Arthroscopic Transosseous Repair of Medial Meniscal Posterior-Root Tear: Pass Sutures

Video 7 of 10 from the JBJS EST article, Arthroscopic Transosseous Repair of a Medial Meniscal Posterior-Root Tear, by Nicholas P. Gannon, Kelsey L. Wise, Jeffrey A. Macalena. Published October 7, 2021.
➡️ https://bit.ly/3zmV922

Journal: JBJS Essential Surgical Techniques
➡️ https://jbjs.org/journal.php?j=est

Subspecialties: Knee, Sports Medicine

Background: Meniscal root tears are soft-tissue and/or osseous injuries characterized by an avulsion of, or tear within 1 cm of, the native meniscal insertion1. These injuries account for 10% to 21% of all meniscal tears, affecting nearly 100,000 patients annually. Medial meniscal posterior-root tears (MMPRTs) expose the tibiofemoral joint to supraphysiologic contact pressure, decreased contact area, and altered knee kinematics similar to a total meniscectomy3. This injury predisposes the patient to exceedingly high rates of osteoarthritis and total knee arthroplasty secondary to an inability to resist hoop stress4. The arthroscopic transosseous repair of an MMPRT is described in the present article.

Description: (1) Preoperative evaluation, including patient history, examination, and imaging (i.e., radiographs and magnetic resonance imaging). (2) Preparation and positioning. The patient is placed in the supine position, and anteromedial and anterolateral portals are created. (3) Placement of sutures. Two simple cinch sutures are placed into the posterior horn, within approximately 5 mm of each other. (4) Footprint decortication. Remove articular cartilage from the native root insertion site. (5) Drilling of the transosseous tibial tunnel. Introduce a tibial tunnel guide over the decorticated base, set guide to 45° to 50°, place a 2-cm vertical incision over an anteromedial tibial guide footprint, advance a 2.4-mm guide pin through the guide, and overream to 5 mm. (6) Passing of the sutures with use of a looped suture passer introduced retrograde through the tibial tunnel to retrieve sutures. (7) Anchor placement and fixation. Apply maximum suture traction, drill a second aperture 0.5 to 1.0 cm distal to the original aperture on the anteromedial aspect of the tibia, pass the suture ends through the anchor, and fix the anchor into the aperture. (8) Repair evaluation and closure. Note the position and stability of the meniscal root relative to the native footprint. Standard closure in layers is performed.

Keywords: JBJS, EST, Essential Surgical Techniques, Key Procedures, medial meniscus posterior root tears, MMPRT, indirect suture anchor repair, indirect transosseous transtibial repair, pin placement, overreaming, reamer, straight suture passer, stiffened suture, tibial tunnel, suture retriever, soft tissue bridge, cannula, meniscus, tibia

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