Posterior Root Repair of Medial Meniscus Combined With Valgus Opening Wedge Tibial Osteotomy

Abstract

The medial meniscal root tear, a particular meniscal injury at the level of its posterior bone insertion, leads to a loss of impact absorption and load distribution capacity, similar to total meniscectomy. Therefore, its repair is fundamental for knee joint longevity. This type of injury often occurs in middle-aged patients with lower limbs varus malalignment, which results in mechanical overloading of the medial compartment and induces premature cartilage wear out. The success of meniscal root repair, with meniscal bone reinsertion, depends on the correction and realignment of varus deformities greater than 5 for physiological levels. In this situation, corrective tibial osteotomy combined with meniscal repair is indicated. Our goal is to describe the step-by-step technique of the valgus opening wedge tibial osteotomy combined with the arthroscopic reinsertion of the posterior meniscal root in tibia during the treatment of a patient with varus deformity and medial meniscus root tear.

Meniscal Root Repair Alone or Combined with Different Procedures After at Least 6 Months of Follow-Up: A Series of Cases

“…In addition, both surgeons received their training at the same hospital and used the same previously published rehabilitation protocol. 19 Another limitation that we acknowledge is the heterogeneity of patients when considering the analysis of the total sample. However, this study was not intended to compare the superiority between methods, but to present the results obtained with MRR in the different situations reported.…”

“…After this period, weight bearing was allowed as tolerated and non-impact exercises were started, such as low-speed cycling, isometric muscle strengthening, and swimming pool activities. 19

Figure 1 Examples of post-operative radiographs for each group. ( A ) AP view of a left knee after isolated medial meniscal root repair surgery; ( B ) AP view of a right knee after combined high tibial osteotomy and medial meniscal repair surgery; ( C ) AP view of a left knee after combined anterior cruciate ligament reconstruction and lateral meniscal root repair surgery.

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Posterior-Medial Meniscal Root Repair Through Lateral Tibial Tunnel Combined With Medial Opening Osteotomy and Homologous Graft

“…Gelber et al, 27 in a review study, also reached the conclusion that osteotomies associated with meniscal repair treatment generate a protective effect on the affected compartment, indicating the association of this technique. Rocha de Faria et al 23 recently described a technique involving a high medial opening osteotomy of the tibia associated with repair of the posterior root of the medial meniscus; however, they indicated that the repair of the tibial tunnel of the posterior root must be performed medially. Another difference from the technique described in our article is that the authors used a conventional Puddu plate (Arthrex) for osteotomy fixation, with the use of autologous bone graft from the iliac crest.…”

“…With this kept in mind, some restrictions are recommended throughout the process, especially noneweight bearing for 6 weeks. 5,7,13,23 If a patient does not comply with this main recommendation, there is a high risk of complications including fracture, leading to misalignment of the proximal tibia and failure of the root repair. We describe our rehabilitation protocol in Table 1.…”

Impediments to Meniscal Repair: Factors at Play Beyond Vascularity

“…First and foremost, concomitant injuries, especially anterior cruciate ligament injuries and reconstruction, place a large mechanical burden on the meniscus ( Dargel et al, 2007 ; Chen et al, 2017 ), and restoration of these tissues and their function are paramount to meniscal function and its ability to be repaired. This may also include an open-wedge osteotomy to correct varus or valgus malalignment ( Jing et al, 2019 ; Rocha de Faria et al, 2021 ), to alleviate loads that are placed on one compartment of the knee. Furthermore, along the same lines, the rehabilitation timeline needs to be precisely controlled ( Cavanaugh and Killian, 2012 ; Spang Iii et al, 2018 ); early overloading may cause re-tear before adequate tissue has been deposited to bridge the tear.…”