Nam-Hong Choi

Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note.

This technical note describes a new arthroscopic technique to repair a tear of posterior root of the medial meniscus. Cartilage at the insertion area of the posterior horn of the medial meniscus (PHMM) was removed using a curved curette inserted through an anteromedial portal. A metal anchor loaded with two FiberWires (Arthrex, Naples, FL) was placed at the insertion area of the PHMM through a high posteromedial portal. A PDS suture was passed the PHMM by curved suture hook through the anteromedial portal. Two limbs of the PDS were then used to pass two limbs of the FiberWire through the meniscus. The same procedure was repeated for the second FiberWire suture. The sutures were tied, achieving secure fixation of the posterior meniscal root at the anatomic insertion.

Comparison of Arthroscopic Medial Meniscal Suture Repair Techniques Inside-Out Versus All-Inside Repair

Background There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. Hypothesis No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Study Design Cohort study; Level of evidence, 2. Methods Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Results Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in pivot-shift test between groups (P = .023). There were 2 complications associated with surgery. In the inside-out group, 1 patient required manipulation, and 2 patients had limited motion at final follow-up. Two patients in the inside-out group experienced transient saphenous nerve injury. Conclusion There was no significant difference in meniscal healing between inside-out and all-inside repair techniques in combination with anterior cruciate ligament reconstructions.

All-Inside Repair for a Root Tear of the Medial Meniscus Using a Suture Anchor

Background: There are no published articles reporting clinical outcomes after all-inside meniscal repair using a suture anchor for a medial meniscal root tear. Purpose: To evaluate the subjective and objective outcomes after repair of medial meniscal root tears. Study Design: Case series; Level of evidence, 4. Methods: Thirteen patients with a root tear of the medial meniscus underwent all-inside repair using a suture anchor. Postoperative evaluation of meniscal status was performed using physical examination criteria, specifically joint line tenderness, McMurray test, and follow-up magnetic resonance imaging (MRI). Functional evaluations were performed using Tegner activity level and Lysholm knee score. Follow-up MRI scans were obtained 6 months postoperatively to evaluate healing of the root tear and measure extrusion of the midbody of the medial meniscus. Results: The average follow-up was 30.8 months (range, 24-40 months). No patients had joint line tenderness or effusion. No patients demonstrated a positive McMurray test result postoperatively. The preoperative mean Tegner activity level was 1.9 (range, 1-6), and the mean Lysholm score was 69.1 (range, 53-91). At last follow-up, the mean Tegner activity level was 3.9 (range, 2-6), and the mean Lysholm score was 90.3 (range, 75-100). Improvements in both the Tegner activity level and Lysholm score were statistically significant (P = .001 and P = .000, respectively). Follow-up MRI was performed in 10 patients. Five (50%) patients showed complete healing; 2 of these 5 patients showed complete healing with isointense signal of a normal meniscus, and 3 showed intermediate signal tissue at the previous tear site without any high signal cleft or ghost sign. Four (40%) patients showed partial healing, and 1 (10%) showed no healing. Mean extrusion of the midbody of the medial meniscus was 3.9 mm (range, 2.2-7.1 mm) preoperatively and 3.5 mm (range, 1.2-6.1 mm) postoperatively. Extrusion was not significantly decreased. Conclusion: This study demonstrated symptomatic improvement after meniscal root repair using a suture anchor. However, follow-up MRI scans did not show complete healing of all repaired root tears.

Meniscal Repair for Radial Tears of the Midbody of the Lateral Meniscus

Background Radial meniscal tears historically have been treated by partial meniscectomy, although they are more biomechanically detrimental than longitudinal tears. Clinical results after meniscal repair for radial tears of the midbody of the lateral meniscus have been reported rarely. Study Design Case series: Level of evidence, 4. Methods Fourteen consecutive patients who had radial tears of the midbody of the lateral meniscus underwent arthroscopic repair. Inclusion criteria were radial tears involving the red-red or red-white zone. All patients underwent all-inside meniscal repair using absorbable sutures. Postoperative evaluation was performed using joint-line tenderness, McMurray test, range of motion, and follow-up magnetic resonance imaging (MRI) scan at 6 months postoperatively. Lysholm knee score and Tegner activity level were evaluated at last follow-up. In 4 patients, second-look arthroscopies were performed. Results The average follow-up was 36.3 months. No patient had joint-line tenderness. Three patients complained of pain or a click on McMurray test. The mean follow-up range of motion was 138.6°. Follow-up MRI scans demonstrated that 5 (35.7%) menisci were healed, 8 (57.1%) were partially healed, and 1 (7.1%) was not healed. The follow-up Lysholm score was 94.7 (range, 81-100; standard deviation [SD] = 6.4) and Tegner score was 5.7 (range, 3-7; SD = 1.4). Second-look arthroscopies in 4 patients showed partial healing of meniscal tears. Conclusion Meniscal repair for radial tears of the midbody of the lateral meniscus may be an effective, alternative treatment to partial meniscectomy.

