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. 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.

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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.)
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References

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