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REPAIR OF MENISCAL RAMP LESIONS THROUGH A POSTEROMEDIAL PORTAL DURING ACL RECONSTRUCTION…
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According to the anatomical studies, the portal
is located at least 1.5cm from the saphenous
nerve and vein. Morgan describes one case of
transient hypoesthesia of the sartorius branch
of the saphenous in one series of 70 cases
probably due to an accessory access portal
situated too anteriorly [10]. The clinical review
of 179 patients who underwent posterior
approaches did not show serious complications
but included 3 cases (1.7%) of residual
hypoesthesia in the saphenous nerve, and
2 cases of puncture of the saphenous vein [23].
The specific technique for passage of the
arthroscope through the intercondylar notch is
necessary to provide transillumination in order
to avoid this complication.
Limitations
Our study has several weaknesses. We did not
perform a systematic MRI or second-look
arthroscopy and it is possible that some of the
repaired menisci were healed incompletely. We
acknowledge that a meniscal repair without
symptoms postoperatively does not always
reflect the true status of the meniscus and that
only second-look arthroscopy can verify
healing of the meniscus or not. It is also
possible that longer follow-up would lead to
poorer results. Further, this study was not a
direct comparison with all inside repair with
implants and in the extended meniscus tears,
additional suture techniques were used which
confound the results. Finally, all repairs were
done during ACL reconstruction. We therefore
cannot extrapolate these results to isolated
meniscal repair with an ACL-intact knee. This
study also includes several biases, including
transfer bias (3 patients were lost to follow up),
performance bias (multiple surgeons with
different abilities), and selection bias because
only peripheral longitudinal tears were repaired
using this technique. Moreover, the transnotch
vizualisation and the posteromedial approach
allow diagnosing hidden lesion which could
have been missed and not repaired using
standard anterior portal and suture technique
with all-inside meniscal implants [11].
CONCLUSION
Our results show that arthroscopic meniscal
repair of ramp lesions during ACL re
construction with a suture hook device through
a posteromedial portal provided a high rate of
meniscus healing at the level of the tear and
appeared to be safe and effective in this group
of patients.
LITERATURE
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