Position of the Bony Bridge of Lateral Meniscal Transplants Can Affect Meniscal Extrusion

Background: There are several reported causes of midbody extrusion after lateral meniscal allograft transplantation. However, there are no reports studying the correlation between the position of the bony bridge and extrusion of the midbody after meniscal allograft transplantation. Hypothesis: The position of the bony bridge of lateral meniscal allografts can affect meniscal extrusion. Study Design: Case series; Level of evidence, 4. Methods: Twenty-three consecutive patients underwent a lateral meniscal allograft transplantation using a fresh-frozen graft. The lateral meniscal allograft was prepared with a bony bridge. Postoperative evaluations of the meniscal allografts were performed using follow-up magnetic resonance imaging 6 months postoperatively. On the coronal view, extrusion was measured as the distance between the outer edge of the articular cartilage of the lateral tibial plateau and the outer edge of the meniscal allograft. On the axial view, the length of the entire tibial plateau (PL) and distance between the lateral edge of the lateral tibial plateau and center of the bony bridge (CB) were measured. Measurements of CB were divided by measurements of PL. The correlation test between CB/PL and extrusion was performed to determine whether the position of the bony bridge can affect extrusion of the midbody of meniscal allograft. Results: The mean center of the bony bridge of the meniscal allograft (CB/PL) was positioned at 42.3% (range, 36.1%-49%; standard deviation [SD] = 3.6%) from the outer edge of the lateral tibial plateau. The mean extrusion of meniscal allografts was 3.2 mm (range, 0-6.5 mm; SD = 2.3). The amount of extrusion was correlated with the position of the bony bridge of the graft and the Pearson correlation coefficient was –.567 (P = .003). The cut-off percentage above which extrusion did not occur was 42.05%. Conclusion: The more closely the center of the bony bridge approached 50% of the entire tibial plateau, the less extrusion of the midbody occurred. Anatomic placement of the bony bridge of lateral meniscal allograft is imperative to prevent extrusion after lateral meniscal allograft transplantation.

Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia

Bony avulsion fractures of the posterior cruciate ligament of the tibia have commonly been treated by open reduction and internal fixation using the posterior approach. However, this approach, using the prone position, makes it difficult to investigate and treat other combined injuries of the knee joint. We report a case of posterior cruciate ligament avulsion of the tibia that was arthroscopically reduced and firmly fixed with two cannulated screws. The posterior sag was absent after the operation and the result was excellent. By arthroscopy, we got rigid fixation of the avulsed fragment for early rehabilitation, and detection of a concomitant injury was also possible.

Femoral Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstruction With Bioabsorbable Transfix

Background: Previous reports have shown that bio-Transfix implants (Arthrex, Naples, Florida) have the possibility of fracture during the early postoperative period. However, to date, there exists no study reporting the radiological and clinical significance of broken bio-Transfix implants. Hypothesis: A broken bio-Transfix results in adverse effects, both radiologically and clinically. Study Design: Cohort study; Level of evidence, 3. Methods: Hamstring anterior cruciate ligament (ACL) reconstructions using bio-Transfix in 50 patients with a minimum of 2 years’ postoperative follow-up were reviewed. On the anteroposterior (AP) and lateral radiographs, the diameter of the femoral tunnel was measured at the widest diameter and compared with the diameter of the reamer used at surgery. Magnetic resonance imaging (MRI) scans were obtained 6 months postoperatively for all patients to evaluate the condition of bio-Transfix implants. The patients were divided into intact and broken bio-Transfix groups. Postoperative stability evaluations were performed using the Lachman and pivot-shift tests and instrumented laxity testing using the KT-1000 arthrometer. Functional evaluations were performed using the Lysholm score and Tegner activity scale. Results: Follow-up MRI scans revealed that the bio-Transfix was broken in 11 and intact in 39 patients. Five implants were broken within the femoral tunnel and 6 were broken outside the femoral tunnel. Two bio-Transfix in the intact group were bent. On the AP and lateral radiographs at 24 months postoperatively, the average diameter of the femoral tunnel in the intact group increased by 13.1% and 17.1%, respectively. In the broken group at 24 months postoperatively, the average diameter of the femoral tunnel increased by 33.6% and 26.5%, respectively. There were significant differences between the 2 groups in the average diameters of the femoral tunnel on the AP radiographs at 24 months postoperatively (P = .000). However, on the lateral radiographs, there were no significant differences between the 2 groups. Postoperative knee stability tests and functional evaluations showed no significant differences between the 2 groups. Conclusion: Broken bio-Transfix implants resulted in significant femoral tunnel widening in the coronal plane, although clinical results were not affected. Surgeons should be aware of this phenomenon when selecting a fixation device for hamstring grafts.

Case Report Tibial Tuberosity Avulsion Fracture Combined With Meniscal Tear

Avulsion fractures of the tibial tuberosity are uncommon injuries. They usually occur during athletic activities in adolescents. The classification of these injuries has been divided into three types. Only two cases of avulsion fractures of tibial tuberosity have previously been reported with associated damages to menisci. We report a type III fracture of the tibial tuberosity associated with tear of the medial meniscus.

Tenosynovial giant-cell tumor in the knee joint

We report the case of a tenosynovial giant-cell tumor causing limitation of extension of the knee. The tumor was treated successfully by arthroscopic removal.

Arthroscopic stabilization of the lateral capsule of the knee in meniscal transplantation

Extrusion of the meniscus has been reported as a complication after meniscus transplantation. Previous reports showed extrusion after meniscal allograft transplantation was associated with development of the osteoarthritis. In this study, a surgical technique is described to tentatively prevent extrusion of the meniscus.