Meniscal Root Repair With Centralization

Meniscal root tears compromise hoop stress resistance and lead to elevated tibiofemoral contact pressures, meniscal extrusion, and rapid progression of osteoarthritis. Prompt diagnosis and intervention are essential to prevent further degenerative changes.

Meniscal root repair is indicated in patients with acute traumatic tears or chronic symptomatic root tears without advanced arthritis. Root repair has been shown to be beneficial regardless of the patient's age, even in the setting of early arthritis. Contraindications to root repair are severe osteoarthritis or poor surgical candidacy. Meniscus centralization is an important augment to the repair, particularly in the setting of meniscal extrusion.

After diagnostic arthroscopy, visualization of the medial compartment is enhanced via controlled medial collateral ligament pie-crusting. The meniscal root footprint is decorticated, and the meniscotibial ligaments are released to mobilize the meniscus. Two luggage-tag sutures are placed across the tear and shuttled through a transtibial tunnel drilled to the native root footprint. A knotless anchor secures the repair. Centralization is achieved by placing a knotless all-suture anchor at the mid-coronal medial tibial plateau, with sutures passed in a mattress configuration through the meniscocapsular junction, preventing extrusion. Root sutures are then tensioned and fixed with the knee in 90° of flexion.

This anatomic transtibial repair with centralization has been shown to restore hoop stresses, reduce meniscal extrusion, and provide superior outcomes compared with meniscectomy or nonoperative management. Patients undergoing root repair report improved pain, function, and activity levels.

Transtibial meniscal root repair with centralization is a reproducible technique that restores meniscal function, minimizes extrusion, and delays the progression of osteoarthritis. The luggage-tag suture configuration mitigates suture cutout, and careful attention to centralization placement and tensioning optimizes outcomes. Postoperative rehabilitation should emphasize progressive weightbearing and strengthening, with return to sport typically achievable by 6 months. This approach provides durable symptom relief and joint preservation when applied to appropriately selected patients.

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