Transosseous Repair of Isolated Posterior Medial Meniscal Root Injuries in Children and Adolescents

Abstract

The meniscal roots are critically important for maintaining knee stability, functional load distribution, and proper knee kinematics. Although adult meniscal root injuries have been a topic of increasing research, medial meniscus injuries also occur in pediatric and adolescent patients, with up to 2% of meniscal injuries involving root attachments. The purpose of this Technical Note is to demonstrate the transosseous repair of isolated posterior medial meniscal root injuries in children and adolescents, including tear visualization on magnetic resonance imaging and during arthroscopy, operative technique, and postoperative management.

Fig 1

Preoperative magnetic resonance imaging (taken 6 days before arthroscopy) with axial (A) and coronal (B) proton density sequences demonstrating a posterior medial meniscal root tear of the right knee (arrow).

Fig 2

Sagittal proton density magnetic resonance imaging sequences showing a right posterior medial meniscal root tear, with the absence of tissue directly anterior to the tibial footprint of the posterior cruciate ligament (A, arrow), and normal meniscus morphology in a 10-year-old pediatric patient (B, arrow). ∗Posterior cruciate ligament.

Fig 3

Arthroscopic photograph of a posterior medial meniscal root avulsion (asterisk) in a right knee before surgical root repair oriented with the femur (F) superiorly and the tibia (T) inferiorly.

Fig 4

Patients should be positioned supine with a lateral post in place for application of valgus stress to the knee. Preoperative markings should include the location of the patellar tendon, standard anterolateral and anteromedial portals, and a transpatellar tendon accessory portal (arrow A). Also marked is the skin incision for the transosseous tunnel (arrow B), which is immediately above the pes anserinus (dotted line). This figure shows a left knee.

Fig 5

After medial collateral ligament trephination to improve access to the posterior medial compartment, the medial meniscus root tear can be identified (A). A curved curet (B) and shaver (C) are used to prepare the tibial footprint and underside of the meniscal root for biologic healing (right knee).

Fig 6

A nonabsorbable link suture is looped around the shaft of the suture passer (A). Then, the suture is passed from superior to inferior (B, arrow) such that after passage and instrument retrieval, a locking luggage tag suture will be applied. This figure shows a right knee.

Fig 7

After suture passage, the 2.4-mm guidewire with sheath is drilled from the anteromedial aspect of the tibia immediately proximal to the pes anserinus to the posterior meniscal root footprint using a curved targeting guide (A). A monofilament passing suture is shuttled up the cannula (B, arrow) for passage of the repair sutures (asterisk). This figure shows a right knee.

Fig 8

The repair sutures are shuttled back through the transosseous tunnel using the monofilament passing suture in order to create a stable repair (A). Global view of the medial compartment shows appropriate tension on the posterior meniscal root (B). This figure shows a right knee.