What did the study look at?
The meniscal roots anchor the meniscus to the bone and are important for preserving the structural and biomechanical properties of the knee joint. The authors note that posterior meniscal root avulsions can cause the meniscus to be pushed out of the joint (extrusion), joint space narrowing and progressive arthritis.
Root tears caused by the surgery itself (iatrogenic), due to malpositioned tunnels during ACL reconstruction, have been reported before. The article aims to show step by step how such a lateral meniscus posterior root tear was diagnosed and treated.
How was it done?
The patient was a 32-year-old male footballer who had undergone ACL reconstruction with his own hamstring tendon 15 months earlier and a partial medial meniscectomy on the same knee about 7 months earlier. He presented with marked pain on the outer side of the knee that had never settled after the ACL reconstruction. Examination showed motion from 1° to 110°, a mild effusion and tenderness along the lateral joint line.
Imaging showed that the tibial tunnel was quite posterior, and MRI showed a lateral meniscal root tear directly next to the ACL graft. At surgery the ACL graft was stable, so it was left in place to avoid the risk of tunnel convergence. The main steps were:
- Preparing the root footprint on the bone with a curette.
- Drilling two parallel 2.4-mm tunnels in the tibia.
- Passing two sutures through the posterior root of the meniscus and pulling them down through the tunnels (transtibial pull-out technique).
- Tying the sutures over a button on the front of the tibia with the knee at 90° of flexion.
What did it find?
Final arthroscopic inspection showed a well-reduced posterior root of the lateral meniscus. The patient's long-term outcome is not reported in this publication. The postoperative plan was no weight-bearing for 4 weeks with the brace locked in extension, range-of-motion work from the first day and an estimated return to activities at 6 to 9 months.
The authors cite earlier work reporting significant improvement in Lysholm and WOMAC scores in 45 patients treated with the transtibial pull-out technique and followed for at least 2 years.
The authors' conclusion
According to the authors, this injury underlines the importance of accurate tibial tunnel placement during ACL reconstruction to avoid posterior meniscal root injuries and related complications. They state that clinicians should consider this condition in patients with persistent pain and instability after a primary ACL reconstruction.
Limitations
The authors list the risks of this repair as repair failure, convergence with the ACL tunnel and further damage from over-repair. They also note that long-term results of repairs in a chronically unstable knee are suboptimal and may lead to osteoarthritis and recurrent instability. The publication is a technique description based on a single case.
Reference
Vadhera AS, DeFroda SF, Lee JS, Singh H, Gürsoy S, Kunze KN, Verma NN, Chahla J. (2023). Treatment of an Iatrogenic Lateral Meniscal Root Tear After ACL Reconstruction. Video Journal of Sports Medicine, 3(1), 26350254221141904. Licence: CC BY-NC-ND 4.0.
DOI: 10.1177/26350254221141904
Free full text: PMC11931228
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.
