Arthroscopic Management for the Unstable Inferior Leaf of the Lateral Meniscus Anterior Horn and Associated Cysts through a Direct Inframeniscal Portal: A Retrospective Study

Abstract

Introduction To investigate the clinical results of arthroscopic management for the unstable inferior leaf of the lateral meniscus anterior horn and associated cysts through an inframeniscal portal. Methods From March 2005 to October 2014, 64 patients with an unstable inferior leaf of the lateral meniscus anterior horn and associated cysts underwent arthroscopic management with an inframeniscal portal. The mean age of the patients was 36.9 years (range, 18 to 49 years). The mean follow-up period was 28 months (range, 24 to 44 months). Clinical results were assessed using physical examination, the Lysholm knee score, and postoperative magnetic resonance scanning. Results The median Lysholm score improved significantly at 1 year after surgery and at final follow-up. Magnetic resonance scanning at least one year after the operation revealed no recurrent meniscal tears or cysts. No reoperations were required after an average follow-up of 28 months. All patients reported significant symptomatic relief after the operation. They had full range of motion at three months and returned to normal activities and sports one year after surgery. ConclusionThe direct inframeniscal portal can provide an effective approach to manage lesions in the anterior horn of the lateral meniscus with predictable clinical outcomes.

Arthroscopic all-inside repair with suture hook for horizontal tear of the lateral meniscus at the popliteal hiatus region: a preliminary report

“…With this approach, the increased contact area between the femoral condyle and tibial plateau may cause osteoarthritic change and instability over time. Another surgical variant is to resect either the superior or inferior leaf of the horizontal tear [3]. However, with the removal of only one leaf, the remaining leaf is always unstable for the meniscus at the popliteal hiatus region, due to the absence of fixation to the coronary ligament and knee joint capsule [4].…”

Meniscus sutures by arthrotomy for a non-transfixing horizontal lesion associated with a cyst

“…They had no recurrence of cyst or meniscal lesion, but the follow-up was short. Chen et al [14] had similar results on 64 patients at 28 months follow-up for full arthroscopic management. Reagan et al [15] also found excellent results in 80% of cases but for arthroscopic partial meniscectomy with or without extra-articular drainage of the cyst.…”

“…Indeed, there is no consensus on management: arthroscopic meniscal surgery or direct approach, procedure on the cyst or not. Some authors propose an arthroscopic meniscal regularization associated with an extra-articular procedure on the cyst with very good results [11][12][13][14][15][16][17][18][19][20][21]. A procedure on the cyst is recommended.…”

Arthroscopic minimum saucerization and inferior-leaf meniscectomy for a horizontal tear of a complete discoid lateral meniscus: Report of two cases

“…When preserving as much volume of the superior-leaf as possible, resecting the anterior part of the inferior-leaf becomes harder because of poor visualization and a difficult approach to the inferior-leaf through standard portals. Previously reported, far-anteromedial portal could improve visualization [ 20 ], and an inferomeniscal portal could achieve direct access of the shaver to the inferior-leaf [ 18 , 21 ]. These additional portals are indispensable for success with this technique.…”

“…Then, the middle and posterior part of the inferior-leaf was removed with a meniscal punch, and the anterior part was removed with a shaver using an inferomeniscal portal ( Fig. 2 d, e) [ 18 ]. About half of the width of the remaining stable superior-leaf was preserved ( Fig.…”