Page 10 - SMU_Summer 2019 Issue 2_Web

TEAM PHYSICIAN CORNER
the healing capacity of the central third of Medial meniscus root repair has
the meniscus has expanded, and contrary demonstrated improved subjective
to classic dogma, 83% of surgically outcomes as well as reduced progression
repaired red-white zones demonstrated toward arthritis and total joint replacement
clinical healing. Encouraged by these compared with debridement or
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results, clinicians continue to push the nonsurgical management. However,
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limits of meniscal repair. The influence of medial root repairs do not work in patients
other factors, including chronicity, tissue with an uncorrected varus of greater than
quality, concomitant injuries, and body Figure 2. All-inside medial meniscus repair. 5 degrees or untreated chondrosis greater
mass index (BMI), on meniscal healing than grade III. In general, complete
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are being critically evaluated. lateral root tears should be repaired in
Innovation in arthroscopic equipment Not all meniscus tears are created all young athletes at the time of ACL
gives the opportunity for surgeons equal, and some provide unique reconstruction. It has been shown that
to consider all-inside meniscal repair challenges. Meniscal root tears require restoring the native anatomy during root
as opposed to the classic gold standard: special consideration. A complete tear repair is critical to restoring contact area
inside-out repair. The evolution of of the posterior meniscus root is the and contact pressure. Novel arthroscopic
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arthroscopic suture passers; novel biomechanical equivalent to a total surgical guides and suture passers facilitate
implant delivery devices; improved meniscectomy. Medial root tears are anatomic root repair (Figure 3).
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size, strength, and biocompatability of often isolated and atraumatic. These Ramp lesions are the “hidden lesion”
implants; and suture materials has fueled may be associated with early to moderate that occurs at the junction of the posterior
this movement. All-inside techniques chondral disease and varus malalignment horn of the medial meniscus and capsule
may reduce morbidity by eliminating the in middle-aged or older patients. Lateral (Figure 4). One must have a high index
need for posteromedial and posterolateral root tears occur in younger patients, of suspicion to reliably diagnosis these,
incisions and neurovascular retraction often associated with athletic trauma and as they are often in a blind spot when
(Figure 2). A recent systematic review anterior cruciate ligament (ACL) tear. using standard arthroscopic portals,
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demonstrated no differences in functional A high index of suspicion is required to and magnetic resonance imaging
outcome scores, failure, or complication diagnose root tears as up to one-third of (MRI) sensitivity is only 77%. Ramp
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rates when comparing all-inside with injuries have been missed on advanced lesions are more common in chronically
inside-out repair. 13 imaging studies. 16 ACL-deficient patients younger than

Figure 3. Posterior lateral root tear: a) detection, b) suture passage, and c) after repair.

Figure 4. Ramp lesions: a) detection, b) suture passage, and c) after repair.

 8 SPORTS MEDICINE UPDATE | Summer 2019, Issue 2