Healing rates of the posterior horn of the lateral meniscus appear to be less favourable than other locations. In part this is due to the loose capsular attachment in this region reducing the success of deployment of anchors on the capsule. Using popliteus as an anchor point is safe and results in a very low rate of re-operation for failure of repair

1.  Co-authors from the
SANTI Study Group
 Hervé Ouanezar
 William G. Blakeney
 Charles Latrobe
 Levi Reina Fernandes
 Jean Romain Delaloye
 Mathieu Thaunat
 Bertrand Sonnery-Cottet
The Popliteus Tendon
Provides a Safe and Reliable
Location
for Anchor Placement in
Posterior Horn Lateral
Meniscal
Repairs
Adnan Saithna, MBChB, DipSEM, FRCS,
MSc
Honorary Professor Nottingham Trent University, UK
Consultant Orthopaedic Surgeon
Southport & Ormskirk Hospitals, UK

2. I (and/or my co-authors) have something to disclose.
Detailed disclosure information is available via:
AANA Printed Final Program
AANA Meeting App
or
AAOS Orthopaedic Disclosure Program on the AAOS website at
http://www.aaos.org/disclosure
.

3. Failure rates of medial/lateral meniscal repairs performed at the time of
ACLR are similar:
• Approx 14% at 6 years Westermann AJSM 2014
Melton KSSTA 2011
Tengrootenhuysen KSSTA 2011
However, repairs of the posterior horn LM are technically more
challenging due to the loose capsular attachment
Only 63% of tears in the region of the popliteal hiatus healed at second
look arthroscopy, Horibe, JBJS Br 1995,
All-inside Lateral Meniscal Repair

4. Cadaveric Study, Uchida et al, The Knee 2016
• Medial Meniscus
– > 90% of anchors deployed
on either the capsule or sMCL
• Lateral Meniscus
– Only 62.5%
deployed on capsule
How often are meniscal repair anchors
successfully placed on the capsule?

5. Can we use popliteus?
Cadaveric Study, Lopez et al, Act Ortop Mex 2011
No macroscopic gapping, or loosening of sutures after 1000 gait cycles

6. All patients who underwent primary ACLR + repair of
unstable vertical LM tears with an all-inside device placed in
the popliteus tendon between 2011-15 were identified
Exclusions:
• Other types of tear (stable tears, and root, radial or bucket handle or
discoid)
• Multiligament Injuries
• Major concomitant procedure (e.g. HTO)
Retrospective Review of Prospectively Collected Data
from the SANTI Study Group Database

7. Surgical Technique

8. Follow Up
Clinical follow up:
• Weeks 3 and 6
• Months 3,6,12 and 24
Final follow up by telephone interview:
• If patients had further surgery, operative records were
obtained
• If they had pain/swelling/locking they were recalled for clinical
and MRI evaluation

9. Results
Study Population
• 200 patients
• Mean age 28.6 (range 14-60)
• Gender distribution M 70%, F 30%
• Mean follow up 45.5 months (range 24.7–75.3)
• The overall ipsilateral re-operation rate was 13%
• 14 (7%) also underwent re-operation for contralateral ACLR

10. Ipsilateral Re-operations
Indication Number %
LM repair failure 7 3.5
MM tear 5 2.5
ACL graft rupture 10 5
Cyclops lesion 3 1.5
Septic Arthritis 1 0.5

11. 0 1 2 3 4 5 6
70
80
90
100
Time (years)
Percentsurvival
Kaplan Meier Cumulative Survivorship using re-operation
for failed LM repair as the endpoint
7 (3.5%) patients underwent re-operation for failed LM at a mean of
24.2 months (range 8.7-43.5) from the date of the index procedure

12. Knee pain at final follow up
Patients undergoing re-operation excluded
174 patients evaluated for pain at final follow up
• 29 patients reported pain or discomfort with a mean VAS
3.6/10
• Of these only 3 had lateral pain
• All proximal to LE
• All resolved with corticosteroid injection
• None had lateral joint line pain
• None had posterior pain

13. Specific complications
No specific complications encountered
• No surgery to remove a symptomatic device from PT
• No PTT tear
• No neurological injuries

14. Risk factors for LM Re-operation
Bimeniscal repair
• Overall re-operation rate bimeniscal (22.4%) vs LM only (9%) p
= 0.005
Chronic ACL rupture
• No failures in 11 patients ACLR >100 months from injury
ALL Reconstruction
• Isolated ACL (4.6%) vs ACL+ALL (2.6%) NS
Number of anchors in popliteus
• One (1.8%) vs Two or more (5.6%) NS

15. Conclusions
• Placing an all-inside device within the popliteus tendon is safe
– no evidence of concerns in this series
• The technique is associated with a very low re-operation rate
for LM repair failure when performed at the time of ACLR

16. Thank you….