case_images: PMC7383304_01
case_images: Magnetic resonance imaging. (a) Ghost sign (dotted area) on sagittal view. (b) Giraffe neck sign (dotted area) and highly damaged articular cartilage on the lateral tibial plateau beside the lateral tibial eminence (arrowhead) on coronal view. (c) Repaired medial meniscus (MM) root (dotted area). (d) Continuity of the repaired MM root (arrow) and improved articular cartilage (arrowhead).
case_images: CRIOR2020-8842167.001.jpg
case_images: PMC7383304_01_CRIOR2020-8842167.001.jpg
case_images: fig1
case_images: Magnetic resonance imaging (MRI) showed high medial tibial slope (MTS) (6.5 ) and relatively low lateral tibial slope (LTS) (4.1 ), PRTs of both menisci (Figures 1 and 2), and damaged cartilage, especially on the medial femoral condyle (MFC) and lateral tibial plateau (LTP) (Figures 1(b) and 2(a)), which were considered to be caused by MMPRT and LMPRT, respectively. Postoperative MRI showed good healing of both roots and articular cartilage (Figures 1(c), 1(d), 2(c), and 2(d)).
case_images: Magnetic resonance imaging:coronal view. (a) Preoperative medial meniscus extrusion (MME) (4.3 mm) and highly damaged articular cartilage on the medial femoral condyle (arrowhead). (b) Preoperative lateral meniscus extrusion (LME) (1.2 mm). (c) Postoperative MME (7.0 mm) and improved articular cartilage (arrowhead). (d) Postoperative LME (0.9 mm).
case_images: CRIOR2020-8842167.002.jpg
case_images: PMC7383304_01_CRIOR2020-8842167.002.jpg
case_images: fig2
case_images: Magnetic resonance imaging (MRI) showed high medial tibial slope (MTS) (6.5 ) and relatively low lateral tibial slope (LTS) (4.1 ), PRTs of both menisci (Figures 1 and 2), and damaged cartilage, especially on the medial femoral condyle (MFC) and lateral tibial plateau (LTP) (Figures 1(b) and 2(a)), which were considered to be caused by MMPRT and LMPRT, respectively. Postoperative MRI showed good healing of both roots and articular cartilage (Figures 1(c), 1(d), 2(c), and 2(d)).
case_images: Arthroscopic findings and three-dimensional computed tomography. (a) Medial meniscus posterior root tear and highly damaged articular surface on the medial femoral condyle (arrowhead). (b) Lateral meniscus posterior root tear and highly damaged articular surface on the lateral tibial plateau (arrowhead). (c) FasT-Fix (Smith & Nephew, Andover, MA, USA) dependent modified Mason-Allen suture technique. (d) A simple stitch suture using the Knee Scorpion suture passer (Arthrex, Naples, FL, USA). (e) Position of the tibial tunnel. (f) Suture is passed between the ACL and the PCL using a suture retriever (Smith & Nephew) (arrowhead). (g) Repaired MM. (h) Repaired LM. MM: medial meniscus. LM: lateral meniscus. ACL: anterior cruciate ligament. PCL: posterior cruciate ligament. MMPR: medial meniscus posterior root. LMPR: lateral meniscus posterior root.
case_images: CRIOR2020-8842167.003.jpg
case_images: PMC7383304_01_CRIOR2020-8842167.003.jpg
case_images: fig3
case_images: Arthroscopic evaluation under general anesthesia revealed these lesions, and no other intraarticular lesions, including meniscofemoral ligament tear, were detected (Figures 3(a) and 3(b)). The MM was sutured by FasT-Fix (Smith & Nephew, Andover, MA, USA) dependent modified Mason-Allen suture technique (Figure 3(c)), whereas the LM was sutured by a single simple stitch using the Knee Scorpion suture passer (Arthrex, Naples, FL, USA) and #2 FiberWire (Arthrex) (Figure 3(d)). Bone tunnel preparation was performed using an MMPRT guide, as described previously (Figure 3(e)). Both suture ends were pulled out through the tibial tunnel after the LM suture was passed between the ACL and the posterior cruciate ligament using a suture retriever (Smith & Nephew) (Figure 3(f)). Tibial fixation was performed under an initial tension of 20 N in the 45  knee-flexion position (Figures 3(g) and 3(h)).
case_images: Second-look arthroscopic findings. (a) Repaired medial meniscus (MM) attached to the tibial footprint. (b) Improved articular cartilage on the medial femoral condyle (arrowhead) and stable MM checked by probing under the 60  knee-flexed position. (c) Repaired LM attached to the tibial footprint. (d) Improved articular cartilage on the lateral tibial plateau (arrowhead) and enough synovial coverage around the LM footprint checked by probing.
case_images: CRIOR2020-8842167.004.jpg
case_images: PMC7383304_01_CRIOR2020-8842167.004.jpg
case_images: fig4
case_images: The stability of the repaired menisci was checked by probing during second-look arthroscopy one year after the primary surgery (Figure 4).