Pull-out suture in posterior root avulsion fracture of the medial meniscus: 2 cases

The menisci are key structures in the complex biomechanics of the knee joint, and are fundamentally important in shock absorption to attenuate axial loads on the articular surfaces of the opposing femur and tibia [1]. The menisci have secondary roles in knee joint stability, proprioception, joint lubrication, and stress distribution. During weight bearing, the menisci bear, distribute, and contain hoop stress by the circumferential orientation of the collagen fibers [2]. Loss of the bony attachments of the posterior horn of the medial meniscus can lead to extrusion of the meniscus [3]. With extrusion, the medial meniscus loses its ability to absorb hoop stress, resulting in a biomechanical equivalent somewhere between the intact knee and a complete meniscectomy [4]. The literature has suggested that meniscal ossicles could arise from multiple causes, including trauma, metaplastic ossification [5], or a sesamoid bone [6]. Irrespective of cause, there has been no agreement regarding treatment of these meniscal ossicles. We performed pull-out sutures for medial meniscus posterior horn root avulsions to restore the normal anatomy and biomechanical function of the meniscus and report results from 2 cases.