Medial Meniscus Radial Tear: A Transtibial 2-Tunnel Technique

Abstract

Abstract:Complete radial tears of the medial meniscus significantly decrease the meniscal tissue's ability to dissipate tibiofemoral loads and have been described as functionally similar to a total meniscectomy, predisposing patients to early osteoarthritis. At present, no consensus exists regarding the optimal surgical treatment of a radial meniscal tear. Current repair techniques have led to a reportedly high rate of incomplete healing or healing of the meniscus in a nonanatomic, gapped position, which compromises its ability to withstand hoop stresses. Improvement regarding the ability to repair and heal medial meniscus radial tears has the potential to result in enhanced preservation of the articular cartilage in the medial compartment of the knee. This technical description details a method for repairing radial tears of the medial meniscus using a transtibial 2-tunnel technique.R adial meniscal tears are common in active individuals and are frequently associated with anterior cruciate and multiligament knee injuries.

Comparable Outcomes After Bucket-Handle Meniscal Repair and Vertical Meniscal Repair Can Be Achieved at a Minimum 2 Years’ Follow-up

“…Standard medial and lateral arthroscopic portals were created adjacent to the patellar tendon, and diagnostic arthroscopic surgery was performed to assess for concurrent injuries. 21 Once the tear was identified, a meniscal rasp was utilized to lightly debride the tear edges. For medial tears, a vertical incision was centered over the joint line, and a dissection was made through the sartorius fascia.…”

Rebar Repair of Radial Meniscus Tears: A Reinforced Suture Technique

“…Nitri et al. 7 describe a transtibial 2-tunnel technique to repair radial tears of the medial meniscus. The drilling of the tibial tunnels may promote healing of the tear by releasing biological factors that could aid in the healing process.…”

“…Several techniques for meniscal repair have been used, including inside-out, all-inside, cross suture, hashtag, cross-tag, double-horizontal mattress suture, single-loop suture, and modified Mason–Allen stitch. 4 , 6 , 7 , 8 , 9 , 10 , 11 When comparing repairs of the meniscus, it is important to consider the factors of cost, minimizing damage to the meniscus, ease of use, healing capability, and restoration of normal biomechanics. The inside-out technique is considered the standard of care in meniscal repair because it allows for cheaper implant cost and the ability to use multiple sutures while maintaining the structural integrity of the meniscus.…”

Transtibial Pull-Out Repair of Converted Radial Tear Adjacent to Medial Meniscus Root

“…13,[16][17][18] Many studies describe methods to repair radial tears of the midbody of the meniscus and posterior root tears. 2,[4][5][6][7]10,11 However, the literature lacks methods to repair a radial tear neighboring a posterior root. In past surgical studies, these radial tears were solely treated with a PM, which caused the development of medial compartment arthritis.…”

“…2,3 Radial tears along the meniscus mid-body can be treated with a partial meniscectomy (PM) or repaired using methods like the inside-out repair, the outside-in repair, and the all-inside repair. 2,3,[5][6][7][8] However, these repairs only alleviate symptoms to varying degrees 3,4 and are unable to restore the meniscus to its original function. 4 Root tears are surgically treated with a PM or reattached to the tibial plateau with a transtibial pull-out repair (TTPR) or suture anchor technique.…”