Posterior-Medial Meniscal Root Repair Through Lateral Tibial Tunnel Combined With Medial Opening Osteotomy and Homologous Graft

When there is a rupture in the meniscal roots or close to them, the menisci suddenly and considerably reduce their capacity to absorb the axial mechanical load that passes through the knee, quickly leading to the development of a process of chondral degeneration. The varus deformity of the lower limb (when the mechanical axis crosses the medial compartment of the knee) favors this type of injury owing to the overload in the medial compartment. When the patient has both varus deformity and medial meniscal posterior root injury, there is a clear indication for surgical realignment of the affected lower limb. There is still not a consensus regarding combining meniscal root repair with corrective osteotomy, although there is a tendency to perform both procedures aiming at long-term joint preservation. We present a safe alternative technique for simultaneous medial meniscal posterior root repair using a lateral tibial transosseous tunnel associated with a valgus-producing high tibial osteotomy with homologous bone grafting, allowing a full return to daily activities and sports. Video 1 Preoperative radiographs are presented for a 62-year-old female patient with sudden posteromedial pain after slouching down the stairs. The radiographs, without showing advanced signs of osteoarthritis, indicate asymmetrical varus of the right knee, with a correction angle of 7.5° planned on panoramic radiographs. Magnetic resonance imaging shows signs of a lesion of the posteromedial root of the medial meniscus. The material needed to perform suturing of the posteromedial root and placement of a single transtibial tunnel with a FlipCutter drill is shown. Initially, an anteromedial longitudinal incision is performed approximately 6 cm distal to the joint interline; subcutaneous dissection is performed and the hamstring tendons are identified and repaired; and release of the superficial medial collateral ligament is performed, with its distal insertion kept intact. Two parallel guidewires are introduced 4 cm distal from the joint line, directed to the fibular head. We begin the medial cortical osteotomy with an oscillating saw at a low rotation speed. We complete the remainder of the osteotomy with osteotomes, always remembering to preserve the lateral cortex. Using a spreader, we open the osteotomy at the degree predetermined during preoperative planning. We introduce a ContourLock plate with a predetermined wedge and start its fixation with the most posterior proximal screw. Aft