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ACL and Hidden Meniscus Lesions

  • Bertrand Sonnery-CottetEmail author
  • Benjamin Freychet
  • Nicolas Jan
  • François-Xavier Gunepin
  • Romain Seil
  • Mathieu Thaunat
Chapter
  • 1.1k Downloads

Abstract

ACL tears are frequently associated with meniscal lesions. Despite improvements in meniscal repair techniques, failure rates remain significant, especially for the posterior horn of the medial meniscus (MM). Therefore, we recommend that a systematic arthroscopic exploration of the posterior horn of the MM be performed. The first step of the arthroscopic exploration requires routine anterior visualization via a standard anterolateral portal. In the second step, the posterior horn of the MM is visualized posteriorly. For this, the scope is positioned deep in the notch underneath the posterior cruciate ligament (PCL) via the anterolateral portal. In the third step, the posterior horn is probed through an additional posteromedial portal. In 17 % of posterior horn MM tears, a tear was discovered through minimal debridement of a superficial soft-tissue layer with a motorized shaver. This type of lesion was called a “hidden lesion.” Suture repairs of these ramp or hidden lesions of the posterior horn of the MM were performed with the use of a suture hook, which was introduced through the posteromedial portal. These meniscal tears have good healing potential with a low rate of revision at an average of 2-year follow-up. It seems to be a promising technique because it allows the placement of vertically oriented sutures with good tissue approximation. The additional posteromedial portal allows for better visualization, easier access, and sufficient debridement prior to repair. In previous work it was demonstrated that repairing these lesions at the time of ACL reconstruction is very important in order to restore knee biomechanics and minimize stress on the ACL graft.

