الفهرس 
Anatomical considerationsOnly 14 pages are availabe for public view
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Abstract
A meniscal root tear is defined as a radial tear that occurs within 1 cm of the meniscal horn insertion. Meniscal root tears account for 10.1% of all arthroscopic meniscectomies. It’s now proved to be an independent factor for development and progression of osteoarthritis. Supra-physiologic loads have been implicated in the development of degenerative changes of the articular cartilage.
Unfortunately, the clinical diagnosis is quite challenging because the common signs and symptoms associated with meniscal body injury is less likely to manifest in patients with root tears. That’s why magnetic resonance imagings combined with arthroscopic examination are the gold standard for accurate meniscal root tears diagnosis.
Arthroscopic meniscal posterior root tear repair is now the gold standard to restore normal meniscal functions, although there’s still much controversy about the best way to be used in the repair. Whether to use anchor technique or transtibial pull out suture technique is still not settled and which type of suture configuration as well as suture type to use are still unsolved questions in the research field.
Although, preliminary results are very promising as regard improvement in the functional knee scoring systems and the clinical as well as radiological signs of meniscal root tear healing, long term results, more case series or higher levels studies, and further improvements to the surgical techniques used are still needed to achieve better results.
The current study helped increase the amount of input to the body of this field. The efficacy of medial meniscal posterior root tear repair using the all arthroscopic transosseous pull out sutures technique was rigorously confirmed through both direct and indirect evidences that showed restoration of meniscal integrity as well as restoration of the articular cartilage homeostasis, when properly combined to specific management protocol.
20 patients, 11 females and 9 males with mean age of 40.8 years and average BMI of 30.5 Kg/m2, formed the population of the current study. The average follow up duration was 15.75 months.
All cases had posterior horn medial meniscus root tear confirmed arthroscopically and treated by TPS technique using 2 simple sutures of fiber wire size 2. All cases applied plain radiographs at 3 months intervals as well as MRIs with quantitative T2 mapping technique incorporated at 6 month and at the final follow up visits postoperatively.
Significant improvements were recorded on the levels of subjective knee scoring system (Lysholm and Tegner), medial meniscal extrusion, gap size, ghost sign, root tear healing. However, no correlation could be found between BMI, age, tear type duration till repair and obtained results. Although a single case showed arthritic progression on X-ray and 2 cases showed progression on MRI, another 2 cases shoed articular cartilage improvement on MRI, 70% of the cases showed significant improvement in terms of T2 mapping quantitative MRI technique.
Based on the results of the current study, we recommend the employment of the transosseous pull out suture technique for medial meniscus posterior root tear repair, with special regards to technicality and judicious patient selection.