Refixation einer posterioren medialen Wurzelläsion in Kombination mit einer meniskotibialen Zentralisation
摘要
The aim of this surgical procedure is transosseous repair of a posterior root lesion of the medial meniscus combined with meniscotibial centralization between the pars posterior and pars intermedia to prevent extrusion. Following knee joint arthroscopy via a high anterolateral standard portal and checking the indication, the insertion zone on the tibial plateau is then located and debrided. A guide wire is placed in the center of the insertion zone of the medial meniscus using a special transosseous aimer. It is recommended that the guide sleeve for the target wire be placed anterolaterally at the proximal tibia. After anatomical placement, the target wire is overdrilled with a 4.5 mm drill. The posterior horn of the medial meniscus is reinforced with braided suture material and the reinforcement thread is pulled into the bone tunnel using an eyelet wire with a thread loop. The centralization suture is then placed in the pars intermedia. This can be done either via a transtibial bone tunnel (4.5 mm) or with a suture anchor. Soft suture anchors are suitable as suture anchors. For the transosseous technique, the meniscus base is reinforced with braided suture material using the “outside in” technique. This reinforcing suture is simply pulled through the tibial bone tunnel and knotted to the reinforcing suture of the posterior horn in the area of the anterolateral tibia. With the suture anchor method, a suture anchor is placed on the medial edge of the tibial plateau and the reinforcement of the meniscus is performed directly with one of the fixation anchor sutures. A 1–2 cm long medial incision should be created to insert the guide wires and drills. The rehabilitation protocol includes 6 weeks of nonweight-bearing, followed by a gradual increase in load. The range of motion is 0‑0-60° for 4 weeks and 0‑0-90° for the 5th–6th week.