Langhans Mark T, Hevesi Mario, Pan Xuankang, Smith Patrick A, Krych Aaron J
Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopedic Surgery, Columbia Orthopaedic Group, Columbia, Missouri, USA.
Video J Sports Med. 2024 Apr 16;4(2):26350254231212931. doi: 10.1177/26350254231212931. eCollection 2024 Mar-Apr.
Lateral meniscal oblique radial tears (LMORTs) are the most common type of lateral meniscal tears and occur concomitantly with anterior cruciate ligament (ACL) tears in up to 12% of cases. Four types of LMORTs have been classified in the literature based on proximity to the meniscal root and extent of the tear. Type 1 and 2 LMORTs represent partial and complete posterior root tears less than 10 mm from the root insertion. Type 3 and 4 LMORTs are partial and complete posterior radial meniscus tears greater than 10 mm from the root insertion.
Type 3 and 4 LMORTs can and should be addressed with an all-inside side-to-side repair at the time of ACL reconstruction. LMORTs that are not repaired at the time of ACL reconstruction can contribute to persistent instability and meniscal extrusion.
Diagnostic arthroscopy is performed to evaluate the posterior aspects of both the medial and lateral meniscus. The medial leaflet is commonly flipped into the notch and scarred to ACL remnant. After identifying and isolating the medial leaflet, an arthroscopic suture passer is used to pass a suture from inferior to superior through the medial leaflet. A second suture is passed from inferior to superior through the lateral leaflet. This is used to shuttle the suture pass through the medial leaflet to the bottom of the meniscus, where it can be tied in a horizontal mattress fashion. The sutures are tied down with aide of an arthroscopic knot pusher. A second set of sutures is passed and used to shuttle a second suture that would be tied posterior to the first suture, again in a horizontal mattress fashion. This allows reduction of the fragments in apposition across the tear. Postoperatively, patients are allowed range of motion from 0° to 90° and to toe touch weightbearing for the first 4 weeks. Patients are advanced to weightbearing as tolerated at 5 weeks. Typical return to sport ranges from 6 to 9 months postoperatively.
Results have been published for 2-year outcomes of type 3 and 4 LMORT repairs and have demonstrated persistent improved patient-reported outcomes as well as healing rates that are greater than 80% and in some series approach nearly 100%.
DISCUSSION/CONCLUSION: Arthroscopic all-inside side-to-side surgical repair is a durable and reliable treatment option for patients presenting for ACL reconstruction with concomitant type 3 or 4 LMORT.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
外侧半月板斜行放射状撕裂（LMORTs）是外侧半月板撕裂最常见的类型，在高达12%的病例中与前交叉韧带（ACL）撕裂同时发生。根据与半月板根部的距离和撕裂程度，文献中已将LMORTs分为四种类型。1型和2型LMORTs代表距根部插入点小于10mm的部分和完全后根部撕裂。3型和4型LMORTs是距根部插入点大于10mm的部分和完全后外侧半月板撕裂。
3型和4型LMORTs在ACL重建时可以且应该采用全关节镜下的横向修复。在ACL重建时未修复的LMORTs可导致持续不稳定和半月板挤压。
进行诊断性关节镜检查以评估内侧和外侧半月板的后部。内侧半月板瓣叶通常会翻转至髁间凹并与ACL残端形成瘢痕。识别并分离内侧半月板瓣叶后，使用关节镜缝合器从下向上穿过内侧半月板瓣叶。第二根缝线从下向上穿过外侧半月板瓣叶。这用于将缝线穿梭通过内侧半月板瓣叶至半月板底部，在此处以水平褥式缝合方式打结。缝线在关节镜打结器的辅助下系紧。穿过第二组缝线，并用于穿梭另一根缝线，该缝线将在第一根缝线后方以水平褥式缝合方式打结。这可使撕裂处的碎片对合复位。术后，患者在最初4周内可进行0°至90° 的活动范围，并可脚尖触地负重。5周时根据耐受情况逐渐增加负重。典型的恢复运动时间为术后6至9个月。
已公布3型和4型LMORT修复的2年结果，结果显示患者报告的结果持续改善，愈合率大于80%，在某些系列中接近100%。
讨论/结论：对于伴有3型或4型LMORT的ACL重建患者，关节镜下全关节镜横向手术修复是一种持久且可靠的治疗选择。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
