Medial Meniscal Posterior Root Avulsion Fracture Repair Using the Nice Knot

Meniscal root tears have recently seen an increase in diagnosis. As we understand more about the biomechanical relationship between the meniscus and tibiofemoral articular surface, it becomes more important to promptly identify and repair these lesions. Root tears may cause up to a 25% increase in forces in the tibiofemoral compartment, potentially leading to hastened degenerative changes visible on radiographs and decreased patient outcomes. The anatomic footprint of the meniscal roots has been described, as well as multiple iterations of repair techniques, with the most popular being the arthroscopic-assisted transtibial pullout technique for repair of the posterior meniscal roots. The tensioning technique varies and has been a surgical step that can lead to error during the procedure. We use a transtibial technique with modifications in the method of suture fixation and tensioning. To begin, we use 2 doubled-over sutures that are passed through the root to create a looped end and a twin-tailed end. This is followed by the use of a locking, tensionable and, if needed, reversible Nice knot that is tied on the anterior tibial cortex over a button. This technique provides controlled and accurate tension to the root repair when tied over a suture button on the anterior tibia with stable suture fixation to root.