Meniscal Root Repair
Introduction
Medial meniscal root tears (MMRTs) are a subset of meniscal injuries.
They are radial tears located within 1 cm of tibial meniscal attachment.
MMRTs can lead to meniscal extrusion, loss of normal meniscus function, altered knee kinematics, and increased peak contact pressures leading to arthritis.
Posterior MMRTs more common in middle-aged women. Lateral meniscal root tears (LMRTs) are more common in those with anterior cruciate ligament (ACL) tear
Patient Selection
Indications
Isolated symptomatic MMRTs with minimal arthritis
Failure of nonsurgical management with continued activity-limiting pain
LMRTs with a concomitant anterior cruciate ligament (ACL) tear
Contraindications
Medial joint space narrowing with Fairbank changes on flexion weight-bearing PA radiographs
Asymmetric varus alignment (>3°) and medial joint space narrowing on long-cassette radiographs
Diffuse International Cartilage Repair Society grade 3 or 4 chondral changes
Preoperative Imaging
Figure 1Coronal (Aand B) and sagittal (Cand D) T2-weighted MRIs demonstrate a medial meniscal root tear (MMRT) (arrow), which is identified by increased signal intensity within the meniscal root that extends to the articular surface. Extrusion of the medial meniscus also is noted. As a result of a complete radial tear, the two fragments are separated and take on the appearance of an empty meniscal space (Cand D). An associated medial femoral condyle articular cartilage lesion also can be seen.
Radiography
45° flexion weight-bearing PA views of both knees, lateral views, and Merchant patella views
Assess for arthritis, patellar height (lateral), patellar tilt/subluxation (Merchant).
Long-cassette AP view to determine overall limb alignment
MRI
Identify tear on contiguous coronal images and sagittal images (Figure 1).
A varying degree of injury is seen, from mild fraying to a full-thickness tear.
A tear is identified by increased signal intensity in the meniscal root that extends to the articular surface on T2-weighted images.
Extrusion of the meniscus more than 3 mm beyond the margin of tibial plateau and an empty meniscus sign also may be present in root tear.
Procedure
Room Setup/Patient Positioning
Supine position
Ipsilateral hip bump
10-lb sandbag to support flexed knee at 90°
Lateral post at level of midthigh
We do not use tourniquet or leg holder.
Special Instruments/Equipment/Implants
30° arthroscope
4.5-mm full-radius resectors (straight and curved)
Arthroscopic curet
ACL transtibial tip guide
Self-retrieving suture passing device
Suture shuttle with looped nitinol wire
Meniscal rasp
No. 2 nonabsorbable braided sutures with a closed loop on one end
4.5-mm cancellous screw with washer or cortical fixation device
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
