Comparison of medial and lateral tibial tunnel in pullout repair of posterior root tear of medial meniscus: Radiologic, clinical, and arthroscopic outcomes

Abstract

Purpose: Medial meniscus posterior root tear (MMPRT) should be repaired to the correct position as possible to maintain hoop tension of the meniscus. In this study, we propose a comparison of the outcome between the medial tunnel and the lateral tunnel in the pullout suture technique using the tibial tunnel for anatomical repair of posterior root tear of medial meniscus. Methods: From April 2010, of patients who underwent pullout suture, 51 cases (24 medial tunnel group (MTG) and 27 lateral tunnel group (LTG)) were able to follow-up with second look arthroscopy. Original Coronal Ratio of Root Attachment (CRORA) was defined as the ratio of the distance from the medial edge of the tibial plateau to the root attach site divided by the entire tibial medial–lateral width on preoperative computed tomography. Error between postoperative CRORA and original CRORA was calculated. We compared this error, clinical outcome, and arthroscopic finding between MTG and LTG. Results: The mean error ratio of postoperative CRORA divided by original CRORA was 0.86 ± 0.11 in MTG, which was significantly ( p = 0.001) lower than that (1.02 ± 0.06) in LTG. The mean value of the root attach point in the MTG with a post/original CRORA value of 0.86 ± 0.11 means statistically significant medialization after the operation. There was no statistically significant difference in changes of International Knee Documentation Committee (IKDC) and Lysholom score between MTG and LTG. The difference between the two groups of arthritis progression was not statistically significant. Conclusion: In patients with MMPRT, CRORA may provide a basis for coronal assessment of root repair position before and after surgery, and lateral tibial tunnel technique can help anatomical repair by reducing technical error due to guide pin slip medially compared to medial tibial tunnel technique.

Midterm Outcomes of Posterior Medial Meniscus Root Tear Repair: A Systematic Review

“…Among these patients, 49% saw progression of at least 1 K-L grade at a mean follow-up of 4.0 years (Figure 2). Eight of these studies reported mean joint space narrowing (2 did not 43,47 ), resulting in 32% of total patients being evaluated. The mean joint space narrowing for these patients was 0.64 mm at a mean follow-up of 4.5 years.…”

“…Only 1 study 19 of the 11 reporting K-L grade progression recorded a P value that was statistically significant. However, 8 studies 15-17,19,37,43,46,48 performed Fisher exact tests on K-L grade distribution pre- and postoperatively. Five studies 15,16,37,43,48 demonstrated statistically significant changes.…”

“…However, 8 studies 15-17,19,37,43,46,48 performed Fisher exact tests on K-L grade distribution pre- and postoperatively. Five studies 15,16,37,43,48 demonstrated statistically significant changes. Of the 8 studies reporting mean joint space narrowing, 6 showed a statistically significant decrease postoperatively.…”

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

“… 41 , 47 Kwon et al. 48 found that lateral tibial tunnel placement is more accurate and the tunnel is usually 5.6 mm medial to the root; by increasing our footprint, this lateral tunnel is placed centrally over the cancellous bone for a maximum healing surface, with the passage of sutures medial to the transition zone for improved repair strength. 49 …”

“…Exposing bleeding cancellous bone in the line of the posterior horn of the medial meniscus, we aim to achieve stable healing of the root and improve stability of the meniscus by increasing the footprint under the red-red zone and location of the circumferential fibers to achieve ideal restoration of the hoop stress distribution without overconstraining the posterior horn movement. 41,47 Kwon et al 48 found that lateral tibial tunnel placement is more accurate and the tunnel is usually 5.6 mm medial to the root; by increasing our footprint, this lateral tunnel is placed centrally over the cancellous bone for a maximum healing surface, with the passage of sutures medial to the transition zone for improved repair strength. 49 The suture type and technique have been investigated comparing multiple iterations, although no studies to date have compared the suture location and combination of suture constructs and materials that we suggest using.…”