The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

No Risk of Tunnel Convergence in Combined ACL Reconstruction and Transtibial Lateral Meniscus Posterior Root Tear Repair. A Technical Note

Document Type : TECHNICAL NOTE

Authors
Nikolaos E. Koukoulias 1
Evangelia Germanou 2
Dimitris Koukoulias 3
1 Sports Trauma and Orthopaedics Department, Saint Luke’s Hospital, Thessaloniki, Greece
2 Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
3 Department of Physiotherapy, Aristotle University of Thessaloniki, Thessaloniki, Greece
10.22038/abjs.2025.88483.4013
Abstract
Lateral meniscus posterior root tears are frequently identified during anterior cruciate ligament reconstruction. These tears are associated with increased knee instability and altered biomechanics in knees deficient in the anterior cruciate ligament, leading to potential cartilage degeneration and compromised graft function if left untreated. Repairing lateral meniscus posterior root tears during anterior cruciate ligament reconstruction improves knee stability and biomechanics, while also yielding better patient-reported outcomes. The transtibial pullout technique is a popular and reliable method for repairing lateral meniscus posterior root tears. However, it poses a substantial risk of tibial tunnel convergence, which may complicate the surgery and compromise the clinical result. We describe a simple and reproducible technique that enables anatomic anterior cruciate ligament reconstruction and lateral meniscus posterior root tear repair with no risk of tibial tunnel convergence.
        Level of evidence: V
Keywords
Arthroscopy
Complications
Knee
Subjects
  1. Forkel P, Reuter S, Sprenker F, et al. Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc. 2015; 23(1):112-118. doi: 10.1007/s00167-014-3467-6.
  2. Lee DR, Lu Y, Reinholz AK, et al. Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review. Arthroscopy. 2025;41(2):390-417. doi: 10.1016/j.arthro.2024.02.017.
  3. Familiari F, Palco M, Russo R, Moatshe G, Simonetta R. Arthroscopic Repair of Posterior Root Tears of the Lateral Meniscus with All-Suture Anchor. Arthrosc Tech. 2022;11(5):e781-e787. doi: 10.1016/j.eats.2021.12.037.
  4. Koukoulias N, Vasiliadis AV, Germanou E, Koukoulias D, Dimitriadis T. Inverted Vertical Locking Loop Technique: A Single Suture Tape, Simple Configuration for Meniscal Root Tears. Arthrosc Tech. 2024;14(4):103281. doi: 10.1016/j.eats.2024.103281.
  5. DeFroda S, Bourbon de Albuquerque J 2nd, Bezold W, et al. Tunnel Overlap Occurs 25% of the Time With Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Root Repair. Arthrosc Sports Med Rehabil. 2024;6(3):100917. doi: 10.1016/j.asmr.2024.100917.
  6. Zhou Y, Bai F, Liu X, She H, Ding C, Xiang B. Shared ACL Bone Tunnel Technique for Repair of Lateral Meniscus Posterior Root Tears Combined With ACL Reconstruction. Orthop J Sports Med. 2022;10(8):23259671221114319. doi: 10.1177/23259671221114319.
  7. Forkel P, Petersen W. Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg. 2012;132(3):387-91. doi: 10.1007/s00402-011-1429-8.
  8. Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2012;40(10):2342-7. doi: 10.1177/0363546512457642.
  9. Matassi F, Taha ZA, Civinini A, Di Muro A, Corti J, Civinini R. Posterior Lateral Meniscal Root Repair Through Lateral Tunnel and Anterior Cruciate Ligament Revision: How to Avoid Tunnel Overlapping. Arthrosc Tech. 2024;13(10):103089. doi: 10.1016/j.eats.2024.103089.
  10. Nlandu A, Giurazza G, Lahsika M, et al. How To Avoid Suture Damage in Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Posterior Root Reinsertion With the Transtibial Pullout Technique: A Technical Note. Arthrosc Tech. 2024;13(2):102849. doi: 10.1016/j.eats.2023.09.024.

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 3
March 2026
Pages 222-227

  • Receive Date 26 May 2025
  • Revise Date 29 July 2025
  • Accept Date 30 September 2025