Cutting Edge Orthopedics - Issue 3

Arthroscopic Meniscus Repair for Recurrent Subluxation of the Lateral Meniscus • 49  which is relatively common. Suganuma et al . [32] defined the recurrent subluxation of lateral meniscus as a disorder with locking episodes but no definite tears or abnormalities of the lateral meniscus. According to Suganuma et al . [33], recurrent subluxation of the lateral meniscus and popliteomeniscal fascicle tear are parts of the same disease entity, and it is difficult to define pop- liteomeniscal fascicle on MRI or arthroscopy, which is important when determining meniscal sta- bility [12, 30]. Hypermobility of the posterior horn with probing during arthroscopic examination suggests peripheral tears of the lateral meniscus posterior horn or tears of the popliteomeniscal fascicle, and such tears may be confirmed by viewing through the posterolateral portal. As described in case reports, several treatment modalities have been applied for treatment of recurrent subluxation of the lateral meniscus, but each case report involved only a few patients [16, 17, 20, 24, 25]. In the present study, only patients exhibiting symptomatic recurrent sub- luxation of the lateral meniscus without displaced bucket-handle tears on MRI were included. The same surgical technique was applied to all cases, and arthroscopic probing was applied to determine whether the repaired lateral meniscus was stable from the posterolateral corner to the midbody. If the repaired lateral meniscus was not stable, additional modified outside-in tech- niques were applied. The modified outside-in technique [4] added more accurate and stronger anatomic fixation in such cases. However, arthroscopic repair of the posterior horn of the lateral meniscus can be challenging to an experienced surgeon because of the difficulty of performing arthroscopic repair due to the anatomically more confined posterolateral compartment and the anatomic complexity of the peroneal nerve, popliteus tendon, and popliteal hiatus [8, 31]. After applying appropriate arthroscopic techniques based on the locations of tears of the lateral menis- cus near the popliteal hiatus, excellent clinical results were achieved after a median follow-up of 41 months. There are some limitations in this study. First, because this study was initiated in 2001, the arthroscopic repair techniques were modified during the study period, and the arthroscopic repair treatments were performed by two different surgeons. However, both surgeons applied the same arthroscopic repair techniques that were developed by a senior author. Second, this study had a minimum 2-year follow-up, which is relatively short. Third, successful and definite healing of the repaired lateral meniscus was not confirmed with postoperative MRI or arthroscopic exploration. Fourth, the number of cases included is small and cannot be analyzed sample size calculation, because of the low incidence of this condition. Symptomatic recurrent subluxation of the lateral meniscus without an obvious tear on MRI is rare, and it is challenging to suspect or diagnose recurrent subluxation of the lateral meniscus at a glance. Therefore, a thorough understanding of anatomy and clinical suspicion are essential for clinicians to prevent missing the disease. Conclusion The described arthroscopic meniscus suture technique is effective for treating symptomatic recurrent subluxation of the lateral meniscus without any complications or recurrence. Clinical