Refixation einer posterioren medialen Wurzelläsion in Kombination mit Zentralisation durch meniskotibiale Naht

Objective

Refixation of a posterior root lesion of the medial meniscus via a tibial drill tunnel and prevention of extrusion using a meniscotibial suture (centralization).

Indications

Posterior root lesion of the medial meniscus.

Contraindications

Grade 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region.

Surgical technique

Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of a targeting device and drilling of a targeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a 4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with a thread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the “outside in” technique and fixation of the inner meniscus base at the edge of the tibial plateau using a transosseous extraction suture or a suture anchor.

Postoperative management

Six weeks nonweight-bearing (0 kg), then gradually increased load. Range of motion: 4 weeks E/F 0–0–60°, 2 weeks 0–0–90°, optionally use of a valgus brace (varus of < 5°).

Results

In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, a transosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.