Repair of popliteomeniscal fascicles tear using a posterior transseptal portal fixes hypermobile lateral meniscus

Keyhani, Sohrab; Movahedinia, Mohammad; Soleymanha, Mehran; Verdonk, René; Kazemi, Morteza; Qoreishy, Mohamad

doi:10.1186/s40634-021-00412-4

Cited by 8 publications

(33 citation statements)

References 42 publications

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“…Recently, posterior knee arthroscopy has gained attention in meniscal repair because of its direct access to meniscal borders [23]. Posterior portals minimize the risk of cartilage and instrument damage and the need for MCL trephination to create extra space [13,24].…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears

et al. 2023

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Background In irreducible bucket-handle medial meniscal tears (BHMMTs), the displaced central fragment is rotated 180° or more, meaning reduction is impossible without derotation of the tear. In chronic cases, the rotated meniscus is deformed and degenerated; thus, the issue of reproducibility and repairability arises. This study presents the clinical outcomes of chronic irreducible and unstable locked BHMMTs. Radiological outcomes were also evaluated using magnetic resonance imaging (MRI). Methods This is a retrospective study of 37 patients with 11 cases of irreducible BHMMT and 26 cases of reducible but unstable chronic BHMMT who underwent operations between 2011 and 2016. Posterior arthroscopy was performed after temporary meniscus fixation using a provisional needle fixation technique. After the posterior repair with vertical mattress sutures was completed using an all-inside technique, the classic outside-in technique was performed for the anterior third of the meniscus. The Lysholm, International Knee Documentation Committee (IKDC), and Tegner activity scores were obtained from all patients before surgery and at the latest follow-up. Radiological evaluations were performed using MRI before surgery and at 6 months postoperatively. Results Between 2011 and 2016, a total of 37 consecutive patients with irreducible and chronic BHMMTs underwent surgery. The average postoperative follow-up was 7.2 ± 1.4 years (mean ± SD). Postoperative Lysholm (89.57 ± 2.7) and IKDC (87.22 ± 3.2) scores improved significantly at the last follow-up when compared with the pre-operative scores (38.44 ± 4.5 and 23.52 ± 7.8, respectively). According to the Tegner activity scale, patients’ postoperative activity levels remained unchanged compared to preoperative levels at the last follow-up. Conclusion Posterior knee arthroscopy with the all-inside posterior suture and inside-out anteromedial suture technique presented in this study yielded excellent clinical outcomes when used to repair chronic irreducible or unstable BHMMTs. Level of evidence: Level IV.

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Section: Discussionmentioning

confidence: 99%

Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears

et al. 2023

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“…The oldest study was published in 1988 [33] and the newest one in 2023 [7] and more than half of the studies were from the past 10 years. Regarding the study design, all of the articles were descriptive, of which 12 studies were case reports [3,8,11,12,17,29,34,35,[40][41][42][43] and eight were case series [7,19,22,24,31,33,49,53]. Therefore, all studies had a level of evidence of IV according to the Oxford Center of Evidence-Based Medicine criteria.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Hypermobile lateral meniscus: A systematic review of current treatment options

