Arthroscopic one-stage direct suture technique for treating anterior cruciate ligament injury combined with anterior meniscus root injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIONG Wentao ^1,2 , ZHANG Fei ³ ^{共同第一作者} , LIU Yang ³ , MA Jipeng ³ ,  ZHANG Qiang ³

1. Chinese People’s Liberation Army Medical School, Beijing, 100093, P. R. China;
2. Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, Sanya Hainan, 572013, P. R. China;
3. Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, 100853, P. R. China;

Corresponding author：

ZHANG Qiang, Email: 301zq@live.cn

Keywords：

Anterior cruciate ligament injury; anterior meniscus root injury; tibial intercondylar eminence fracture; arthroscopy

DOI：

10.7507/1002-1892.202506100

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Objective To investigate the effectiveness of one-stage direct suture technique under arthroscopy for the treatment of anterior cruciate ligament (ACL) injury combined with anterior meniscus root injury. Methods The clinical data of 9 patients with ACL injury or tibial intercondylar eminence fracture combined with anterior meniscus root injury who were admitted and met the selection criteria between September 2017 and September 2024 were retrospectively analyzed. There were 3 males and 6 females, aged 21-52 years, with an average age of 37.1 years. The time from injury to surgery ranged from 5 days to 5 years, with a median time of 40 days. Among them, 5 cases had ACL injury, including 4 cases of type 1 and 1 case of type 2 according to Sherman classification; 4 cases had tibial intercondylar eminence fracture, including 3 cases of type 3 and 1 case of type 2 according to Meyers-McKeever classification. There were 7 cases of anterior root injury of lateral meniscus and 2 cases of anterior root injury of medial meniscus. The preoperative International Knee Documentation Committee (IKDC) score was 45.0±12.3, and Lysholm score was 49.2±12.4. Preoperatively, 7 cases were positive in anterior drawer test, Lachman test, and McMurray test, while 2 cases could not complete the test due to pain limitation. Preoperatively and at last follow-up, IKDC score and Lysholm score were used to evaluate knee joint function, anterior drawer test and Lachman test were used to evaluate knee joint stability, and McMurray test was used to evaluate meniscus condition. Results The operation time was 30-100 minutes, with an average of 64.2 minutes; the total hospital stay was 2-12 days, with an average of 4.5 days; the postoperative hospital stay was 1-4 days, with an average of 1.8 days. All incisions healed by first intention without surgery-related complications. All 9 patients were followed up 2-30 months, with an average of 18.8 months. No internal fixation-related complications occurred during the follow-up. At last follow-up, MRI review showed good ligament tension, and CT showed good fracture healing. The results of anterior drawer test and Lachman test were all negative. McMurray sign was negative in all cases. The IKDC score was 88.3±5.1, and Lysholm score was 88.3±5.6, both showing significant improvement compared to preoperative scores (t=14.001, P<0.001; t=10.192, P<0.001). Conclusion One-stage direct suture technique under arthroscopy for repairing ACL injury or tibial intercondylar eminence fracture combined with anterior meniscus root injury can achieve good effectiveness without fixation device-related complications.

