Cutting Edge Orthopedics - Issue 3

48 • CUTTING EDGE - ORTHOPEDICS modified all-inside technique only (17 patients) or a combination of the modified all-inside suture and modified outside-in techniques (7 patients). The combined intra-articular pathologies were: a chondral lesion at the lateral compartment in four knees, medial plica in one knee, and Baker’s cyst in one knee. At the last follow-up all knees had achieved full ranges of motion, and all patients had returned to their prior life activities with little or no limitations and without requiring additional operations. Five patients had persistent mild symptoms about which they had complained before arthroscopic repair: catching sensation in three knees and limited function during squatting and jumping in two knees. Since their symptoms were mild compared to their original symptoms and daily activities were possible, they refused follow-up MRI exams. A locking episode recurred in one patient during the follow-up period, but the symptoms had subsided at the final follow-up. The median Tegner activity level was 4 (range 2–6) preoperatively and had significantly improved to 7 (range 3–10, p < 0.0001) at the last follow-up. The median Lysholm knee score improved from 76 (range 25–90) preoperatively to 94 (range 76–100) at the final follow-up ( p < 0.0001), and the median preoperative HSS score improved from 86 (range 13–95) to 95 (range 84–100) at the final follow-up ( p < 0.0001). Discussion The most important finding of this current study was the modified all-inside and modified out- side-in techniques resulted in excellent clinical outcomes for treating symptomatic recurrent sub- luxation of the lateral meniscus. It is difficult to determine whether arthroscopic repair of the lateral meniscus results in better outcomes than other treatments. However, such repair should be considered as a treatment option if possible. With this technique, patients can preserve the lateral meniscus without partial or total removal, which is preventive against further damages. Several clinical studies have reported the pathophysiology and clinical features of recurrent subluxation of the lateral meniscus. LaParade et al . [20] reported that six patients with isolated tears of the popliteomeniscal fascicles that caused lateral meniscal hypermobility were identi- fied by positive figure-4 test results. However, Suganuma et al . [33] determined that it remains difficult to suspect recurrent subluxation of the lateral meniscus based on clinical examination alone and believed that a finding of subluxation of the lateral meniscus with the peripheral margin of the posterior segment moving anteriorly at 90° of flexion of the knee joint on arthroscopy is needed for the diagnosis of recurrent subluxation of lateral meniscus if the patient has a history of mechanical locking episodes with pain on the lateral joint line. In our series, four patients received arthroscopic exploration at other hospitals due to locking episodes before visiting our hospital, but still had the same symptoms after initial treatment and did not receive clear explanations of their symptoms. Therefore, it is important for surgeons not to overlook recurrent subluxation of the lateral meniscus and to suspect recurrent subluxation when patients report symptoms related to deep flexion, especially with locking episodes of the knee joint. Discoid lateral meniscus, meniscal tear, and loose bodies in the knee joint also cause locking symptoms [1, 18]. MRI is useful to rule out other diseases, especially discoid lateral meniscus,