Transtibial pullout repair of the lateral meniscus posterior root tear combined with anterior cruciate ligament reconstruction reduces lateral meniscus extrusion: A retrospective study

Abstract

Background: Lateral meniscus (LM) posterior root tears (PRT) are often associated with anterior cruciate ligament (ACL) injury and can result in rotational instability, joint overloading, and degenerative changes in the knee. Improved rotational stability and kinematics have been reported after LMPRT repair. However, it is unclear which repair technique can achieve the greatest reduction in lateral meniscus extrusion (LME).Hypothesis: We hypothesized that transtibial pullout repair would decrease LME to a greater extent than other repair techniques.Patients and Methods: Seventeen patients with ACL injury but complete LM posterior root were evaluated. Nine underwent ACL reconstruction (ACLR) and transtibial pullout repair, and eight underwent ACLR and other repairs such as inside-out suturing. Double-bundle ACLR was performed using hamstring tendons, and LMPRT pullout was performed through the bone tunnel for the PL bundle. Magnetic resonance imaging was performed immediately preoperatively and at >6 months postoperatively, and LME was measured from coronal images only.Results: A significant decrease in the size of LME from pre-to postoperative measurement was observed in the transtibial pullout repair group (−0.5 ± 0.7 mm) than the other-repair group (1.0 ± 0.9 mm, P < 0.01). Pre-and postoperative LME measurements were not significantly different between the two groups.Discussion: The most important finding of this study is that transtibial pullout repair results in Transtibial pullout repair of LMPRT combined with ACLR reduces LM extrusion a greater decrease in LME than other repair techniques in patients with ACL injury and LMPRT. This technique might be useful for restoring hoop tension by decreasing LME.

Clinical, Radiographic, and Arthroscopic Outcomes of Surgical Repair for Radial and Avulsed Lesions on the Lateral Meniscus Posterior Root During ACL Reconstruction: A Systematic Review

“…2,3,10,13,20,27,30 A critical issue for successful repair of tears of the LMPR is proper surgical technique, and meniscal extrusion is a common and objective outcome to measure postsurgical meniscal function. 1,15,18 Currently, there are 2 surgical techniques with clinical follow-up records. The side-toside technique can be used to repair radial tears with a root remnant of adequate tissue quality.…”

“…2,18,30 There were no significant reductions of coronal extrusion after LMPR repairs in all 3 studies, but 1 comparative study among them showed significantly greater decreases of coronal extrusion after pullout repairs than after side-to-side repairs. 18 In 2 studies repairing radial tears of the LMPR by the side-to-side suture technique, the sagittal extrusion increased in 1 study but decreased in the other. 2,30 The LMPR signal on follow-up MRI was reported in 2 studies.…”

“…Of the 469 articles initially identified by electronic searches, 9 studies were ultimately included ( Figure 2). Of the 9 studies included, 5 were retrospective cohort studies (level 3), 10,13,18,20,30 and the remaining 4 were case series (level 4). 2,3,27,32 The general features of each included study are summarized in Table 2.…”

“…Overall, 5 different functional scores were utilized (Table 2): the Lysholm score (7 studies 2,3,10,13,20,27,32 ), IKDC subjective score (6 studies 2,3,10,18,20,32 ), Tegner score (5 studies 3,10,13,27,32 ), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (1 study 13 ), and 12-Item Short Form Health Survey (SF-12) score (1 study 13 ). All but 1 of these studies showed significant improvements (P < .05) in each functional score at the final follow-up compared with the preoperative status (Table 5), including the mean Lysholm score (from 58.3 to 91.4), the mean IKDC subjective score (from 61.1 to 87.2), and the Tegner score (from 2.5 to 6.0).…”

“…In 1 study, weightbearing AP radiographs showed no significant narrowing (0.04 mm) of lateral joint space width in patients undergoing side-to-side repairs for tears of the LMPR. 30 In another study, the chondral status on MRI scans after LMPR pullout repairs was rated as normal in 81% of patients, mild in 16% of patients, and moderate in 32 26 NA NA SSS Not needed Okazaki 18 8 HST DB SSS Not needed 9 HST DB POS ACL tunnel Pan 20 31 HST DB POS ACL tunnel LaPrade 13 10 NA NA POS Additional tunnel Krych 10 26 NA NA POS Additional tunnel a ACL, anterior cruciate ligament; BPTB, bone-patellar tendonbone; DB, double bundle; HST, hamstring tendon; LMPR, lateral meniscus posterior root; NA, not available; POS, pullout suture; SB, single bundle; SSS, side-to-side suture; TB, triple bundle. 3% patients, none of which was significantly different from their preoperative status.…”