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. 2017:2017:9264907.
doi: 10.1155/2017/9264907. Epub 2017 Nov 13.

Arthroscopic Management for the Unstable Inferior Leaf of the Lateral Meniscus Anterior Horn and Associated Cysts through a Direct Inframeniscal Portal: A Retrospective Study

Dongyang Chen  1   2   3 , Qiangqiang Li  3 , Ye Sun  4 , Jianghui Qin  1   2 , Yao Yao  1   2 , Qing Jiang  1   2   3
Affiliations

Arthroscopic Management for the Unstable Inferior Leaf of the Lateral Meniscus Anterior Horn and Associated Cysts through a Direct Inframeniscal Portal: A Retrospective Study

Dongyang Chen et al. Biomed Res Int. 2017.

Abstract

Introduction: To investigate the clinical results of arthroscopic management for the unstable inferior leaf of the lateral meniscus anterior horn and associated cysts through an inframeniscal portal.

Methods: From March 2005 to October 2014, 64 patients with an unstable inferior leaf of the lateral meniscus anterior horn and associated cysts underwent arthroscopic management with an inframeniscal portal. The mean age of the patients was 36.9 years (range, 18 to 49 years). The mean follow-up period was 28 months (range, 24 to 44 months). Clinical results were assessed using physical examination, the Lysholm knee score, and postoperative magnetic resonance scanning.

Results: The median Lysholm score improved significantly at 1 year after surgery and at final follow-up. Magnetic resonance scanning at least one year after the operation revealed no recurrent meniscal tears or cysts. No reoperations were required after an average follow-up of 28 months. All patients reported significant symptomatic relief after the operation. They had full range of motion at three months and returned to normal activities and sports one year after surgery.

Conclusion: The direct inframeniscal portal can provide an effective approach to manage lesions in the anterior horn of the lateral meniscus with predictable clinical outcomes.

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Figures

Figure 1
Figure 1
Exposure and examination for the horizontal tear located in the anterior horn of the lateral meniscus. (a) An “intact” meniscus was shown under arthroscopy through the anterolateral portal. (b) A horizontal tear was identified by transferring the scope to the anteromedial portal. (c) A probe passed through the anterolateral portal helped to expose and palpate the tear.
Figure 2
Figure 2
Meniscectomy procedure through the direct inframeniscal portal. (a) A spinal needle was inserted into the interval between the anterior horn and tibial plateau, or into the tear if it extended to the capsule, 1 cm lateral to the patellar tendon. (b), (c) A 5 mm horizontal incision was made by a sharp scalpel (black arrow) and penetrated the capsule just beneath the meniscus or through the tear. (d) The motorized shaver and back-biting cutter passed through the inframeniscal portal to resect the unstable inferior meniscus and then to smooth and contour the remnant rim of the meniscus under monitoring by a scope through the anteromedial portal. (e) Resection of a cyst located in the front of the anterior horn. (f) The anterior horn of the lateral meniscus after meniscectomy. L = lateral, M = medial, and P = patella.
Figure 3
Figure 3
(a) Overall schematic of the inframeniscal technique and three portals. (A) Lateral patellofemoral axillary portal. (B) Medial patellofemoral axillary portal. (C) Inframeniscal portal. (b), (c) Schematic of arthroscopic view illustrates the inframeniscal portal.
Figure 4
Figure 4
(a), (c) Horizontal tear of the anterior horn of the lateral meniscus was observed in a sagittal and coronal MRI in a 19-year-old college soccer player (black arrow). (b), (d) Sagittal and coronal MRIs one year after the operation revealed the resected inferior leaf of the lateral meniscus anterior horn.
Figure 5
Figure 5
Flow diagram of the study.
See this image and copyright information in PMC

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