What did the study look at?
Anterior cruciate ligament (ACL) injuries are often accompanied by meniscal injuries. A meniscal root tear is defined as a tear within 1 cm of where the meniscus attaches to bone, and the authors report that such tears make up 20% of all meniscal tears. They note that the medial meniscus acts as a secondary stabiliser against forward movement of the shinbone, and that untreated root tears raise contact pressures in the joint and speed up the development of arthritis. This publication is a technique video describing ACL reconstruction combined with repair of the posterior medial meniscal root through tunnels in the shinbone (a transtibial pull-out technique).
How was it done?
The technique is demonstrated in a 34-year-old man with pain, instability and mechanical symptoms after a twisting injury. MRI showed an ACL tear together with a posterior medial meniscal root tear and marked extrusion of the meniscus. The main steps are:
- A bone–tendon–bone graft was taken from the patient's own patellar tendon and the femoral tunnel was drilled.
- The medial collateral ligament was partly released to create working space, and a bony bed for healing was prepared at the meniscal root's natural attachment site. The authors stress that, according to biomechanical studies, placing the repair even 5 mm away from this site may not restore joint loading properly.
- Two small tunnels 2.8 mm wide and 5 mm apart were drilled in the shinbone, and two sutures placed through the meniscal root were passed through them.
- The tibial ACL tunnel was positioned so that it would not meet the root tunnels; the graft was fixed with titanium screws and the root sutures were tied over a button on the shinbone.
What did it find?
No measured outcomes for this patient are reported. The authors state that, with a standard postoperative protocol, return to sport is anticipated 6–9 months after surgery. The abstract states that within two years patients are expected to have better knee-specific quality of life, less pain, a return to activities and low graft failure rates. The authors also cite a recent systematic review showing significant improvement in a range of outcome scores after transtibial root repair.
The authors' conclusion
The authors conclude that recent advances in understanding the relationship between the medial meniscus and the ACL should encourage surgeons to continue considering this combined treatment in suitable patients. Contraindications listed include advanced osteoarthritis (Kellgren–Lawrence grade 3 or above), a body mass index over 30, poor-quality meniscal tissue and unrepairable cartilage defects. It should be noted that this information is based on a technique description shown in a single patient.
Reference
LaPrade RF, Parvaresh KC, Vadhera AS, Singh H, Gürsoy S, Verma NN, Chahla J. (2023). Anterior Cruciate Ligament Reconstruction With Transtibial Medial Meniscus Root Repair. Video Journal of Sports Medicine, 3(2):26350254231155499. Licence: CC BY-NC-ND 4.0.
DOI: 10.1177/26350254231155499
Free full text: PMC11934115
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
