Revision of Failed Medial Meniscus Posterior Root Repair: A Case Report

Meniscal root tear decreases the ability of the meniscus to convert the axial load to radially directed hoop stress. This leads to a decreased contact area and increased contact pressures, leading to early osteoarthrosis of the knee and eventually higher chances of undergoing total knee replacement. Meniscal root repair helps to restore normal knee kinematics; however, non-anatomical repair results in increased strain in the repair and causes early failure of the repair, leading to abnormal knee kinematics.

A 45-year-old female with a body mass index of 40.6, hypothyroid, and type II diabetes mellitus presented to the outpatient department with the complaints of left knee pain and difficulty in walking. She had undergone an arthroscopic medial meniscus posterior root repair 1 year back. Clinical and radiological examinations helped to diagnose a re-tear of the medial meniscus root with a non-anatomic tibial tunnel. She then underwent arthroscopic revision root repair surgery. Currently, the patient is at a 1-year follow-up and has resumed her activities of daily living.

Anatomical repair of the posterior horn of the medial meniscus is important in restoring normal knee kinematics and for the ability of the meniscus to maintain the hoop stress. Non-anatomic repair leads to early failure and progression to rapid cartilage degeneration, resulting in early osteoarthritis and eventual knee replacement. Any revision surgery presents its own different set of challenges. The basic principles must be adhered to while addressing any failure of the primary surgery.