1.	Sherman MF, Lieber L, Bonamo JR, et al. The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med, 1991, 19(3): 243-255.
2.	Wait TJ, Kolaczko JG, Stevanovic O, et al. Lateral Extra-articular Tenodesis: The Onlay Technique. Arthrosc Tech, 2023, 12(8): e1383-e1389.
3.	van der List JP, DiFelice GS. Arthroscopic Primary Anterior Cruciate Ligament Repair With Suture Augmentation. Arthrosc Tech, 2017, 6(5): e1529-e1534.
4.	Liao W, Zhang Q. Arthroscopic primary repair for partial proximal anterior cruciate ligament tear in military personnel. Clin J Sport Med, 2021, 31(5): e258-e264.
5.	Liao W, Zhang Q. Is primary arthroscopic repair using the pulley technique an effective treatment for partial proximal ACL tears? Clin Orthop Relat Res, 2020, 478(5): 1031-1045.
6.	Ahmad SS, Difelice GS, van der List JP, et al. Primary repair of the anterior cruciate ligament: real innovation or reinvention of the wheel? Knee Surg Sports Traumatol Arthrosc, 2019, 27(1): 1-2.
7.	van der List JP, DiFelice GS. Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament. Knee, 2017, 24(4): 798-807.
8.	Achtnich A, Herbst E, Forkel P, et al. Acute proximal anterior cruciate ligament tears: Outcomes after arthroscopic suture anchor repair versus anatomic single-bundle reconstruction. Arthroscopy, 2016, 32(12): 2562-2569.
9.	Ahn JH, Lee YS, Chang JY, et al. Arthroscopic all inside repair of the lateral meniscus root tear. Knee, 2009, 16(1): 77-80.
10.	LaPrade RF, Floyd E, Carlson G, et al. Meniscal root tears: Solving the silent epidemic. Journal of Arthroscopic Surgery and Sports Medicine, 2021, 2: 47-57.
11.	Feucht MJ, Bigdon S, Bode G, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res, 2015, 10: 34. doi: 10.1186/s13018-015-0184-x.
12.	Banovetz MT, Roethke LC, Rodriguez AN, et al. Meniscal root tears: A decade of research on their relevant anatomy, biomechanics, diagnosis, and treatment. Arch Bone Jt Surg, 2022, 10(5): 366-380.
13.	Espejo-Reina A, Prado-Novoa M, Espejo-Baena A, et al. Biomechanical consequences of anterior root detachment of the lateral meniscus and its reinsertion. Sci Rep, 2022, 12(1): 6182. doi: 10.1038/s41598-022-10229-5.
14.	未查到该文献, 请提供电子版以便我们对照.Itthipanichpong T, Moonwong S. Medial Meniscus Root Tear: Current Update Review. 2022.
15.	Menge TJ, Chahla J, Dean CS, et al. Anterior meniscal root repair using a transtibial double-tunnel pullout technique. Arthrosc Tech, 2016, 5(3): e679-e684.
16.	Feucht MJ, Minzlaff P, Saier T, et al. Avulsion of the anterior medial meniscus root: case report and surgical technique. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1): 146-151.
17.	Nikolić DK. Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc, 1998, 6(1): 26-30.
18.	Vedi V, Williams A, Tennant SJ, et al. Meniscal movement. An in-vivo study using dynamic MRI. J Bone Joint Surg (Br), 1999, 81(1): 37-41.
19.	Bernard CD, Kennedy NI, Tagliero AJ, et al. Medial meniscus posterior root tear treatment: A matched cohort comparison of nonoperative management, partial meniscectomy, and repair. Am J Sports Med, 2020, 48(1): 128-132.
20.	Kim JY, Bin SI, Kim JM, et al. Partial meniscectomy provides the favorable outcomes for symptomatic medial meniscus tear with an intact posterior root. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3497-3503.
21.	Iversen JV, Krogsgaard MR. Tibial avulsion fracture of the posterior root of the medial meniscus in children. Knee Surg Sports Traumatol Arthrosc, 2014, 22(1): 109-111.
22.	Hein CN, Deperio JG, Ehrensberger MT, et al. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee, 2011, 18(3): 189-192.
23.	Sai Krishna MLV, Chauhan N, Vanapalli RK, et al. Anterior root tear of the meniscus: A report of two cases. Indian J Orthop, 2023, 57(7): 1158-1163.
24.	Shen JW, Song GY, Zhang H, et al. Prevalence of lateral meniscal extrusion for posterior lateral meniscal root lesion with and without concomitant midbody radial tear in anterior cruciate ligament injury. Arthroscopy, 2016, 32(5): 828-834.
25.	Aderinto J, Walmsley P, Keating JF. Fractures of the tibial spine: epidemiology and outcome. Knee, 2008, 15(3): 164-167.
26.	Owens BD, Crane GK, Plante T, et al. Treatment of type Ⅲ tibial intercondylar eminence fractures in skeletally immature athletes. Am J Orthop (Belle Mead NJ), 2003, 32(2): 103-105.
27.	Ishibashi Y, Tsuda E, Sasaki T, et al. Magnetic resonance imaging AIDS in detecting concomitant injuries in patients with tibial spine fractures. Clin Orthop Relat Res, 2005(434): 207-212.
28.	Hayes JM, Masear VR. Avulsion fracture of the tibial eminence associated with severe medial ligamentous injury in an adolescent. A case report and literature review. Am J Sports Med, 1984, 12(4): 330-333.
29.	van Loon T, Marti RK. A fracture of the intercondylar eminence of the tibia treated by arthroscopic fixation. Arthroscopy, 1991, 7(4): 385-388.
30.	Lubowitz JH, Grauer JD. Arthroscopic treatment of anterior cruciate ligament avulsion. Clin Orthop Relat Res, 1993(294): 242-246.
31.	McLennan JG. The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia. J Bone Joint Surg (Br), 1982, 64(4): 477-480.
32.	Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI Study Group. Am J Sports Med, 2017, 45(7): 1547-1557.
33.	Castoldi M, Magnussen RA, Gunst S, et al. A randomized controlled trial of bone-patellar tendon-bone anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis: 19-year clinical and radiological follow-up. Am J Sports Med, 2020, 48(7): 1665-1672.
34.	Inderhaug E, Stephen JM, Williams A, et al. Anterolateral tenodesis or anterolateral ligament complex reconstruction: Effect of flexion angle at graft fixation when combined with ACL reconstruction. Am J Sports Med, 2017, 45(13): 3089-3097.
35.	Inderhaug E, Stephen JM, Williams A, et al. Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction. Am J Sports Med, 2017, 45(2): 347-354.
36.	Inderhaug E, Stephen JM, El-Daou H, et al. The effects of anterolateral tenodesis on tibiofemoral contact pressures and kinematics. Am J Sports Med, 2017, 45(13): 3081-3088.
37.	Shimakawa T, Burkhart TA, Dunning CE, et al. Lateral compartment contact pressures do not increase after lateral extra-articular tenodesis and subsequent subtotal meniscectomy. Orthop J Sports Med, 2019, 7(6): 2325967119854657. doi: 10.1177/2325967119854657.

