Description
Transtibial Pull-Out Suture Repair for Chronic Lateral Meniscus Posterior Root Avulsion in ACL Reconstruction: A Minimum 2 Years Follow-up with Second-Look Arthroscopy
Objective: The objective of this study was to evaluate the clinical, radio-logical, and arthroscopic outcomes in patients undergoing transtibial pull-out suture repair for chronic lateral meniscus posterior root (LMPR) avul-sion during anterior cruciate ligament (ACL) reconstruction (ACLR).
Methods: From January 2016 to December 2020, 61 patients of 675 primary ACLR cases had a chronic LMPR avulsion and underwent tran-stibial pull-out suture repair. Of the 61 patients, 33 (54.1%) were available for at least two years of follow-up with second-look arthroscopy to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated via KT-1000 arthro-meter side-to-side difference (KT-SSD) and pivot-shift test (PST) under anesthesia. Anterior tibial subluxation (ATS) of the lateral compartment was measured on magnetic resonance imaging. Changes in ATS were compared between patients with preoperative ATS ≥6 mm (large ATS group) and <6 mm (small ATS group).
Results: After a mean follow-up of 27.5 months, 1 (3.0%) LMPR avulsion failed to heal on second-look arthro-scopy. Lysholm and Tegner scores were improved from 60.4 to 91.4 (P<0.001) and 3 to 6 (P<0.001). KT-SSD was decreased from 9.1 mm to 2.0 mm (P<0.001). Residual PST was positive in 3 (9.1%) knees while high-grade PST was found in 23 (69.7%) cases preoperatively. ATS was reduced from 5.7 mm to 3.5 mm (P=0.001) within all cases. Compared to the small ATT group, the large ATT group had more ATS reduction (3.7 mm vs 0.3 mm, P=0.004) but still larger postoperative ATT (5.0 mm vs 1.8 mm, P=0.004).
Conclusion: The transtibial pull-out suture repair for chronic LMPR avulsion yielded reliable meniscus healing with satisfactory knee stability in patients undergoing ACLR. The static tibiofemoral relationship in the sagittal plane was significantly improved but not fully restored when patients demonstrated excessive ATS preoperatively.
