Summary

Arthroscopic MMPRR using a transtibial double tunnel pull-out technique with modified Mason-Allen stitches improved clinical and radiographic outcomes

Abstract

Purpose

To evaluate clinical and radiographic outcomes of medial meniscus posterior root repair (MMPRR) using a transtibial double tunnel pull-out technique with modified Mason-Allen stitches.

Methods

Patients who underwent MMPRR using a transtibial double tunnel pull-out technique with modified Mason-Allen stitches were included, and minimal follow-up was 12 months. Clinical outcomes included VAS pain score, Lysholm score, and IKDC score. Radiographic outcomes included hip-knee-ankle (HKA) angle and Kellgren-Lawrence (K-L) grade. MRI data (extrusion distance and healing status of meniscus) were also analyzed.

Results

28 patients (2 male, 26 female) were included, with a mean follow-up of 18.7 months. Clinical outcomes were significantly improved at last follow-up compared with baseline: VAS pain score (1.7 v 4.9, P < .0001), Lysholm score (83.2 v 60.0, P < .0001) and IKDC score (69.3 v 40.5, P < .0001). Nine patients of the K-L grade (0/1/2/3/4) were progressed (from 24/4/0/0/0 preoperatively to 16/10/2/0/0). The HKA angle increased from 1.8° before surgery to 2.5°, but there was no significant difference. 70% of patients had good correction of extrusion (<3mm) and 50% were included in the group with well-healed meniscus.

Conclusions

Our study demonstrated that arthroscopic MMPRR using a transtibial double tunnel pull-out technique with modified Mason-Allen stitches improved clinical and radiographic outcomes.

A Sugical technique
Landmarks relevant to the insertion of the MMPH, including tibial attachment of the posterior cruciate ligament, tibial medial eminence, and articular surface of the tibial plateau, then be identified. For the creation of a bony bed, a curette was inserted through the AM portal, and bony preparation was done.
Passage of the Knee Scorpion suture passer loaded with a No. 2 Ultrabraid through the AM portal was then performed. The separated segment of the medial meniscus posterior horn (MMPH) is penetrated using a Scorpion needle at about 5 mm medial point to a detached margin. The second stitch was penetrated in the anterior location of the first stitch, in the same method. The upper 2 strands of stitched were pulled out and tied. And using the shuttle relay technique, exchanged the first stitch with the second stitch to make a horizontal loop.
The Knee Scorpion suture passer was reintroduced using the AM portal, and two vertical stitches are penetrated just medial side of the horizontal stitch.
Insertion of the Meniscus Root Repair System was made using the AM portal. The tip of guide was placed in the most medial side of the decorticated site of MMPR. A 2.4 mm Kirschner wire (K-wire) was advanced through the guide system. The location of the K-wire was confirmed using an arthro-scope via the AL portal. The second K-wire was placed parallel and about 5 mm laterally to the first tunnel. Once verified that the position of the K-wire was acceptable, the medial side K wire was removed first. A metal wire was inserted into the created tunnel, and then it was withdrawn through the AM portal using an arthroscopic grasper.
The wire was pulled through the tibial tunnel. For the medial tunnel, two horizontal stitches and two inferior vertical stitches are passed, a total of four stitches. For the lateral tunnel, the two superior vertical stitches are passed. The sutures from two tunnels are tied over the anteromedial tibial cortex. And the tie was performed between the two tunnels with the knee at 30° flexion. An arthroscopic re-evaluation was conducted to check repair of the torn posterior root and restore tension within the entire medial meniscus.