Meniscal / Root Repair
Dr. Garcia speaks on meniscal root tears and cutting edge treatment. Check out his first monthly sports and shoulder blog.
Meniscal Root Injury
The root attachments of the posterior horns of the medial and lateral meniscus are very important for joint health. When these are torn, the loading of the joint is equivalent to having no meniscus on the affected side. Thus, these patients can often have early onset arthritis, the development of bony edema, insufficiency fractures, and the failure of concurrent cruciate ligament reconstruction grafts. For this reason, much research has gone in to meniscus root repairs over the last several years.
Description of a Meniscus Root Repair
The technique of a meniscus root repair involves isolating the root, placing a minimum of 2 sutures in the remaining meniscal attachment, and trying to reposition it back to a more anatomic position. In some instances, the meniscus posterior horn may need to be released from scar tissue to allow it to be repositioned. This is important because these repairs are still quite tenuous with current technology, so it is important to try to put the meniscus back into a position where there would not be a lot of tension on the repair with knee range of motion.
After sutures are placed arthroscopically into the meniscal attachment, a small diameter tunnel, usually 5 millimeters in size, is reamed to the meniscal root attachment site, the sutures are pulled down the tunnel, and tied over a button on the anterior cortex of the tibia. One should assess the range of motion at that point in time that can be performed in a “safe zone” to make sure that the physical therapist does not flex them harder in this time frame.
Progression of range of motion is more limited than for a standard meniscus root repair, usually limiting patients to 0-60 or 0-90 degrees range of motion for the first 4 weeks and then slowly increasing range of motion as tolerated. Patients are allowed to initiate weightbearing at 6 weeks, but should avoid any significant squatting, squatting and lifting, or sitting cross-legged for a minimum of 5-6 months. They may start the use of a stationary bike, and may slowly wean off crutches starting at 6 weeks post-operatively.
The results of meniscus root repairs in the literature are encouraging, but more improvement is necessary in the future. Repairs have been found to delay or improve the findings of bony edema and the early onset of arthritis in many patients. It has been found that one suture alone for the repair does not work well, so a minimum of 2 sutures is required to maximize meniscal healing. Further study into meniscus root tears and radial root tears is ongoing by our research laboratory to try to improve the treatment of these complex problems.