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Letter to the Editor Regarding“H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study”
in the July 2021 issue of Arthroscopy. I really like the publication and am hoping that applying H-Plasty repair to patients may lead to more wonderful surgical repair.
However, as a doctor in question, I would like to make a significant correction regarding the operation of the operative type. The points I doubt lie in the axial width of the posterior lateral meniscus root. When the incision is sutured, the area of three holes along the length of the incision may result in an iatrogenic rupture of the meniscus due to the injury punctured by the tip of the suturing instrument (with its specific diameter) （fig 1，2）. This is because of a number of reasons which are as follows: Firstly, the diameter of adult posterolateral meniscus root is approximately (7 mm)
. But when suturing, the minimum diameter of the equipment’s needle (Smith & Nephew USA) is 1.6mm (fig 1). However, the total diameter of the three holes is 4.8mm (fig 2). Secondly, the fibers traveling through the meniscus are oblique rather than vertical while suturing (fig 3), which enlarges the area of fiber damage, Thirdly, as we all know
, the lateral meniscus（1） is a red area that is fully vascularized, the middle（2） is red that is white junction area at the border of the vascular area, and the innermost（3） is a white area within the avascular area of the meniscus, which is difficult to heal (fig 3). To summarise, this type of H-Plasty Repair is excellent and improved to the intact level, but it is likely to cause iatrogenic injury to the posterolateral meniscus.
Fig. 1Three longitudinal holes in the suture area in the original as well as the diameter of the equipment’s needle (Smith & Nephew).
Fig. 31 shows the outer third region of the menisci; 2 illustrates the middle third region of the menisci; and 3 depicts the inner third region of the menisci （from Schepsis AA, Busconi BD. Sports Medicine, 2006, Lippincott Williams & Wilkins）3 3 shows the meniscus vascular distribution. Frontal section of medial compartment oblique through meniscus while suturing.
LIU Xinwei Corresponding author: Department of Orthopaedics, General Hospital of Northern Theater Command ,Shenyang 110016, China;E-mail:[email protected] Number:+86 17744564314
We thank the authors for their interest in our study titled “H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study.”1 We would like to respond as follows.
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