Medial Meniscus Posterior Root Transtibial Pullout Repair With Progressively Tensioning Subcortical Fixation Button

Abstract

We describe a surgical technique to repair medial meniscus posterior root tears through a transtibial pullout repair with a subcortical button for tibial fixation. This technique allows progressive tensioning of the repaired root without losing tension both during suturing of the knots above the button and after the procedure, owing to the specific button configuration.

Fig 1

The medial meniscus posterior root (MMPR) is palpated with a probe, and the integrity is checked. Patient in supine position, right knee, arhtroscopic view from standar AL portal. (PCL, posterior cruciate ligament.)

Fig 2

Low-profile tibial guide positioned over debrided root to reproduce its anatomic footprint. Patient in supine position, right knee, arhtroscopic view from standar AL portal. (MMPR, medial meniscus posterior root.)

Fig 3

A 4.5-mm tibial tunnel is drilled into the anatomic footprint of the medial meniscus. Patient in supine position, right knee, arhtroscopic view from standar AL portal. (MMPR, medial meniscus posterior root.)

Fig 4

Two nonabsorbable No. 2 high-resistance sutures are passed through the medial meniscus posterior root and retrieved outside the joint. Patient in supine position, right knee, arhtroscopic view from standar AL portal.

Fig 5

A No. 2 Vicryl suture (Ethicon) is pulled inside the tibial tunnel into the joint and is retrieved outside the joint. Patient in supine position, right knee, arhtroscopic view from standar AL portal. (MMPR, medial meniscus posterior root.)

Fig 6

The medial meniscus posterior root (MMPR) sutures are pulled outside the joint through the tibial tunnel. Patient in supine position, right knee, arhtroscopic view from standar AL portal.

Fig 7

The 2 medial meniscus posterior root sutures are divided based on color. Patient in supine position, right knee, arhtroscopic view from standar AL portal.

Fig 8

With the use of the Arthrex Biceps Button-specific needle, the 4 tails of the medial meniscus posterior root sutures are passed through the button.

Fig 9

(A, B) The sutures coming from the medial meniscus posterior root are passed in the configuration shown, allowing constant tensioning of the sutures without loosening. Patient in supine position, right knee, arhtroscopic view from standar AL portal.

Fig 10

A 3.2-mm unicortical hole is drilled 2 cm below the transtibial tunnel. The sutures coming from the medial meniscus posterior root have been passed in a specific configuration that allows constant tensioning of the sutures without loosening. Patient in supine position, right knee, arhtroscopic view from standar AL portal.

Fig 11

The button is inserted and impacted into the unicortical tibial hole while tension is maintained on the sutures. Patient in supine position, right knee, arhtroscopic view from standar AL portal.

Fig 12

The the implant handle of the button is removed; the button is deployed in a subcortical manner, and pulling the free tails of the sutures allows the correct flip of the button. Patient in supine position, right knee, arhtroscopic view from standar AL portal.

Fig 13

The sutures are tensioned progressively under an arthroscopic view. Patient in supine position, right knee, arhtroscopic view from standar AL portal. (MMPR, medial meniscus posterior root.)