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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”

Published:January 12, 2023DOI:https://doi.org/10.1016/j.arthro.2023.01.008
      To the editor:
      I, with great interest, read the report by Zheng-Zheng Zhang and Wei-Ping Li
      • Zhang Z.Z.
      • Luo H.
      • Zhang H.Z.
      • Zhou Y.F.
      • Chen Z.
      • Jiang C.
      • Song B.
      • Li W.P.
      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)
      • Gee S.M.
      • Posner M.
      Meniscus Anatomy and Basic Science.
      . 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
      • Fox A.J.
      • Wanivenhaus F.
      • Burge A.J.
      • Warren R.F.
      • Rodeo S.A.
      The human meniscus: a review of anatomy, function, injury, and advances in treatment.
      , 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.
      Figure thumbnail gr1
      Fig. 1Three longitudinal holes in the suture area in the original as well as the diameter of the equipment’s needle (Smith & Nephew).
      Figure thumbnail gr2
      Fig. 2The three holes account for the diameter of the posterolateral meniscus root.
      Figure thumbnail gr3
      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.

      Supplementary Data

      References

        • Zhang Z.Z.
        • Luo H.
        • Zhang H.Z.
        • Zhou Y.F.
        • Chen Z.
        • Jiang C.
        • Song B.
        • Li W.P.
        H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study.
        Arthroscopy. 2021 Jul; 37: 2204-2216.e2
        • Gee S.M.
        • Posner M.
        Meniscus Anatomy and Basic Science.
        Sports Med Arthrosc Rev. 2021 Sep 1; 29: e18-e23
        • Fox A.J.
        • Wanivenhaus F.
        • Burge A.J.
        • Warren R.F.
        • Rodeo S.A.
        The human meniscus: a review of anatomy, function, injury, and advances in treatment.
        Clin Anat. 2015 Mar; 28: 269-287

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