Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique

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Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique Bancha Chernchujit, M.D., Renaldi Prasetia, M.D., M.Med.Sc. Arthroscopy Techniques Volume 6, Issue 5, Pages e1937-e1943 (October 2017) DOI: 10.1016/j.eats.2017.07.018 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Diagnostic arthroscopy of the right knee. The patient is in supine position with the right knee joint at 90° flexion. The anterolateral portal is the viewing portal. (A) Detached posterior lateral meniscus root (round), meniscofemoral ligament (star), and medial wall of the lateral condyle femur (rectangular). (B) Detached posterior medial meniscus root (pentagon). Arthroscopy Techniques 2017 6, e1937-e1943DOI: (10.1016/j.eats.2017.07.018) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Posterior medial meniscal root repair. The patient is in supine position with the right knee extended, valgus, and slightly externally rotated. The anterolateral portal is the viewing portal. The anteromedial portal is the working portal. (A) Inserting No. 2 PDS suture through a 4.5-mm EndoButton reamer with a hip joint drill guide instrument (Acufex). (B) Insertion of a No. 0 Ultrabraid through the posterior root medial meniscus (PRMM). (C) Insertion of Ultratape through the PRMM using Ultrabraid as a shuttle suture. (D) PRMM repair with a cinch stitch to its anatomic attachment through the transosseous tibial tunnel. Arthroscopy Techniques 2017 6, e1937-e1943DOI: (10.1016/j.eats.2017.07.018) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Posterior lateral meniscus root repair. The patient is in supine position with the right knee in a figure-of-4 position. The anterolateral portal is the viewing portal, and the anteromedial portal is the working portal. (A) Insertion of a No. 0 Ultrabraid through the posterior root lateral meniscus (PRLM). (B) Cinch suture configuration of Ultratape on the PRLM. (C) Insertion of a No. 2 PDS through a 4.5-mm EndoButton reamer with a hip joint drill guide instrument (Acufex). (D) PRLM repair with a cinch stitch to its anatomic attachment through the transosseous tibial tunnel. Arthroscopy Techniques 2017 6, e1937-e1943DOI: (10.1016/j.eats.2017.07.018) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 ACL reconstruction. The patient is in supine position with the right knee in hanging flexion. The anterolateral portal is the viewing portal, and the anteromedial portal is the working portal. (A) Femoral tunnel preparation performed with the knee in 120° flexion. (B) Tibial tunnel preparation. (C) Inserting graft through the tibia and femoral tunnel. (ACL, anterior cruciate ligament.) Arthroscopy Techniques 2017 6, e1937-e1943DOI: (10.1016/j.eats.2017.07.018) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A) Anterior tibial fixation in full extension of the right knee joint for posterior root repair of both medial and lateral menisci and backup fixation of ACL reconstruction with 6.5-mm cancellous screw with washer. (B) Anteroposterior radiograph of the right knee joint in supine position shows the proper position of the 6.5-mm cancellous screw with washer as anterior tibial fixation for both medial-lateral meniscus root repair and backup fixation of ACL reconstruction. (ACL, anterior cruciate ligament.) Arthroscopy Techniques 2017 6, e1937-e1943DOI: (10.1016/j.eats.2017.07.018) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 The 3 tibial tunnels shown are as follows: the medial site for the anterior cruciate ligament, the middle site for the posterior medial meniscus root, and the lateral site for the posterior lateral meniscus root. The aim is to prevent graft and thread impingement inside the tibia. Arthroscopy Techniques 2017 6, e1937-e1943DOI: (10.1016/j.eats.2017.07.018) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions