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ACL and Hidden Meniscus Lesions

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Rotatory Knee Instability

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Abstract

ACL tears are frequently associated with meniscal lesions. Despite improvements in meniscal repair techniques, failure rates remain significant, especially for the posterior horn of the medial meniscus (MM). Therefore, we recommend that a systematic arthroscopic exploration of the posterior horn of the MM be performed. The first step of the arthroscopic exploration requires routine anterior visualization via a standard anterolateral portal. In the second step, the posterior horn of the MM is visualized posteriorly. For this, the scope is positioned deep in the notch underneath the posterior cruciate ligament (PCL) via the anterolateral portal. In the third step, the posterior horn is probed through an additional posteromedial portal. In 17 % of posterior horn MM tears, a tear was discovered through minimal debridement of a superficial soft-tissue layer with a motorized shaver. This type of lesion was called a “hidden lesion.” Suture repairs of these ramp or hidden lesions of the posterior horn of the MM were performed with the use of a suture hook, which was introduced through the posteromedial portal. These meniscal tears have good healing potential with a low rate of revision at an average of 2-year follow-up. It seems to be a promising technique because it allows the placement of vertically oriented sutures with good tissue approximation. The additional posteromedial portal allows for better visualization, easier access, and sufficient debridement prior to repair. In previous work it was demonstrated that repairing these lesions at the time of ACL reconstruction is very important in order to restore knee biomechanics and minimize stress on the ACL graft.

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Authors and Affiliations

  1. Centre Orthopédique Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Générale de Santé, Hôpital privé Jean Mermoz, 24 Avenue Paul Santy, Lyon, 69008, France

    Bertrand Sonnery-Cottet, Benjamin Freychet, Nicolas Jan & Mathieu Thaunat

  2. Service d’orthopédie, Clinique mutualiste de la porte de L’Orient, Rue Robert de la Croix, Lorient, 56100, France

    François-Xavier Gunepin

  3. Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg–Clinique d’Eich, Luxembourg City, Luxembourg

    Romain Seil

Authors
  1. Bertrand Sonnery-Cottet
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  2. Benjamin Freychet
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  3. Nicolas Jan
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  4. François-Xavier Gunepin
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  5. Romain Seil
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  6. Mathieu Thaunat
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Correspondence to Bertrand Sonnery-Cottet .

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Editors and Affiliations

  1. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

  2. Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden

    Jón Karlsson

  3. Orthopaedic Surgery, Kobe University School of Medicine, Kobe, Japan

    Ryosuke Kuroda

  4. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

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Sonnery-Cottet, B., Freychet, B., Jan, N., Gunepin, FX., Seil, R., Thaunat, M. (2017). ACL and Hidden Meniscus Lesions. In: Musahl, V., Karlsson, J., Kuroda, R., Zaffagnini, S. (eds) Rotatory Knee Instability. Springer, Cham. https://doi.org/10.1007/978-3-319-32070-0_30

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  • DOI: https://doi.org/10.1007/978-3-319-32070-0_30

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32069-4

  • Online ISBN: 978-3-319-32070-0

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