Arthroscopic transtibial pullout repair for posterior meniscus root tears

Abstract

Objective: Anatomic repair of the torn meniscal root using transosseous sutures through the proximal tibia.

Indications: Nontraumatic meniscal root tears without severe degenerative changes (Kellgren-Lawrence grade ≤ 2), good quality meniscal tissue, traumatic root tears with or without concomitant anterior cruciate ligament tears or multiligament injuries.

Contraindications: Uncorrected varus or valgus malalignment (>3°), osteoarthritis Kellgren-Lawrence grades III and IV, and diffuse articular cartilage changes International Cartilage Regeneration and Joint Preservation Society (ICRS) grades III and IV of the effected compartment, noncompliance.

Surgical technique: Root tear confirmed by probing; location for the planned root refixation on the tibial plateau is identified. A tibial socket or full transtibial tunnel created with an aiming drill guide. Using a self-retrieving suture passing device or a curved suture passer, the torn meniscus root sutured with no. 0 non-absorbable braided suture. Meniscal sutures passed through the tibial tunnel and the meniscus root reduced into the socket or tunnel by tensioning the free ends of the sutures, followed by fixation on the tibial cortex.

Follow-up: Toe touch weight-bearing for 6 weeks, restricted range of motion (0-60° of flexion) for 6 weeks, no axial loading at flexion angles >90° until 6 months postoperatively.

Results: For medial root tears, pullout repair significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in the short-term. Complete healing observed in only 60% of patients. Negative prognostic factors: varus malalignment > 5°, cartilage degeneration Outerbridge grade III and IV, and older age. Outcomes after lateral root repair are encouraging with apparent prevention of progression of osteoarthritis.

Keywords: Anterior cruciate ligament; Degenerative meniscal disease; Knee; Osteoarthritis; Root repair.