Continuous Meniscal Suture in Radial Meniscal Tear: The Hourglass Technique

Abstract

The key to preventing early knee osteoarthritis is meniscal preservation. The main functions of the meniscus are impact absorption, mechanical load transmission, lubrication, joint stability, and proprioception. Radial lesions that extend to the joint capsule are called complete radial tears. This type of injury compromises 2 of the main meniscal functions, which are impact absorption and load distribution, which is equivalent, from a biomechanical perspective, to a total meniscectomy. In the recent past, the treatment of choice for this type of injury was partial meniscectomy. However, several studies have observed progressive joint degeneration after this type of treatment. Recently, different types of meniscal sutures involving radial lesions of the meniscus have been developed. It is believed that such repairs may bring a decrease in future osteoarthritis in this patient profile. The purpose of this article is to describe the steps of continuous meniscal suture for the treatment of radial tears of the medial and lateral menisci.T he key to preventing early knee osteoarthritis is meniscal preservation. 1 This statement is based on the main functions of the meniscus, which are impact absorption, mechanical load distribution, lubrication, joint stability, and proprioception. [2][3][4][5] The patterns of meniscal injury are diverse. They can be longitudinal, horizontal, oblique, radial, and complex. Radial lesions that extend to the joint capsule are called complete radial lesions. This type of injury compromises 2 of the main meniscal functions, which are impact absorption and distribution, which is equivalent, from a biomechanical perspective, to a total meniscectomy. This is because the meniscus loses its tensile strength, in addition to predisposing to meniscal extrusion. 6,7 Tears of the meniscal may lead to increased magnitude and changed distribution of mechanical stress contributing to the spontaneous subchondral bone osteonecrosis. 8 Radial tears are commonly related to trauma in young patients and are often associated with other joint injuries,

Anterior Cruciate Ligament Rupture Combined with Complete Radial Tear of the Posterior Horn of the Lateral Meniscus: Suture or Resection?

“…10 Lateral meniscus root tears not only markedly compromise the joint loading function but also result in severely depleted anterior tibial translation and severely restricted internal rotation of the ACL-deficient knee 11 ; these complications pose a challenge for the surgeon, particularly the radial tear of the posterior horn of the meniscus. 12,13 Meniscus suture rates have previously been found to be very low. 14,15 The effect of body mass index (BMI) on the outcome of arthroscopic treatment of ACL rupture combined with complete radial tear of the posterior horn of the lateral meniscus remains unexplored.…”