Keywords

Anterior Cruciate Ligament Anterior Cruciate Ligament Reconstruction Medial Meniscus Posterior Horn Meniscal Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Ahldén M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J (2012) The Swedish National Anterior Cruciate Ligament Register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. Am J Sports Med 40(10):2230–2235CrossRefPubMedGoogle Scholar
  2. 2.
    Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH (2011) Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 39(10):2187–2193. doi: 10.1177/0363546511416597 CrossRefPubMedGoogle Scholar
  3. 3.
    Ahn JH, Kim SH, Yoo JC, Wang JH (2004) All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy 20:101–108CrossRefPubMedGoogle Scholar
  4. 4.
    Ahn JH, Lee YS, Yoo JC, Chang MJ, Koh KH, Kim MH (2010) Clinical and second-look arthroscopic evaluation of repaired medial meniscus in anterior cruciate ligament-reconstructed knees. Am J Sports Med 38(3):472–477. doi: 10.1177/0363546509348102 CrossRefPubMedGoogle Scholar
  5. 5.
    Ahn JH, Wang JH, Yoo JC (2004) Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament–deficient knees: results of second-look arthroscopies in 39 cases. Arthroscopy 20:936–945CrossRefPubMedGoogle Scholar
  6. 6.
    Amin KB, Cosgarea AJ, Kaeding CC (1999) The value of intercondylar notch visualization of the posteromedial and posterolateral compartments during knee arthroscopy. Arthroscopy 15:813–817CrossRefPubMedGoogle Scholar
  7. 7.
    Aşík M, Sener N (2002) Failure strength of repair devices versus meniscus suturing techniques. Knee Surg Sports Traumatol Arthrosc 10(1):25–29CrossRefPubMedGoogle Scholar
  8. 8.
    Bedi A, Dines J, Dines DM, Kelly BT, O’Brien SJ, Altchek DW, Allen AA (2010) Use of the 70 ° arthroscope for improved visualization with common arthroscopic procedures. Arthroscopy 26:1684–1696. doi: 10.1016/j.arthro.2010.04.070 CrossRefPubMedGoogle Scholar
  9. 9.
    Bollen SR (2010) Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: a previously unrecognized association. J Bone Joint Surg Br 92:222–223. doi: 10.1302/0301-620X.92B2.22974 CrossRefPubMedGoogle Scholar
  10. 10.
    Calder SJ, Myers PT (1999) Broken arrow: a complication of meniscal repair. J Arthrosc Relat Surg 15(6):651–652CrossRefGoogle Scholar
  11. 11.
    Cory E, James KW, Elifho O, Connor Z, Dale NR, Robert AA (2015) Posteromedial meniscocapsular tear: prevalence, detection sensitivity, biomechanics, and repair technique. In Scientific Exhibit SE81. American Academy of Orthopaedic surgeons. http://aaos2015.conferencespot.org/58906-aaos-1.1965581/cory-edgar-1.1970358
  12. 12.
    Ellermann A, Siebold R, Buelow JU, Sobau C (2002) Clinical evaluation of meniscus repair with a bioabsorbable arrow: a 2- to 3-year follow-up study. Knee Surg Sports Traumatol Arthrosc 10(5):289–293CrossRefPubMedGoogle Scholar
  13. 13.
    Fakioglu O, Ozsoy MH, Ozdemir HM, Yigit H, Cavusoglu AT, Lobenhoffer P (2013) Percutaneous medial collateral ligament release in arthroscopic medial meniscectomy in tight knees. Knee Surg Sports Traumatol Arthrosc 21(7):1540–1545. doi: 10.1007/s00167-012-2128-x CrossRefPubMedGoogle Scholar
  14. 14.
    Gillies H, Seligson D (1979) Precision in the diagnosis of meniscal lesions: a comparison of clinical evaluation, arthrography, and arthroscopy. J Bone Joint Surg Am 61:343–346PubMedGoogle Scholar
  15. 15.
    Gillquist J, Hagberg G, Oretorp N (1979) Arthroscopic examination of the posteromedial compartment of the knee joint. Int Orthop 3:13–18CrossRefPubMedGoogle Scholar
  16. 16.
    Gold DL, Schaner PJ, Sapega AA (1995) The posteromedial portal in knee arthroscopy: an analysis of diagnostic and surgical utility. Arthroscopy 11:139–145CrossRefPubMedGoogle Scholar
  17. 17.
    Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L (2012) Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconstruction registry comparison between Norway and the USA. Acta Orthop 83:577–582. doi: 10.3109/17453674.2012.741451 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hamberg P, Gillquist J, Lysholm J (1983) Suture of new and old peripheral meniscus tears. J Bone Joint Surg Am 65(2):193–197PubMedGoogle Scholar
  19. 19.
    Ireland J, Trickey EL, Stoker DJ (1980) Arthroscopy and arthrography of the knee: a critical review. J Bone Joint Surg Br 62:3–6PubMedGoogle Scholar
  20. 20.
    Kimori K, Suzu F, Yamashita F, Sakakida K, Hirasawa Y (1989) Evaluation of arthrography and arthroscopy for lesions of the posteromedial corner of the knee. Am J Sports Med 17:638–643CrossRefPubMedGoogle Scholar
  21. 21.
    Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH (2006) Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. J Arthrosc Relat Surg 22(1):3–9CrossRefGoogle Scholar
  22. 22.
    Lewicky RT, Abeshaus MM (1982) Simplified technique for posterior knee arthroscopy. Am J Sports Med 10:22–23CrossRefPubMedGoogle Scholar
  23. 23.
    Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J (2011) Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med 39:832–837. doi: 10.1177/0363546510388933 CrossRefPubMedGoogle Scholar
  24. 24.
    Mariani PP (2011) Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 19:1148–1153. doi: 10.1007/s00167-011-1424-1 CrossRefPubMedGoogle Scholar
  25. 25.
    Morgan CD (1991) The “all-inside” meniscus repair. Arthroscopy 7:120–125CrossRefPubMedGoogle Scholar
  26. 26.
    Noyes FR, Chen RC, Barber-Westin SD, Potter HG (2011) Greater than 10-year results of red-white longitudinal meniscal repairs in patients 20 years of age or younger. Am J Sports Med 39:1008–1017. doi: 10.1177/0363546510392014 CrossRefPubMedGoogle Scholar
  27. 27.
    Ogilvie-Harris DJ, Weisleder L (1995) Arthroscopic synovectomy of the knee: is it helpful? J Arthrosc Relat Surg 11(1):91–95CrossRefGoogle Scholar
  28. 28.
    Park IS, Kim SJ (2006) New meniscus repair technique for peripheral tears near the posterior tibial attachment of the posterior horn of the medial meniscus. Arthoscopy 22:908.e1–908.e4Google Scholar
  29. 29.
    Peltier A, Lording TD, Lustig S, Servien E, Maubisson L, Neyret P (2015) Posteromedial meniscal tears may be missed during anterior cruciate ligament reconstruction. Arthroscopy 31(4):691–698. doi: 10.1016/j.arthro.2014.12.003 CrossRefPubMedGoogle Scholar
  30. 30.
    Pujol N, Barbier O, Boisrenoult P, Beaufils P (2011) Amount of meniscal resection after failed meniscal repair. Am J Sports Med 39(8):1648–1652. doi: 10.1177/0363546511402661 CrossRefPubMedGoogle Scholar
  31. 31.
    Seil R, Rupp S, Jurecka C, Rein R, Kohn D (2001) Effect of various suture strength factors on behavior of meniscus sutures in cyclic loading conditions. Unfallchirurg 104(5):392–398CrossRefPubMedGoogle Scholar
  32. 32.
    Seil R, VanGiffen N, Pape D (2009) Thirty years of arthroscopic meniscal suture: what’s left to be done? Orthop Traumatol Surg Res 95:S85–S96. doi: 10.1016/j.otsr.2009.09.004 CrossRefPubMedGoogle Scholar
  33. 33.
    Sonnery-Cottet B, Archbold P, Zayni R, Thaunat M, Bortolletto J, Fayard JM, Chambat P (2011) High lateral portal for sparing the infrapatellar fat-pad during ACL reconstruction. Orthop Traumatol Surg Res 97:870–873. doi: 10.1016/j.otsr.2011.08.007 CrossRefPubMedGoogle Scholar
  34. 34.
    Sonnery-cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R (2014) Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 42(4):921–926. doi: 10.1177/0363546514522394 CrossRefPubMedGoogle Scholar
  35. 35.
    Sonnery-Cottet B, Mortati R, Gadea F, Thaunat M, Moyere F, Chouteau J (2013) Osteolysis of the tibial plateau after meniscal repair with hybrid suture anchor. Knee Surg Sports Traumatol Arthrosc 21(9):2137–2140. doi: 10.1007/s00167-012-2296-8 CrossRefPubMedGoogle Scholar
  36. 36.
    Strobel MJ (1988) Menisci. In: Fett HM, Flechtner P (eds) Manual of arthroscopic surgery. Springer, New York, pp 171–178Google Scholar
  37. 37.
    Tolin BS, Sapega AA (1993) Arthroscopic visual field mapping at the periphery of the medial meniscus: a comparison of different portal approaches. Arthroscopy 9:265–271CrossRefPubMedGoogle Scholar
  38. 38.
    Walgrave S, Claes S, Bellemans J (2013) High incidence of intraoperative anchorage failure in FasT-fix all inside meniscal suturing device. Acta Orthop Belg 79(6):689–693PubMedGoogle Scholar
  39. 39.
    Wilmes P, Lorbach O, Brogard P, Seil R (2008) Complications with all-inside devices used in reconstructive meniscal surgery. Orthopade 37:1088–1089, 1091–1095, 1097–1098. doi: 10.1007/s00132-008-1307-4
  40. 40.
    Yiannakopoulos CK (2007) Diagnosis and treatment of postarthroscopic synovial knee fistulae: a report of four cases and review of the literature. J Knee Surg 20(1):34–38PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Bertrand Sonnery-Cottet
    • 1
    Email author
  • Benjamin Freychet
    • 1
  • Nicolas Jan
    • 1
  • François-Xavier Gunepin
    • 2
  • Romain Seil
    • 3
  • Mathieu Thaunat
    • 1
  1. 1.Centre Orthopédique SantyFIFA Medical Center of Excellence, Groupe Ramsay-Générale de Santé, Hôpital privé Jean MermozLyonFrance
  2. 2.Service d’orthopédieClinique mutualiste de la porte de L’OrientLorientFrance
  3. 3.Department of Orthopaedic SurgeryCentre Hospitalier de Luxembourg–Clinique d’EichLuxembourg CityLuxembourg

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