1. Sherman MF, Lieber L, Bonamo JR, et al. The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med, 1991, 19(3): 243-255.
2. Wait TJ, Kolaczko JG, Stevanovic O, et al. Lateral Extra-articular Tenodesis: The Onlay Technique. Arthrosc Tech, 2023, 12(8): e1383-e1389.
3. van der List JP, DiFelice GS. Arthroscopic Primary Anterior Cruciate Ligament Repair With Suture Augmentation. Arthrosc Tech, 2017, 6(5): e1529-e1534.
4. Liao W, Zhang Q. Arthroscopic primary repair for partial proximal anterior cruciate ligament tear in military personnel. Clin J Sport Med, 2021, 31(5): e258-e264.
5. Liao W, Zhang Q. Is primary arthroscopic repair using the pulley technique an effective treatment for partial proximal ACL tears? Clin Orthop Relat Res, 2020, 478(5): 1031-1045.
6. Ahmad SS, Difelice GS, van der List JP, et al. Primary repair of the anterior cruciate ligament: real innovation or reinvention of the wheel? Knee Surg Sports Traumatol Arthrosc, 2019, 27(1): 1-2.
7. van der List JP, DiFelice GS. Range of motion and complications following primary repair versus reconstruction of the anterior cruciate ligament. Knee, 2017, 24(4): 798-807.
8. Achtnich A, Herbst E, Forkel P, et al. Acute proximal anterior cruciate ligament tears: Outcomes after arthroscopic suture anchor repair versus anatomic single-bundle reconstruction. Arthroscopy, 2016, 32(12): 2562-2569.
9. Ahn JH, Lee YS, Chang JY, et al. Arthroscopic all inside repair of the lateral meniscus root tear. Knee, 2009, 16(1): 77-80.
10. LaPrade RF, Floyd E, Carlson G, et al. Meniscal root tears: Solving the silent epidemic. Journal of Arthroscopic Surgery and Sports Medicine, 2021, 2: 47-57.
11. Feucht MJ, Bigdon S, Bode G, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res, 2015, 10: 34. doi: 10.1186/s13018-015-0184-x.
12. Banovetz MT, Roethke LC, Rodriguez AN, et al. Meniscal root tears: A decade of research on their relevant anatomy, biomechanics, diagnosis, and treatment. Arch Bone Jt Surg, 2022, 10(5): 366-380.
13. Espejo-Reina A, Prado-Novoa M, Espejo-Baena A, et al. Biomechanical consequences of anterior root detachment of the lateral meniscus and its reinsertion. Sci Rep, 2022, 12(1): 6182. doi: 10.1038/s41598-022-10229-5.
14. 未查到该文献, 请提供电子版以便我们对照.Itthipanichpong T, Moonwong S. Medial Meniscus Root Tear: Current Update Review. 2022.
15. Menge TJ, Chahla J, Dean CS, et al. Anterior meniscal root repair using a transtibial double-tunnel pullout technique. Arthrosc Tech, 2016, 5(3): e679-e684.
16. Feucht MJ, Minzlaff P, Saier T, et al. Avulsion of the anterior medial meniscus root: case report and surgical technique. Knee Surg Sports Traumatol Arthrosc, 2015, 23(1): 146-151.
17. Nikolić DK. Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc, 1998, 6(1): 26-30.
18. Vedi V, Williams A, Tennant SJ, et al. Meniscal movement. An in-vivo study using dynamic MRI. J Bone Joint Surg (Br), 1999, 81(1): 37-41.
19. Bernard CD, Kennedy NI, Tagliero AJ, et al. Medial meniscus posterior root tear treatment: A matched cohort comparison of nonoperative management, partial meniscectomy, and repair. Am J Sports Med, 2020, 48(1): 128-132.