Vosoughi,

Mafhoumi,

Gouravani

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe reliable data on the incidence of hypermobile lateral meniscus (HLM) and its clinical manifestations, diagnostic methods and therapeutic approaches are limited. This systematic study aimed to review available treatment options for HLM and the outcomes of each approach.MethodsA systematic search was performed in four electronic databases (PubMed, EMBASE, Scopus, Web of Science) to identify studies in which arthroscopically confirmed cases of HLM were treated surgically or nonsurgically, and the required data comprising study characteristics, patient data, treatment approaches and outcome measures were extracted from eligible studies.ResultsTwenty studies with a total of 212 patients (138 males and 74 females) and 219 knees were included. The most frequently reported symptoms were locking sensations, knee pain, giving way and snapping. Treatments used by the studies were: radiofrequency energy in two studies; arthroscopic partial meniscectomy in one study; open surgery in two studies; and arthroscopic meniscal repair in 17 studies. Eleven studies used an all‐inside repair method and an inside‐out meniscal repair was reported in eight studies. Three studies reported the usage of posterior arthroscopy for therapeutic or diagnostic approaches. Evaluation of symptom resolution was the main outcome measurement for which almost all of the studies stated relief of symptoms after intervention.ConclusionDespite the lack of definite consensus about the most appropriate intervention for HLM, therapeutic preference was directed towards arthroscopic all‐inside and inside‐out repair techniques. Although the surgeon's decision remains the key factor in choosing the most suitable treatment option for each individual, posterior arthroscopic meniscal repair may be considered as a better option for HLM treatment according to the findings of this review.Level of EvidenceLevel IV.

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“…Although clinical evaluations have been introduced for diagnosis ( 21 ), arthroscopy is the best modality for evaluating lateral meniscus movement ( Fig. 5A and B ) and observing popliteomeniscal fascicle rupture at the popliteal hiatus, both of which can be easily performed through posterior arthroscopy ( 26 ) ( Fig. 5C ).…”

Section: Hypermobile Lateral Meniscusmentioning

confidence: 99%

“…Knee locking and osteoarthritic changes were reported as complications after these treatments ( 29 ). Following advances in knee arthroscopy equipment and techniques, the popliteomeniscal junction can now be treated arthroscopically by direct repair ( 26 ) ( Fig. 5D ).…”

Section: Hypermobile Lateral Meniscusmentioning

confidence: 99%

“…Similar to the medial compartment of the knee, assessing the posterior horn of the lateral meniscus utilizing anterior portals to reach the popliteomeniscal ligaments at the popliteal hiatus is limited by the narrow anatomy of the posterolateral compartment ( 30 ). Therefore, posterior arthroscopic techniques can be helpful in these cases to achieve functional and anatomical fixation of the lateral meniscus ( 26 ). As opposed to anterior arthroscopy, posterior arthroscopy provides surgeons with complete access to the popliteomeniscal junction and elevates the sagging fragment without requiring the figure-of-four position ( 31 ) ( Fig.…”

Section: Hypermobile Lateral Meniscusmentioning

confidence: 99%

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Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques

et al. 2023

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Various uses of posterior knee arthroscopy have been shown, including all-inside repair of posterior meniscal lesions, posterior cruciate ligament (PCL) reconstruction or PCL avulsion fixation, extensile posterior knee synovectomy for pigmented villonodular synovitis or synovial chondromatosis, posterior capsular release in the setting of knee flexion contractures, and loose bodies removal. Posterior arthroscopy provides direct access to the posterior meniscal borders for adequate abrasion and fibrous tissue removal. This direct view of the knee posterior structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures. During PCL reconstruction, posterior arthroscopy gives the surgeon proper double access to the tibial insertion site, which can result in less acute curve angles and the creation of a more anatomic tibial tunnel. Moreover, it gives the best opportunity to preserve the PCL remnant. Arthroscopic PCL avulsion fixation is more time-consuming with a larger cost burden compared to open approaches, but in the case of other concomitant intra-articular injuries, it may lead to a better chance of a return to pre-injury activities. The high learning curve and overcaution of neuromuscular injury have discouraged surgeons from practicing posterior knee arthroscopy using posterior portals. Evidence for using posterior portals by experienced surgeons suggests fewer complications. The evidence suggests toward learning posterior knee arthroscopy, and this technique must be part of the education about arthroscopy. In today's professional sports world, where the quick and complete return of athletes to their professional activities is irreplaceable, the use of posterior knee arthroscopy is necessary.

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Repair of popliteomeniscal fascicles tear using a posterior transseptal portal fixes hypermobile lateral meniscus

Cited by 8 publications

References 42 publications

Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears

Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears

Hypermobile lateral meniscus: A systematic review of current treatment options

Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques

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