Open Medial Meniscus Centralization With Arthroscopic Root Repair

Meniscotibial ligament disruption and medial meniscal extrusion may represent early and predisposing events contributing to medial meniscal root tears. If left untreated, these extruded tears may result in loss of medial compartment cartilage. As a result, multiple approaches have been developed to centralize the extruded meniscus.

In this case, we present a 45-year-old man who sustained a left medial meniscal root tear with extrusion while playing tennis. Indications for root repair with meniscal centralization include extrusion >3 mm seen on magnetic resonance imaging after an acute meniscal root tear or subjective meniscal extrusion seen intraoperatively.

The medial meniscal root tear is first repaired arthroscopically per surgeon preference. Then a medial incision is made along the proximal tibia and a submeniscal arthrotomy performed. Two double-loaded 3.0-mm anchors are placed along the proximal medial tibial edge. Sutures are passed in a Mason-Allen configuration through the meniscal body and capsule. Tightening of the sutures results in meniscal centralization. The root repair sutures are then tensioned and fixed along the medial proximal tibia.

Recent data have shown meniscal root repair with centralization is associated with significant improvements in pain, function, and quality of life and no significant progression of osteoarthritis.

Medial meniscal centralization can be safely performed with an open approach. An open approach may allow for more accurate anchor placement and more near-anatomic replication of meniscotibial ligaments.

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