Lynch Danny, Duerr Robert A
Department of Orthopedic Surgery, Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Video J Sports Med. 2022 Feb 1;2(1):26350254211058736. doi: 10.1177/26350254211058736. eCollection 2022 Jan-Feb.
Medial meniscus posterior root tears (MMPRT) can lead to significant pain, functional limitations, and osteoarthritis (OA). Biomechanically, MMPRT has been shown to be equivalent to total meniscectomy in terms of peak contact pressure in the medial compartment. Transtibial repair of a meniscus root tear has also been shown to restore hoop stresses and reduced peak contact pressure to the normal intact state. Clinically, root repair was shown to reduce rates of OA progression and need for total knee arthroplasty when compared with nonoperative treatment or partial meniscectomy for MMPRT.
Medial meniscus posterior root repair is indicated in patients with a symptomatic MMPRT who are appropriate surgical candidates: age ≤65 years, body mass index ≤40 kg/m, <5° varus alignment, no more than Kellgren-Lawrence grade 2 changes, and willing and able to undergo the demanding postoperative rehabilitation program.
This surgical technique video demonstrates our preferred technique for arthroscopic transtibial medial meniscus posterior root repair using a case example in a commonly encountered patient. The repair is completed using a 3 simple suture triangle configuration with 2 tibial tunnels to create a broad footprint for healing.
There are a number of case series and comparative studies published with good clinical outcomes using similar transtibial medial meniscus posterior root repair techniques. In short-term follow-up of 18 patients at a mean of 10.5 months post-operatively, we have demonstrated improvements in pain and functional status with a 16.7% clinical failure rate and 11% rate of conversion to arthroplasty.
In this surgical technique video, we review the anatomy of the native medial meniscus posterior root and the biomechanical and clinical consequences of a MMPRT. We highlight important technique pearls and pitfalls to avoid failures and complications during the surgical demonstration. Finally, we review postoperative rehabilitation guidelines and clinical outcomes within the existing literature. In patients with MMPRT, transtibial repair provides a safe and reliable technique to achieve healing of the medial meniscus posterior root and return patients to full activities with reduced risk of OA progression.
内侧半月板后根撕裂（MMPRT）可导致严重疼痛、功能受限和骨关节炎（OA）。从生物力学角度来看，MMPRT在内侧间室的峰值接触压力方面已被证明等同于半月板全切除术。半月板根撕裂的经胫骨修复也已被证明可恢复环向应力，并将峰值接触压力降低至正常完整状态。临床上，与MMPRT的非手术治疗或部分半月板切除术相比，根修复显示可降低OA进展率和全膝关节置换术的需求。
内侧半月板后根修复适用于有症状的MMPRT且适合手术的患者：年龄≤65岁，体重指数≤40kg/m²，内翻畸形<5°，Kellgren-Lawrence分级不超过2级变化，并且愿意且能够接受严格的术后康复计划。
本手术技术视频通过一个常见患者的病例展示了我们首选的关节镜下经胫骨内侧半月板后根修复技术。使用3个简单缝线三角形配置和2个胫骨隧道完成修复，以创建一个宽阔的愈合区域。
使用类似的经胫骨内侧半月板后根修复技术发表了许多病例系列和比较研究，临床结果良好。在对18例患者进行平均术后10.5个月的短期随访中，我们证明了疼痛和功能状态有所改善，临床失败率为16.7%，转换为关节置换术的比率为11%。
在本手术技术视频中，我们回顾了天然内侧半月板后根的解剖结构以及MMPRT的生物力学和临床后果。我们强调了重要的技术要点和陷阱，以避免手术演示过程中的失败和并发症。最后，我们回顾了现有文献中的术后康复指南和临床结果。对于MMPRT患者，经胫骨修复提供了一种安全可靠的技术，可实现内侧半月板后根的愈合，并使患者恢复完全活动，同时降低OA进展的风险。
