2017 ISAKOS Biennial Congress ePoster #1308
Arthroscopic Partial Meniscectomy Using Submeniscal Portal for Horizontal Tear of Anterior Horn of the Lateral Meniscus
Sang Hak Lee, MD, PhD, Seoul KOREA, REPUBLIC OF
Kyoung-Ho Yoon, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Jin-Hwan Ahn, MD, Seoul KOREA, REPUBLIC OF
Chan Il Bae, MD, Seoul KOREA, REPUBLIC OF
Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, KOREA, REPUBLIC OF
FDA Status Not Applicable
Summary
A horizontal tear of LMAH by submeniscal portal, ensuring an excellent approach and complete meniscectomy especially lower parts without surgical complication when partial meniscectomy was incomplete in anterior approach.
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Abstract
Purpose
A horizontal tear of lateral meniscus anterior horn(LMAH) is a relatively frequency occurrence, especially in discoid meniscus. However, the lower part of a horizontal tear of LMAH is not easily observed by anterior approach, which often causes reports of remaining symptoms or recurrence following incomplete meniscectomy. Accordingly, this study intends to report on the clinical result conducted on a patient treated with arthroscopic partial meniscectomy based on the submeniscal portal due to a horizontal tear of LMAH.
Methods
Between January 2014 and April 2015, 75 cases were treated by arthroscopic meniscectomy due to a horizontal tear of LMAH whose symptoms were present during the period. Inclusion criteria are 1) those who are confirmed to have a horizontal tear of LMAH as a result of magnetic resonance imaging, and 2) those who are confirmed to have tear fragments on the lower part of LMAH as a result of arthroscopy by anteromedial approach. Among 75 cases with symptoms treated with arthroscopic meniscectomy due to a horizontal tear of LMAH, 33 cases were received additional meniscectomy using the submeniscal portal. Their average age at the time of surgery was 36.9 (range, 3-63) and the average follow up period was 17.1 months (range, 12-26). 31 cases were discoid meniscus (complete type:16 cases, incomplete type:15 cases) and 2 cases were normal shape lateral meniscus. 28 cases were treated with arthroscopic partial meniscectomy only while 5 cases performed meniscus repair additionally. In arthroscopic surgery, as much as we have used anteromedial and anterolateral approaches to perform a partial meniscectomy and performed additional partial meniscectomy by submeniscal portal in the presence of incompletely removed tear fragments at LMAH lower part observed in anteromedial approach. The clinical outcomes have been assessed using the Tegner activity level, Lysolm knee, and the Hospital for Special Surgery (HSS) scores prior to surgery and at final follow-up. In addition, we have inspected whether or not patients are able to fully extent knee joints along with the presence of pains while in extension and varus instability as well.
Results
At final follow-up, all cases were able to fully extend their knee joints without varus instability except 2 cases who had complaint of slight pains in fully extended knee position. One case, recurred pain while extending knee joints at 12-month follow-up, who was performed additional partial meniscectomy and meniscus repair. The mean Tegner activity level improved significantly from 2.9 (1–7) to 6.9 (3–9) (p<0.0001). The average Lysolm knee score and the average HSS score were elevated from 67.6 to 91.0 points (p<0.0001), and from 77.3 to 92.2 points, respectively (p<0.0001).
Conclusion:A horizontal tear of LMAH by submeniscal portal, ensuring an excellent approach and complete meniscectomy especially lower parts without surgical complication when partial meniscectomy was incomplete in anterior approach.