Takigami Junsei, Hashimoto Yusuke, Tomihara Tomohiro, Taniuchi Masatoshi, Takahashi Daichi, Katsuda Hiroshi
Department of Orthopaedic Surgery, Shimada Hospital, Kashiyama, Japan.
Department of Health and Sport Management, Graduate School of Sport and Exercise Science, Osaka University of Health and Sports Science, Sennan, Japan.
Arthrosc Tech. 2024 May 26;13(9):103031. doi: 10.1016/j.eats.2024.103031. eCollection 2024 Sep.
Pullout repair of medial meniscal posterior root tears (MMPRTs) is generally recommended for patients with well-aligned knees, whereas open-wedge high tibial osteotomy (OWHTO) is often recommended for patients with MMPRTs and varus osteoarthritis. Although the management of MMPRTs with OWHTO has been controversial, retaining meniscal function can be expected through pullout repair. Conventionally, bone tunnels in pullout repair are created from the proximal anteromedial tibia. However, this technique could cause a killer angle of the repaired meniscus and could have a risk of turning the guidewire toward the neurovascular band. Therefore, we create a bone tunnel from the proximal anterolateral tibia combined with open-wedge distal tibial tubercle osteotomy, which can prevent an increase in postoperative patellofemoral contact stress; moreover, the bone tunnel can be created easily from the lateral tibia compared with OWHTO. This Technical Note describes the combined surgical procedure for patients with MMPRTs and varus osteoarthritis, which has advantages including physiological pullout direction of the repaired meniscus, lower risk of neurovascular damage, and placement of a longer plate screw that could interfere with the bone tunnel. We highlight the meticulous consideration given to the interference of the bone tunnel between the osteotomy line and plate screw.
内侧半月板后根撕裂（MMPRTs）的拉出修复通常推荐给膝关节对线良好的患者，而对于MMPRTs合并膝内翻骨关节炎的患者，常推荐开放性楔形高位胫骨截骨术（OWHTO）。尽管采用OWHTO治疗MMPRTs一直存在争议，但通过拉出修复有望保留半月板功能。传统上，拉出修复中的骨隧道是从胫骨近端前内侧创建的。然而，这种技术可能导致修复半月板的“致命角”，并有将导丝转向神经血管束的风险。因此，我们结合开放性楔形胫骨结节远端截骨术，从胫骨近端前外侧创建骨隧道，这可以防止术后髌股关节接触应力增加；此外，与OWHTO相比，从胫骨外侧更容易创建骨隧道。本技术说明描述了针对MMPRTs合并膝内翻骨关节炎患者的联合手术方法，其优点包括修复半月板的生理拉出方向、神经血管损伤风险较低，以及放置可能干扰骨隧道的较长钢板螺钉。我们强调了对截骨线与钢板螺钉之间骨隧道干扰的细致考虑。
