The popliteomeniscal fascicles: from diagnosis to surgical repair: a systematic review of current literature

Abstract

Background Popliteomeniscal fascicles (PMF) are considered the posterolateral meniscocapsular extensions which connect the lateral meniscus to the edge of the tibia. PMFs disruption leads to hypermobility of the lateral meniscus with pain and locking sensation. Recognition and treatment of PMFs tear remain very challenging. The aim of this systematic review is to collect and analyse the articles concerning popliteomeniscal fascicle disruption from diagnosis to surgical approach. Methods PubMed, Scopus, Web of Science and EMBASE were searched. Various combinations of the keywords “Popliteomeniscal Fascicles”, “Lateral Meniscus”, “Popliteal Hiatus”, “Posterolateral Corner”, “Tear” and “Surgical Repair” were used. The original literature search identified a total of 85 articles comprising of duplicates. The PRISMA guidilines were followed. Studies in English language and published in peer-reviewed journals were included. Articles with level of evidence I to IV were included Results A total of three articles were included in the qualitative analysis. All the articles included are retrospective case series, with a level of evidence IV. Studies concerning patients with pre-operative imaging MRI and clinical assessment, reporting surgical technique and clinical outcomes assessed by physical examination and/or subjective evaluation scales were analysed. Conclusions MRI and the Figure-4 test allow to assess PMF tears pre-operatively. Arthroscopic evaluation constitutes the gold standard to confirm the diagnosis. Although surgery is considered resolutive for symptoms, there is still controversy about the most appropriate technique. Further higher quality studies are required.

Surgical treatment of popliteomeniscal fascicles tears is associated with better patient-reported outcome measures. A systematic review and meta-analysis

“…The PMFs are important stabilizers of the lateral meniscus, and their damage is one of the causes of a hypermobile lateral meniscus (HLM) [ 1 , 2 , 4 , 7 , 8 ]. PMFs injuries occur mainly in athletes performing sports with sudden changes of direction, such as dancers, football players, and wrestlers [ 9 ]. Identifying PMFs tears is challenging both from a clinical point of view and magnetic resonance imaging (MRI) assessment [ 4 , 5 , 9 – 11 ].…”

“…PMFs injuries occur mainly in athletes performing sports with sudden changes of direction, such as dancers, football players, and wrestlers [ 9 ]. Identifying PMFs tears is challenging both from a clinical point of view and magnetic resonance imaging (MRI) assessment [ 4 , 5 , 9 – 11 ]. This is because they rarely occur as isolated lesions but are often associated with anterior cruciate ligament (ACL) or PLC knee injuries [ 1 , 9 , 11 – 13 ].…”

“…Identifying PMFs tears is challenging both from a clinical point of view and magnetic resonance imaging (MRI) assessment [ 4 , 5 , 9 – 11 ]. This is because they rarely occur as isolated lesions but are often associated with anterior cruciate ligament (ACL) or PLC knee injuries [ 1 , 9 , 11 – 13 ]. As mentioned by Temponi et al, nearly 20% of patients with an ACL lesion have some injury to the PLC when evaluated by MRI, including PMFs tears [ 13 ].…”

“…As mentioned by Temponi et al, nearly 20% of patients with an ACL lesion have some injury to the PLC when evaluated by MRI, including PMFs tears [ 13 ]. From a clinical point of view, lateral pain and a sensation of locking or snapping are the main symptoms [ 4 , 9 , 11 ]. LaPrade et al introduced a clinical test, the figure-4 position, reproducing pain on the lateral knee due to entrapment of the lateral meniscus into the joint in case of damage to the PMFs [ 5 ].…”

Repair of popliteomeniscal fascicles tear using a posterior transseptal portal fixes hypermobile lateral meniscus

“…Osteoarthritic changes and joint locking have been reported in such treatments [12]. Current studies recommend the direct repair of the popliteomeniscal junction using different arthroscopic repair techniques [16][17][18].…”