Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 20;10(1):e21-e27.
doi: 10.1016/j.eats.2020.09.004. eCollection 2021 Jan.

Arthroscopic Medial Meniscal Posterior Root Repair With Transtibial Luggage-Tag and Horizontal Mattress Sutures

David Drynan  1 , Marcel Betsch  2 , Waael Aljilani  2 , Daniel B Whelan  3
Affiliations

Arthroscopic Medial Meniscal Posterior Root Repair With Transtibial Luggage-Tag and Horizontal Mattress Sutures

David Drynan et al. Arthrosc Tech. .

Abstract

Medial meniscal posterior root repair techniques have shown positive yet varied results in the literature. The decision to perform repair has improved clinical outcomes in many situations, although the healing rate is approximately 64% and the repair strength is roughly one-third of the native root strength, with meniscal extrusion being common. We present a technique based on biomechanical evidence to obtain a strong anatomic posterior root repair to restore nearly normal knee mechanics, combining an increased size of footprint under the lateral aspect of the medial meniscal horn for healing and a luggage-tag suture with a posteriorly placed horizontal mattress suture. The horizontal mattress suture is passed to capture the circumferential fibers of the meniscus and the luggage-tag suture is passed to capture the radial fibers of the meniscal body, through a single transtibial tunnel. The aim of this repair is to restore the normal meniscal function.

PubMed Disclaimer

Figures

Fig 1
Fig 1
Diagnostic arthroscopic findings, confirming a type 2 posterior medial meniscal root tear (supine position, right side, viewing from the anterolateral portal).
Fig 2
Fig 2
Curettage to the medial root and cartilage under the radial fibers and body (right side, viewing from the lateral portal), with a curved curette through the medial portal.
Fig 3
Fig 3
Tibial footprint preparation (supine position, right side, viewing from the anterolateral portal).
Fig 4
Fig 4
Acufex anterior cruciate ligament guide used to drill through the center of the posterior medial root repair, slightly medial to the anatomic origin, to improve footprint healing (supine position, right side, viewing from the anterolateral portal).
Fig 5
Fig 5
Hewson suture passer placed in the center-medial aspect of the footprint (supine position, right side, viewing from the anterolateral portal).
Fig 6
Fig 6
Passage of a horizontal mattress suture posterior to the luggage-tag suture, capturing the initial circumferential fibers in the body (supine position, right side, viewing from anterolateral portal). The ConMed suture passer is in the root or body. The white suture is 1 limb of the horizontal mattress suture. The black arrow indicates the Hewson suture passer. The luggage-tag suture is passed through the tibial tunnel.
Fig 7
Fig 7
Suture configuration, with the luggage-tag suture (blue) in the anterior-central aspect and the horizontal mattress suture (white) in the peripheral aspect (supine position, right side, viewing from anterolateral portal).
Fig 8
Fig 8
The medial meniscal root is reduced to the footprint and an ultrabraid is tied via a single tibial tunnel over an Endobutton. (Supine position, right side, view from anterolateral portal.)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ozkoc G., Circi E., Gonc U., Irgit K., Pourbagher A., Tandogan R.N. Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2008;16:849–854. - PubMed
    1. Bin S.I., Kim J.M., Shin S.J. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. 2004;20:373–378. - PubMed
    1. Sonnery-Cottet B., Mortati R., Archbold P., Gadea F., Clechet J., Thaunat M. Root avulsion of the posterior horn of the medial meniscus in skeletally immature patients. Knee. 2014;21:1291–1296. - PubMed
    1. LaPrade C.M., James E.W., Cram T.R., Feagin J.A., Engebretsen L., LaPrade R.F. Meniscal root tears: A classification system based on tear morphology. Am J Sports Med. 2015;43:363–369. - PubMed
    1. Daney B.T., Aman Z.S., Krob J.J. Utilization of transtibial centralization suture best minimizes extrusion and restores tibiofemoral contact mechanics for anatomic medial meniscal root repairs in a cadaveric model. Am J Sports Med. 2019;47:1591–1600. - PubMed

LinkOut - more resources