Meniscotibial Ligament Tear and Meniscocapsular Detachment of Anterior Horn of the Lateral Meniscus

The meniscotibial ligament (MTL) tear, along with a meniscocapsular separation, is a very rarely diagnosed injury pattern often missed on magnetic resonance imaging (MRI). The meniscus becomes hypermobile and can cause anterior knee pain, instability, and frequent locking. A 29-year-old female patient presented to the outpatient department with a history of a noncontact injury 3 months ago. Her Tegner Lysholm Knee Score was 41/100. On examination, there was lateral joint line tenderness and a positive McMurray test with a clicking sensation. MRI was performed, which showed torn fascicles in the anterior horn of the lateral meniscus. Knee arthroscopy confirmed that MTL was completely torn along with meniscocapsular detachment. A Scorpion jaw (Arthrex, Naples, FL) loaded with 2-0 FiberWire was used to take three bites from the meniscus. These ends of sutures were loaded on a 2.9 mm PushLock anchor and inserted at the tibia border. An 18G needle was loaded with a monofilament nitinol loop suture and passed through the capsule into the joint. A suture retriever was used to pick suture ends and pass through the loop. The monofilament loop was then pulled to pass the FiberWire ends from the capsule. All six FiberWire ends were passed through the capsule and three knots were tied from outside to reattach the capsule. This kind of injury can lead to anterolateral instability of the knee. Diagnosis of this lesion is very challenging and crucial. Biomechanical instability has prompted us to pay specific attention to its investigation and management. The described repair technique gives good results due to rigid fixation and the postoperative rehabilitation is also fast.