Name:
Medial Meniscus Root Tear With Bone Fragment: Repair Technique
Description:
Medial Meniscus Root Tear With Bone Fragment: Repair Technique
Thumbnail URL:
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Duration:
T00H06M00S
Embed URL:
https://stream.cadmore.media/player/c0c7c482-4c21-45d9-910e-6ff0b2f4d69b
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/c0c7c482-4c21-45d9-910e-6ff0b2f4d69b/Medial meniscus root tear with bone fragment.mp4?sv=2019-02-02&sr=c&sig=CZaH4kg%2FPWBnqsSOLiJO0Ayo0CLWRpHW9BHgaEQojnw%3D&st=2024-11-21T17%3A09%3A18Z&se=2024-11-21T19%3A14%3A18Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
NICHOLAS COLYVAS: This is Dr. Nicholas Colyvas. I'm a Clinical Professor at the Department of Orthopedic Surgery at UCSF. I'm presenting the repair technique for a medial meniscus root tear with a bone fragment. The patient presenting today is a 36-year-old male police officer who was injured two months ago while kicking in a door.
NICHOLAS COLYVAS: He twisted his knee. He had some pain and swelling in the knee, and his physical exam showed medial meniscus signs but no findings of instability or other significant issues. His imaging showed a posterior horn medial meniscus tear at the root, and this is evident on the coronals as well as on the sagittals. The coronal show
NICHOLAS COLYVAS: the meniscus is extruded and there is actually a flipped fragment of the posterior horn visible on one of the image sequences. There is a absent posterior horn on the sagittal that is consistent with what's called the ghost sign. Evidence of a root tear versus a regular posterior horn tear. And this ghost sign extended into the posterior horn considerably in this case.
NICHOLAS COLYVAS: And the flip meniscus seen on the coronal view is also seen here on the sagittal view. Sometimes on the axial views, it's very easy to see the root tear, sometimes not. In this case, it's not the best cut, but the flipped posterior horn is seen there. So here in the medial compartment of the knee, we're using a probe to flip back that fragment of the posterior horn
NICHOLAS COLYVAS: and there it flips back into position, and now we probe it and we see that there is the bony fragment there lying in what was the root of the posterior horn of the medial meniscus. At this point, we start the preparation with a spinal needle to trephinate the capsule posteriorly and provide some vascular flow for the healing and this will extend out to the posterior horn from the root to the posterior horn.
NICHOLAS COLYVAS: Because this tear extends not quite to the mid body, but certainly well into the posterior horn.
NICHOLAS COLYVAS: Once we've trephinated, we then use a shaver to further debride that area and prepare that surface solution, sorry to prepare the surfaces so that there can be good healing once that meniscus is placed back in position. The drill is then brought out through the tibial tunnel and that then is prepared with a curette that will open up that tunnel and also provide a good bony bed
NICHOLAS COLYVAS: more posteriorly for that fragment to sit up against and for bony healing to be achieved in this case, similar to what we do with a standard root repair for a good bleeding bony surface for the repair. In this case, because there is a bony fragment, the shaver is also directed to the fragment itself once the tibial side has been prepared and the bony fragment then also prepared to a good
NICHOLAS COLYVAS: bleeding bony surface. Once these have been well prepared and ready for fixation, a standard root repair using racking sutures is then done and the sutures pulled through the tibia, tightened into position so that the bony surfaces are in close out position, nicely compressed, and the meniscus is in place. The final fixation is made.
NICHOLAS COLYVAS: In this case, we added a horizontal suture at the back and in addition we added a microfracture of the notch for growth factors. Some of the surgical notes here is that this was not a typical root tear in that there was also a bony avulsion, which is sometimes seen, and that has to be addressed.
NICHOLAS COLYVAS: I think the key to fixing these is to be sure that the bony fragment and the tibia are well prepared with clean bony surfaces prior to fixation. The mattress suture was added, in this case the posterior horn, because this was an extensive tear that went into the posterior horn and so provided some additional fixation there. In addition to a button, I also will frequently, in a larger tear or one that I have some concerns about, add a swivel lock or some type of additional tibial fixation to ensure that the construct does not loosen.
NICHOLAS COLYVAS: I also fairly standardly provide a notch microfracture for growth factors, and in this case the surgery was very successful. This patient returned to full activity and back to his work as a police officer at about four months post op. [VIDEO ENDS]
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