Intra-Tunnel Knotless Anchor Fixation for Lateral Meniscus Posterior Root Tears: A Novel Technique

Abstract

Lateral meniscus posterior root tears (LMPRTs) are radial tears that occur within 10 mm of the posterior root tibial connection, also known as lateral meniscus posterior root avulsions. A common surgical approach for LMPRT (2) that contributes to positive biomechanical outcomes is independent transtibial pullout repair.(6,7,8) If this treatment is performed on people who need both LMPRT repair and ACL restoration, an extra tibial tunnel is required. The installation of a tibial tunnel increases surgical challenges and lengthens operation time, as well as the danger of iatrogenic damage to the normal architecture of the knee. To circumvent these drawbacks, we have developed a novel technique for intra-tunnel LMPRT repair using a knotless anchor construct at the upper posterior edge of the tibial tunnel. A stab incision is made to create the standard antero lateral portal and after introducing the trochar and the scope, a round of diagnostic arthroscopy is performed and the posterior root of lateral meniscus tear is identified. After creating an anteromedial portal, With help of 1 fiber tape, a loaded bite is taken with the help of a first pass mini device (Smith & Nephew), via the antero medial portal, deep into the posterior root ( around 5 mm), using a self winching technique, and reduction of the LMPRT is checked. The position for the anchor entry is visualized in the superior edge of the tibial tunnel along its posterior wall, and the tapes are passed through the knotless anchor extra-articulately outside the AM portal. Thereafter, the anchor is shuttled in through the AM portal and punched in the footprint on the posterior-superior edge of the tibial tunnel with visualization of the reduction of the LMPR to the footprint. This technique offers a simple solution to a complex problem in the form of a simple procedure. This technique is a good choice when a tear of the posterior root of the LM occurs.