Short-term effectiveness of transtibial pull-out technique for complete radial tear of lateral meniscus body_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHONG Hehe , SUN Pengpeng , CHEN Jing , YAO Haohao , XIONG Huazhang ,  WU Shuhong

Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China;

Corresponding author：

WU Shuhong, Email: 15329112966@163.com

Keywords：

knee; lateral meniscus; radial tear; arthroscopy; transtibial pull-out technique; side-to-side suture technique

DOI：

10.7507/1002-1892.202502023

Video：

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Objective To investigate the short-term effectiveness of transtibial pull-out technique combined with side-to-side suture technique in treatment of complete radial tear of lateral meniscus body. Methods Between May 2020 and August 2023, 15 patients with complete radial tear of lateral meniscus body were repaired by arthroscopic transtibial pull-out technique combined with side-to-side suture technique. There were 11 males and 4 females, with an average age of 25.2 years (range, 15-43 years). Twelve cases were acute injuries and 3 were chronic injuries. All patients had tenderness in the lateral compartment of the knee. No abnormal alignment was observed on the X-ray films of the knee. MRI showed the complete radial tear of lateral meniscus body without associated injuries such as anterior cruciate ligament or cartilage. Preoperative Lysholm score was 44.5±6.4, International Knee Documentation Committee (IKDC) subjective score was 40.2±8.4, Tegner score was 1.3±1.1, and visual analogue scale (VAS) score for pain was 5.1±1.1. The operation time, incision healing, and complications such as vascular/nerve injury were recorded. During follow-up, the range of motion of the knee and tenderness in the lateral compartment of the knee were observed. The knee function and pain were evaluated using Lysholm score, Tegner score, IKDC subjective score, and VAS score. X-ray films and MRI of the knee were reexamined to assess knee degeneration. Results The operation time was 60-145 minutes (mean, 89.6 minutes). All incisions healed by first intention, and no complications such as vascular/nerve injury occurred. All patients were followed up 17-56 months (mean, 38.4 months). All patients had no knee extension limitation and 3 cases had tenderness in the lateral compartment of the knee. The Lysholm score, IKDC subjective score, Tegner score, and VAS score for pain were 85.3±7.8, 82.1±15.7, 4.7±1.2, and 1.5±1.0, respectively, which were superior to those before operation (P<0.05). Imaging reexamination showed that the meniscus was reset at 1 day after operation, and there was no sign of knee degeneration at the last follow-up. Conclusion Transtibial pull-out technique combined with side-to-side suture technique can effectively treat the complete radial tear of lateral meniscus body and obtain good short-term effectiveness.

1.	Kemmochi M, Sasaki S, Takahashi M, et al. The use of platelet-rich fibrin with platelet-rich plasma support meniscal repair surgery. J Orthop, 2018, 15(2): 711-720.
2.	Markes AR, Hodax JD, Ma CB. Meniscus form and function. Clin Sports Med, 2020, 39(1): 1-12.
3.	Danso EK, Oinas JMT, Saarakkala S, et al. Structure-function relationships of human meniscus. J Mech Behav Biomed Mater, 2017, 67: 51-60.
4.	Everhart JS, Magnussen RA, Abouljoud MM, et al. Meniscus tears accelerate joint space loss and lateral meniscal extrusion increases risk of knee arthroplasty in middle-aged adults. J Orthop Res, 2020, 38(11): 2495-2504.
5.	Doral MN, Bilge O, Huri G, et al. Modern treatment of meniscal tears. EFORT Open Rev, 2018, 3(5): 260-268.
6.	Alomar AZ, Al Jedia KM, Shadid AM, et al. Concurrent research around meniscus: a bibliometric analysis and review of the top fifty cited papers. Indian J Orthop, 2022, 56(5): 785-796.
7.	Robles E, Michelin RM, Schlechter JA. Use of an accessory anteromedial portal to facilitaterepair of mid-body radial tears of the lateral meniscus in children and adolescents. Arthroscopy Tech, 2021, 10(12): 2675-2681.
8.	José LR, Pavao DM, Albuquerque RS, et al. Continuous meniscal suture in radial meniscal tear: the Hourglass technique. Arthroscopy Tech, 2021, 10(7): 1763-1772.
9.	Winkler PW, Wiere G, Csapo R, et al. Quantitative evaluation of dynamic lateral meniscal extrusion after radial tear repair. Orthop J Sports Med, 2020, 8 (4): 2325967120914568. doi: 10.1177/2325967120914568.
10.	Atsumi S, Hara K, Arai Y, et al. A novel arthroscopic all-inside suture technical using the Fast-Fix 360 system for repairing horizontal meniscal tears in yong athletes: 3 case report. Medicine, 2018, 19(2): 112-115.
11.	Hansen CF, Madsen MØ, Warming S, et al. Pedi-IKDC exhibits questionable measurement properties in a cohort of pediatric patients with ACL rupture. Scand J Med Sci Sports, 2023, 33(9): 1831-1840.
12.	Lin JS, Akers A, Miller TL. Updates and advances in the management of lateral meniscal radial tears: a critical analysis review. JBJS Rev, 2020, 8(11): e2000056. doi: 10.2106/JBJS.RVW.20.00056.
13.	Jeon YS, Alsomali K, Yang SW, et al. Posterior horn lateral meniscal oblique radial tear in acute anterior cruciate ligament reconstruction incidence and outcomes after all-inside repair: clinical and second-look arthroscopic evaluation. Am J Sports Med, 2022, 50(14): 3796-3804.
14.	Zhang ZZ, Luo H, Zhang HZ, et al. H-plasty repair technique improved tibiofemoral contact mechanics after repair for adjacent radial tears of posterior lateral meniscus root: a biomechanical study. Arthroscopy, 2021, 37(7): 2204-2216.
15.	Homan MD, Kennedy NI, LaPrade CM, et al. Combined rip-stop and transtibial pull-out technique for lateral meniscus radial repairs. Arthrosc Tech, 2023, 12(9): e1623-e1629.
16.	Kim JG, Lee DW. Editorial commentary: Efforts to heal meniscal radial tears are ongoing. Arthroscopy, 2021, 37(3): 941-943.
17.	LaPrade RF, LaPrade CM, James EW. Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg, 2015, 23(2): 71-76.
18.	Chang PS, Radtke L, Ward P, et al. Midterm outcomes of posterior medial meniscus root tear repair: a systematic review. Am J Sports Med, 2022, 50(2): 545-553.
19.	LaPrade RF, Matheny LM, Moulton SG, et al. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Am J Sports Med, 2017, 45(4): 884-891.
20.	Yasuda K, Sakai T, Kondo E, et al. Bleeding from the bone marrow enhances remodeling of the in situ frozen-thawed anterior cruciate ligament. Clin Biomech (Bristol), 2007, 22(8): 941-949.

