Posterior lateral meniscal root tear due to a malpositioned double-bundle anterior cruciate ligament reconstruction tibial tunnel

LaPrade, Christopher M.; Jisa, Kyle A.; Cram, Tyler R.; LaPrade, Robert F.

doi:10.1007/s00167-014-3273-1

Cited by 14 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These authors also described a similar presentation such as ours in which they treated a patient coming from an outside hospital who experienced a posterior lateral meniscal root tear following an ACL reconstruction due to a posteriorly placed tibial tunnel at the time of the index procedure. 3 However, this patient differed from ours in that they underwent a double-bundle reconstruction technique in addition to the meniscal repair to restore their previously placed ACL graft. During this technique, it is important to evaluate both the status of the cruciate ligament as well as the meniscus intraoperatively to determine the optimal course of treatment or surgical intervention without exacerbating the iatrogenic nature of the case.…”

Section: Surgical Techniquesmentioning

confidence: 69%

Treatment of an Iatrogenic Lateral Meniscal Root Tear After ACL Reconstruction

Vadhera

DeFroda

Lee

et al. 2023

Video Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The meniscal roots are essential for preserving the structural and biomechanical properties of the tibiofemoral joint. Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction have previously been reported in the literature to account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. Indication: Patients are indicated for surgery when presenting with a verified, symptomatic, complete meniscal root tear seen on advanced imaging or diagnostic arthroscopy. Contraindications for a root repair include the development of advanced osteoarthritis in the ipsilateral compartment, older age, and malalignment in the affected compartment. Technique Description: The ACL graft was appreciated and noted to be vertical and posterior relative to its native anatomical position, violating the lateral posterior horn root attachment. A full lateral posterior meniscal root avulsion was then confirmed directly adjacent to the graft tunnel. A curette was used to prepare the footprint of the lateral meniscal root on the posterolateral tibia for the 2-tunnel transtibial pull-out tunnels, and a grasper was used to position the torn meniscal root back into its anatomical site. Two ultrabraided sutures were passed through the posterior horn of the lateral meniscus using a suture passer. These were then passed through the tunnels into the body of the meniscal root and reduced to its native anatomical position. The suture repair was then secured over an Endobutton Fixation Device at 90° of knee flexion through each tunnel into its native anatomical position while confirming its adequate tension by viewing arthroscopically. Results: Within 2 years postoperatively, patients are expected to have improved overall knee-specific quality of life, reduced pain, and a successful return to activities. Discussion/Conclusion: This injury underscores the importance of an accurate tibial tunnel placement during ACL reconstruction to avoid posterior meniscal root injuries and other associated complications. Physicians should consider such pathology in the differential diagnosis of patients presenting with persistent pain and instability following a primary ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

show abstract

Section: Surgical Techniquesmentioning

confidence: 69%

Treatment of an Iatrogenic Lateral Meniscal Root Tear After ACL Reconstruction

Vadhera

DeFroda

Lee

et al. 2023

Video Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…The importance of conducting reconstruction of ACL and PCL tears and tears of the meniscus root in accordance with the anatomic landmarks on the tibial plateau surface to achieve the desired clinical and biomechanical outcomes has been clearly underlined in the literature. [14][15][16][17][18] The landmarks of these ligaments on the tibial plateau surface have been precisely demonstrated in anatomic studies. 1,11,12,24 However, there is limited information about the entry points of these tunnels on the anteromedial aspect of the tibia in reconstruction or repair procedures.…”

Section: Discussionmentioning

confidence: 99%

Optimal Tibial Tunnel Placement for Medial and Lateral Meniscus Root Repair on the Anteromedial Tibia in the Setting of Anterior and Posterior Cruciate Ligament Reconstruction of the Knee

