posterior meniscal root tears
Posterior meniscal root tears are common concomitant injuries in case of anterior cruciate ligament (ACL) injury. Preservation of the posterior meniscal root is important to prevent an increase in tibiofemoral contact pressure, which could result in osteoarthritis. We describe an arthroscopic evaluation after treatment for posterior meniscal root tear associated with ACL injury.
Among patients with anatomical double bundle ACL reconstruction with hamstring tendon autograft, there were 148 patients who were able to evaluate by postoperative arthroscopy. Eleven patients of them were performed suturing or removal of a part of the posterior meniscal root tear, we compared the site and form of the posterior meniscal root tears at the initial surgery with the results of the postoperative arthroscopic evaluation. Eleven patients were 6 men and 5 women, with an average age 30.3 years (range 13-56 years).
Knee instability improved after ACL reconstruction surgery in all the patients. Of these 11 patients with a posterior meniscal root tear, 2 had a medial meniscus tear and 9 a lateral meniscus tear. In terms of LaPrade classification, there was 1 case of medial meniscus Type-3 tear and 1 with a Type-4 tear. Concerning about patients with a lateral meniscus tear, there was 1 with a Type-1 tear, 2 with Type-3 and 6 with a Type-4 tear. The all-inside suture method using Suture Hook technique and FAST-FIX 360 was performed in 8 patients, removal of a part of the meniscus was performed in 3 patients. According to Seo classification, arthroscopic evaluation showed complete healing in 5 patients and lax healing in 3 patients. In all cases of all-inside suturing for a posterior meniscal root tear, meniscal instability had improved and good results were obtained, but in cases requiring removal of a part of the meniscus, cartilage damage had worsened.
As for short-term postoperative results, good results were obtained with the all-inside suture method for posterior meniscal root tear.
Moreover, since cartilage damage worsened after removal of a part of the meniscus, we consider that aggressive suturing contributes to prevent cartilage damage worsening.