1. Kemmochi M, Sasaki S, Takahashi M, et al. The use of platelet-rich fibrin with platelet-rich plasma support meniscal repair surgery. J Orthop, 2018, 15(2): 711-720.
2. Markes AR, Hodax JD, Ma CB. Meniscus form and function. Clin Sports Med, 2020, 39(1): 1-12.
3. Danso EK, Oinas JMT, Saarakkala S, et al. Structure-function relationships of human meniscus. J Mech Behav Biomed Mater, 2017, 67: 51-60.
4. Everhart JS, Magnussen RA, Abouljoud MM, et al. Meniscus tears accelerate joint space loss and lateral meniscal extrusion increases risk of knee arthroplasty in middle-aged adults. J Orthop Res, 2020, 38(11): 2495-2504.
5. Doral MN, Bilge O, Huri G, et al. Modern treatment of meniscal tears. EFORT Open Rev, 2018, 3(5): 260-268.
6. Alomar AZ, Al Jedia KM, Shadid AM, et al. Concurrent research around meniscus: a bibliometric analysis and review of the top fifty cited papers. Indian J Orthop, 2022, 56(5): 785-796.
7. Robles E, Michelin RM, Schlechter JA. Use of an accessory anteromedial portal to facilitaterepair of mid-body radial tears of the lateral meniscus in children and adolescents. Arthroscopy Tech, 2021, 10(12): 2675-2681.
8. José LR, Pavao DM, Albuquerque RS, et al. Continuous meniscal suture in radial meniscal tear: the Hourglass technique. Arthroscopy Tech, 2021, 10(7): 1763-1772.
9. Winkler PW, Wiere G, Csapo R, et al. Quantitative evaluation of dynamic lateral meniscal extrusion after radial tear repair. Orthop J Sports Med, 2020, 8 (4): 2325967120914568. doi: 10.1177/2325967120914568.
10. Atsumi S, Hara K, Arai Y, et al. A novel arthroscopic all-inside suture technical using the Fast-Fix 360 system for repairing horizontal meniscal tears in yong athletes: 3 case report. Medicine, 2018, 19(2): 112-115.
11. Hansen CF, Madsen MØ, Warming S, et al. Pedi-IKDC exhibits questionable measurement properties in a cohort of pediatric patients with ACL rupture. Scand J Med Sci Sports, 2023, 33(9): 1831-1840.
12. Lin JS, Akers A, Miller TL. Updates and advances in the management of lateral meniscal radial tears: a critical analysis review. JBJS Rev, 2020, 8(11): e2000056. doi: 10.2106/JBJS.RVW.20.00056.
13. Jeon YS, Alsomali K, Yang SW, et al. Posterior horn lateral meniscal oblique radial tear in acute anterior cruciate ligament reconstruction incidence and outcomes after all-inside repair: clinical and second-look arthroscopic evaluation. Am J Sports Med, 2022, 50(14): 3796-3804.
14. Zhang ZZ, Luo H, Zhang HZ, et al. H-plasty repair technique improved tibiofemoral contact mechanics after repair for adjacent radial tears of posterior lateral meniscus root: a biomechanical study. Arthroscopy, 2021, 37(7): 2204-2216.
15. Homan MD, Kennedy NI, LaPrade CM, et al. Combined rip-stop and transtibial pull-out technique for lateral meniscus radial repairs. Arthrosc Tech, 2023, 12(9): e1623-e1629.
16. Kim JG, Lee DW. Editorial commentary: Efforts to heal meniscal radial tears are ongoing. Arthroscopy, 2021, 37(3): 941-943.
17. LaPrade RF, LaPrade CM, James EW. Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg, 2015, 23(2): 71-76.
18. Chang PS, Radtke L, Ward P, et al. Midterm outcomes of posterior medial meniscus root tear repair: a systematic review. Am J Sports Med, 2022, 50(2): 545-553.
19. LaPrade RF, Matheny LM, Moulton SG, et al. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Am J Sports Med, 2017, 45(4): 884-891.
20. Yasuda K, Sakai T, Kondo E, et al. Bleeding from the bone marrow enhances remodeling of the in situ frozen-thawed anterior cruciate ligament. Clin Biomech (Bristol), 2007, 22(8): 941-949.

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