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background: Although the risk of tibial tunnel convergence in the setting of multiligamentous reconstruction has been reported in the literature, the risk of tunnel convergence in the setting of posterior cruciate ligament (PCL), anterior cruciate ligament (ACL) reconstruction and medial and lateral meniscus root repair has not been defined. Purpose: To examine the risk of tunnel convergence and to determine optimal tunnel placement for ACL and PCL reconstruction performed in conjunction with posterior medial and lateral meniscus root repairs on the anteromedial proximal tibia. Study Design: Descriptive laboratory study. Methods: Three-dimensional (3D) tibial models were created using computed tomography scans of 20 cadaveric specimens. After determining optimal tunnel entry and exit points for ACL and PCL reconstructions, and medial and lateral meniscus root reattachment to the anatomic footprints, we used image processing software to create root tunnels over the anteromedial tibia on the tibial models. ACL and PCL tunnels were kept constant. The meniscus root repair tunnels were then reoriented to match the angle of the ACL tunnel, making both tunnels parallel in the sagittal plane. Tunnel convergence risk was analyzed by identifying the shortest 3D distance between tunnel axes and subtracting the radius of each tunnel from this distance for single- and double-tunnel repair techniques in both case scenarios. Results: All specimens demonstrated convergence between the ACL and lateral meniscus root tunnels when the root tunnel’s entry was created proximal to the ACL tunnel’s entry for single- and double-tunnel techniques, but no convergence was seen between these tunnels using the parallel orientation in the sagittal plane. There were no cases of convergence between the ACL and medial meniscus root tunnels in any of the configurations. The greatest distance between the ACL and medial meniscus root tunnels was achieved using the single-tunnel technique in parallel orientation (12.1 ± 2.8 mm). There were no cases of convergence between the PCL and medial meniscus root tunnels in the original orientation; however, 2 of 20 specimens demonstrated convergence using the parallel orientation with the double-tunnel technique, and there were no cases of convergence using the single-tunnel technique. The PCL and lateral meniscus root tunnels did not demonstrate convergence in any configuration. Conclusion: There was a high risk of convergence between ACL and posterior meniscus root tunnels when all the tunnels were created on the anteromedial tibia. Reorienting meniscus root tunnels parallel to ACL tunnels may help reduce this risk. There is increased risk of tunnel convergence with root repairs in cases of bicruciate reconstructions, and therefore a double-tunnel root repair technique should be used with caution. Clinical Relevance: To avoid tibial tunnel convergence when performing ACL and PCL reconstruction with medial and lateral meniscus root repair, surgeons should reorient the meniscus root repair tunnels to be parallel on the sagittal plane to the ACL tunnel to decrease the risk of convergence. In cases of bicruciate ligament reconstruction, use of the double-tunnel technique requires caution to avoid convergence risk with the PCL tunnel.

show abstract

“… 29 A case report on the occurrence of iatrogenic injury to the PL meniscal root from a posteriorly malpositioned double-bundle ACL tibial tunnel has been described. 30 …”

Section: Discussionmentioning

confidence: 99%

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft through Single Femoral Tunnel and Single Branched Tibial Tunnel

Selim

2018

Arthroscopy Techniques

View full text Add to dashboard Cite

Conventional single-bundle anterior cruciate ligament (ACL) reconstruction cannot improve the rotational stability of the knee. Traditional double-bundle ACL reconstruction requires is demanding, complex, time- and implant consuming, and associated with a high incidence of complications. Double-bundle ACL reconstruction using a free quadriceps tendon autograft through 3 independent tunnels provides some advantage, but the antegrade graft passage, tibial tunnel confluence, and graft site morbidity represent disadvantages. This Technical Note describes a modification of double-bundle ACL reconstruction using the hamstring tendon autograft through a single branched tibial tunnel and a single femoral tunnel using 2 interference screws (Arthrex, Naples, FL). The gracilis tendon autograft is passed through tibial tunnel stem to the posterolateral tibial tunnel branch to the posterolateral position in the femoral tunnel. The semitendinosus tendon autograft is passed through the tibial tunnel stem to the anteromedial tibial tunnel branch to the anteromedial position in the femoral tunnel. Both grafts are fixed by 2 interference screws: 1 at the femoral tunnel and 1 at the tibial tunnel stem with the knee at 20° flexion.

show abstract

Posterior lateral meniscal root tear due to a malpositioned double-bundle anterior cruciate ligament reconstruction tibial tunnel

Abstract: Case report, Level IV.

Cited by 14 publications

References 18 publications

Treatment of an Iatrogenic Lateral Meniscal Root Tear After ACL Reconstruction

Treatment of an Iatrogenic Lateral Meniscal Root Tear After ACL Reconstruction

Optimal Tibial Tunnel Placement for Medial and Lateral Meniscus Root Repair on the Anteromedial Tibia in the Setting of Anterior and Posterior Cruciate Ligament Reconstruction of the Knee

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft through Single Femoral Tunnel and Single Branched Tibial Tunnel

Contact Info

Product

Resources

About