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Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear

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Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear

Toshitaka Tsunematsu, MD, JAPAN Tomoki Ohori, MD, PhD, JAPAN Akira Tsujii, MD, PhD, JAPAN Shuto Yamashita, MD, JAPAN Ayaka Tanaka, MD, JAPAN Syunya Otani, MD, PhD, JAPAN Seira Sato, MD, PhD, JAPAN Ken Nakata, MD, PhD, JAPAN Seiji Okada, MD, PhD, Prof., JAPAN

Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan, Suita, Osaka, JAPAN

2025 Congress ePoster Presentation 2025 Congress Not yet rated

Anatomic Location

Knee

Anatomic Structure

Meniscus Medial

Diagnosis / Condition

Tears Osteoarthritis

Treatment / Technique

Repair / Reconstruction Arthroscopy

Sports Medicine

Biomechanics

Summary: This biomechanical study demonstrates that placing bone tunnels at the anatomical attachment of the posterior root significantly improves the mechanical effects of transtibial pull-out repair for medial meniscus posterior root tears.

Introduction

Medial meniscus posterior root tear (MMPRT) significantly deteriorates the mechanical functions (load distribution and transmission) of the MM against tibio-femoral compressive load, leading to rapid progression of knee osteoarthritis. Although transtibial pull-out repair (TPR) is usually performed for MMPRT, the restraining effect to MM extrusion and its clinical outcomes are not satisfactory. The insufficiency of the mechanical effects of TPR might be inappropriate bone tunnel location or number. The purpose of this study was to compare the mechanical effect of TPR for MMPRT by the location and number of bone tunnels.

Materials And Methods

Fresh-frozen porcine knee joints were used as specimens. After exposing the posterior horn of the medial meniscus (MM), an MMPRT was created at the junction between the posterior root fibers and the posterior horn. Bone tunnels were created at three locations: just under the MMPRT near the cartilage surface (Tear site hole: TH), anterior and posterior anatomical attachment of the posterior root fibers (anterior and posterior footprint hole: AFH and PFH). Pull-out repair was performed by placing two #2-0 ULTRA BRAID sutures (Smith & Nephew) using a cinch-loop technique through the posterior horn of the MM, passing them through the bone tunnels, and fixing them to the anterolateral proximal tibia using a double spike plate (Smith & Nephew) under 10N of tension. The specimens were divided into three groups as follows: TH group using the TH, FH1 group using the AFH, and FH2 group using both the AFH and PFH. Mechanical testing was conducted using a 6 degree-of-freedom robotic system (FRS2010, Technology Services) to measure the varus angle (˚) under a 5 Nm varus torque at 30°, 60°, 90°, and 120° of knee flexion. The results were compared among the Intact group, MMPRT group, TH group, FH1 group, and FH2 group.

Results

The maximum varus angles (30°/60°/90°/120°) were as follows: Intact group 2.9°/6.5°/5.0°/0.1°, MMPRT group 3.2°/7.5°/6.8°/2.3°, TH group 2.8°/6.7°/5.4°/0.4°, FH1 group 2.8°/6.2°/4.7°/-0.3°, and FH2 group 2.7°/6.3°/5.0°/0.0°. The maximum varus angles in FH1 and FH2 groups were significantly lower than those in MMPRT and TH groups and were comparable to those in Intact group.

Discussion

In this study, it was found that when the bone tunnel in TPR for MMPRT was created at the anatomical attachment of the posterior root, the restraining effect against MM extrusion was higher compared with the tunnel created at MMPRT site across all the knee flexion angles. Previous studies have suggested that the deterioration of the mechanical function of the MM evoked by MMPRT was mainly highlighted in the knee flexed position, which was comparable to that of total meniscectomy. Creating bone tunnels at the MMPRT site in TPR might disturb a physiological movement of the MM posterior root and lead to insufficient stabilization for MMPRT. Therefore, creating bone tunnel in TPR for MMPRT at the anatomical attachment of the posterior root could be essential to restore the mechanical function of the MM.

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Are Femoral Condyle Volumes Associated with the Injury of the Meniscus? A 3D Evaluation in a Large Cohort Study of ACL-Injured Patients ePoster Presentation Vincenzo Condello, MD, ITALY Anna Ghidotti, MSc, ITALY Daniele Regazzoni, Prof, ITALY Caterina Rizzi, Prof, ITALY Arcangelo Russo, ITALY Marco Collarile, MD, ITALY Vincenzo Madonna, MD, ITALY
Preventive Effect of Boiogito, a Japanese Traditional Herbal Medicine, on Osteophyte Formation in a Rat Model of Knee Osteoarthritis. ePoster Presentation Takayuki Okumo, MD, PhD, JAPAN Tokito Tatsuo, MD, JAPAN Kanako Izukashi, MD, JAPAN Hideshi Ikemoto, Ph.D. , JAPAN Naoki Adachi, Ph.D., JAPAN Atsushi Sato, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN Masataka Sunagawa, Prof., PhD., JAPAN
Proof Of Concept Of A Novel Surgical Technique To Improve The Treatment Of Horizontal Cleavage Meniscus Tears: “The Quad Tendon Augmentation Technique”. ePoster Presentation Maximiliano Ibañez, MD, SPAIN Caroline Mouton, PhD, LUXEMBOURG Felix Hoffmann, MD, LUXEMBOURG Romain Seil, MD, Prof., LUXEMBOURG
Contralateral Synovial Fluid Biomarkers Predict 10-Year Patient-Reported Outcomes Of Arthroscopic Partial Meniscectomy ePoster Presentation Vishal Sundaram, BA, UNITED STATES Emily Berzolla, BS, UNITED STATES Michael Moore, BA, UNITED STATES Nathaniel P. Mercer, MD, UNITED STATES Bradley Austin Lezak, MD, MPH, UNITED STATES Heath Patrick Gould, MD, UNITED STATES Daniel James Kaplan, MD, UNITED STATES Eric Strauss, UNITED STATES
Ideal Remaining Meniscus Width and Risk Factors for Decrease of Meniscus Width after Reshaping Surgery in Pediatric Patients with Discoid Lateral Meniscus ePoster Presentation Kyeong Baek Kim, MD, KOREA, REPUBLIC OF Joon Ho Wang, MD, PhD, KOREA, REPUBLIC OF Seong Man Jeon, MD, KOREA, REPUBLIC OF
Ultrasonographic Findings Associated with Medial Meniscus Posterior Root Tear ePoster Presentation Manase Nishimura, MD, JAPAN Yasushi Takata, MD, PhD, JAPAN Yoshihiro Ishida, MD, JAPAN Naoki Takemoto, MD, JAPAN Kentaro Fujita, MD, JAPAN Takuya Sengoku, PT, PhD, JAPAN Yushin Mizuno, MSc, PT, JAPAN Junsuke Nakase, MD, PhD, JAPAN
The Adequate Volume Of Midbody During The Intraoperative Finding Is 11Mm For Reshaping Surgery Of Discoid Lateral Meniscus ePoster Presentation Yusuke Hashimoto, MD, PhD, JAPAN Yohei Nishida, MD, JAPAN Kazuya Nishino, MD, JAPAN Ken Iida, MD, JAPAN Shuko Tsumoto, MD, JAPAN

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Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear

Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear

Introduction

Materials And Methods

Results

Discussion

Knee Meniscus ePosters

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Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear

Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear

Introduction

Materials And Methods

Results

Discussion