fascicle of the lateral meniscus. This facilitates communication among surgeons.…”

“…Both arthroscopic and open repair approaches have been used to repair isolated popliteal tears in different case series. 101,121,196,248 All clinical evidence at final follow-up demonstrated complete resolution of preoperative…”

“…185 Direct arthroscopic visualization of popliteomeniscal tear or forward translation of the intact meniscus beyond the midpoint of the lateral condyle to the tibia on probing are the standard methods to diagnose lateral meniscal lesions around the popliteal hiatus. 101,221 Zheng et al 248 defined the popliteomeniscal tear of the lateral meniscus within a range area of 1 cm to the front or rear edge of the popliteal hiatus. They offered an arthroscopic classification of the popliteomeniscal fascicle of a lateral meniscal tear into 3 types and further developed the classification into 8 subtypes involving the meniscal tears anterior to the popliteal tendon.…”

Preoperative Magnetic Resonance Imaging as a Diagnostic Aid for Hypermobile Lateral Meniscus

“…These are the fibers that connect the posterior part of the lateral meniscus to the joint capsule, and are located on the medial and lateral sides of the popliteal tendon. These structures can be visualized with an arthroscope [ 10 , 14 ]. Since these PMFs are the primary restraints to anterior displacement of the posterolateral corner of the lateral meniscus at 90 degrees of flexion of the knee joint, when these fibers tear or stretch out for some reason, it is thought to cause hypermobile lateral meniscus [ 10 , 11 ].…”