Skip to main content
Log in

Anterior meniscus root avulsion following intramedullary nailing for a tibial shaft fracture

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

This paper presents the first reported case of iatrogenic injury to the anterior medial meniscal root attachment following intramedullary nailing for a tibial shaft fracture. The patient experienced a closed right tibia–fibula fracture 7 years prior to presentation, which was treated with a reamed intramedullary nail. The nail was removed 3 years after the index surgery due to chronic anterior knee pain, which persisted following hardware removal. At presentation, the patient was diagnosed with an anterior horn medial meniscal root tear likely secondary to insertion of the intramedullary nail through the anatomic footprint of the anterior medial root. After undergoing a medial meniscus anterior horn root repair, the patient was asymptomatic and resumed normal activities.

Level of evidence

Case report, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

References

  1. Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Jt Surg Am 90:1922–1931

    Article  Google Scholar 

  2. Berlet GC, Fowler PJ (1998) The anterior horn of the medical meniscus. An anatomic study of its insertion. Am J Sports Med 26:540–543

    CAS  PubMed  Google Scholar 

  3. Bone LB, Sucato D, Stegemann PM, Rohrbacher BJ (1997) Displaced isolated fractures of the tibial shaft treated with either a cast or intramedullary nailing. An outcome analysis of matched pairs of patients. J Bone Jt Surg Am 79:1336–1341

    CAS  Google Scholar 

  4. Buehler KC, Green J, Woll TS, Duwelius PJ (1997) A technique for intramedullary nailing of proximal third tibia fractures. J Orthop Trauma 11:218–223

    Article  CAS  PubMed  Google Scholar 

  5. Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: Is extent associated with severity of degeneration or type of tear? Am J Roentgenol 183:17–23

    Article  Google Scholar 

  6. Court-Brown CM, Gustilo T, Shaw AD (1997) Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma 11:103–105

    Article  CAS  PubMed  Google Scholar 

  7. Hiesterman TG, Shafiq BX, Cole PA (2011) Intramedullary nailing of extra-articular proximal tibia fractures. J Am Acad Orthop Surg 19:690–700

    PubMed  Google Scholar 

  8. Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF (2012) Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med 40:2342–2347

    Article  PubMed  Google Scholar 

  9. Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD (1995) Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11:386–394

    Article  CAS  PubMed  Google Scholar 

  10. Karladani AH, Granhed H, Edshage B, Jerre R, Styf J (2000) Displaced tibial shaft fractures: a prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients. Acta Orthop Scand 71(2):160–167

    Article  CAS  PubMed  Google Scholar 

  11. Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032

    Article  PubMed  Google Scholar 

  12. Kohn D, Moreno B (1995) Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy 11:96–103

    Article  CAS  PubMed  Google Scholar 

  13. LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Jt Surg Am 96(6):471–479

    Article  Google Scholar 

  14. Lefaivre KA, Guy P, Chan H, Blachut PA (2008) Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma 22:525–529

    Article  PubMed  Google Scholar 

  15. Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skelet Radiol 33:569–574

    Article  CAS  Google Scholar 

  16. Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37:124–129

    Article  PubMed  Google Scholar 

  17. McConnell T, Tornetta P III, Tilzey J, Casey D (2001) Tibial portal placement: the radiographic correlate of the anatomic safe zone. J Orthop Trauma 15:207–209

    Article  CAS  PubMed  Google Scholar 

  18. Morandi M, Banka T, Gaiarsa GP, Guthrie ST, Khalil J, Hoegler J, Lindeque BG (2011) Intramedullary nailing of tibial fractures: review of surgical techniques and description of a percutaneous lateral suprapatellar approach. Orthopedics 33:172–179

    Article  Google Scholar 

  19. Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, LaPrade RF (2014) Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in-situ pullout repair restores derangement of joint mechanics. Am J Sports Med 42(3):699–707

    Google Scholar 

  20. Papalia R, Vasta S, Franceschi F, D’Adamio S, Maffulli N, Denaro V (2013) Meniscal root tears: from basic science to ultimate surgery. Br Med Bull 106:91–115

    Article  CAS  PubMed  Google Scholar 

  21. Shelbourne KD, Roberson TA, Gray T (2011) Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med 39:1439–1443

    Article  PubMed  Google Scholar 

  22. Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ (2002) Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Jt Surg Am 84-A:580–585

    Google Scholar 

  23. Tornetta P III, Riina J, Geller J, Purban W (1999) Intraarticular anatomic risks of tibial nailing. J Orthop Trauma 13:247–251

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert F. LaPrade.

Additional information

Investigation performed at the Steadman Philippon Research Institute, Vail, Colorado.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ellman, M.B., James, E.W., LaPrade, C.M. et al. Anterior meniscus root avulsion following intramedullary nailing for a tibial shaft fracture. Knee Surg Sports Traumatol Arthrosc 23, 1188–1191 (2015). https://doi.org/10.1007/s00167-014-2941-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-2941-5

Keywords

Navigation