20. Kim JY, Bin SI, Kim JM, et al. Partial meniscectomy provides the favorable outcomes for symptomatic medial meniscus tear with an intact posterior root. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3497-3503.
21. Iversen JV, Krogsgaard MR. Tibial avulsion fracture of the posterior root of the medial meniscus in children. Knee Surg Sports Traumatol Arthrosc, 2014, 22(1): 109-111.
22. Hein CN, Deperio JG, Ehrensberger MT, et al. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee, 2011, 18(3): 189-192.
23. Sai Krishna MLV, Chauhan N, Vanapalli RK, et al. Anterior root tear of the meniscus: A report of two cases. Indian J Orthop, 2023, 57(7): 1158-1163.
24. Shen JW, Song GY, Zhang H, et al. Prevalence of lateral meniscal extrusion for posterior lateral meniscal root lesion with and without concomitant midbody radial tear in anterior cruciate ligament injury. Arthroscopy, 2016, 32(5): 828-834.
25. Aderinto J, Walmsley P, Keating JF. Fractures of the tibial spine: epidemiology and outcome. Knee, 2008, 15(3): 164-167.
26. Owens BD, Crane GK, Plante T, et al. Treatment of type Ⅲ tibial intercondylar eminence fractures in skeletally immature athletes. Am J Orthop (Belle Mead NJ), 2003, 32(2): 103-105.
27. Ishibashi Y, Tsuda E, Sasaki T, et al. Magnetic resonance imaging AIDS in detecting concomitant injuries in patients with tibial spine fractures. Clin Orthop Relat Res, 2005(434): 207-212.
28. Hayes JM, Masear VR. Avulsion fracture of the tibial eminence associated with severe medial ligamentous injury in an adolescent. A case report and literature review. Am J Sports Med, 1984, 12(4): 330-333.
29. van Loon T, Marti RK. A fracture of the intercondylar eminence of the tibia treated by arthroscopic fixation. Arthroscopy, 1991, 7(4): 385-388.
30. Lubowitz JH, Grauer JD. Arthroscopic treatment of anterior cruciate ligament avulsion. Clin Orthop Relat Res, 1993(294): 242-246.
31. McLennan JG. The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia. J Bone Joint Surg (Br), 1982, 64(4): 477-480.
32. Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI Study Group. Am J Sports Med, 2017, 45(7): 1547-1557.
33. Castoldi M, Magnussen RA, Gunst S, et al. A randomized controlled trial of bone-patellar tendon-bone anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis: 19-year clinical and radiological follow-up. Am J Sports Med, 2020, 48(7): 1665-1672.
34. Inderhaug E, Stephen JM, Williams A, et al. Anterolateral tenodesis or anterolateral ligament complex reconstruction: Effect of flexion angle at graft fixation when combined with ACL reconstruction. Am J Sports Med, 2017, 45(13): 3089-3097.
35. Inderhaug E, Stephen JM, Williams A, et al. Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction. Am J Sports Med, 2017, 45(2): 347-354.
36. Inderhaug E, Stephen JM, El-Daou H, et al. The effects of anterolateral tenodesis on tibiofemoral contact pressures and kinematics. Am J Sports Med, 2017, 45(13): 3081-3088.
37. Shimakawa T, Burkhart TA, Dunning CE, et al. Lateral compartment contact pressures do not increase after lateral extra-articular tenodesis and subsequent subtotal meniscectomy. Orthop J Sports Med, 2019, 7(6): 2325967119854657. doi: 10.1177/2325967119854657.

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