Menisco Lateral Hipermóvil: Diagnóstico y Tratamiento de Lesiones de Fascículos Poplíteo Meniscales

Resumen

El Síndrome de Menisco Hipermóvil, caracterizado por bloqueos mecánicos dolorosos de la rodilla, tiene un sustento anatómico basado en los fascículos poplíteo meniscales anteroinferior y posterosuperior, responsables de la estabilidad primaria de la esquina posterolateral meniscal. Con un cuadro clínico característico, usualmente con Resonancia Magnética sin hallazgos sugerentes de patología, la artroscopía juega un rol esencial en casos de alta sospecha, comprobando el diagnóstico al presentar hipermobilidad del cuerno posterior del menisco lateral. Método: Se presentan 9 casos resueltos, con hiperlaxitud posterolateral meniscal, y presentación clínica caracterizada por bloqueo articular de rodilla sin causa aparente. En todos los casos se realizó reparación de los fascículos poplíteo meniscales con suturas meniscales, con resolución completa de la sintomatología y sin complicaciones post quirúrgicas.

Conclusión El manejo del cuadro de menisco hipermóvil está basado por la sospecha clínica y el descarte de otras patologías como causa subyacente de la sintomatología. El manejo quirúrgico con suturas meniscales ha demostrado restaurar la biomecánica normal del compartimento posterolateral de la rodilla, logrando la resolución completa de los síntomas.

Nivel de evidencia IV.

Abstract

Hypermobile Meniscus Syndrome, characterized by painful mechanical blockages of the knee, has an anatomical support based on the anteroinferior and posterosuperior poplíteomeniscal fascicles, responsible for the primary stability of the posterolateral meniscal corner. With a characteristic clinical presentation, usually with Magnetic Resonance without suggestive findings of pathology, arthroscopy plays an essential role in cases of high suspicion, checking the diagnosis by presenting hypermobility of the posterior horn of the lateral meniscus. Method: We present 9 resolved cases, with posterolateral meniscal hypermobility, and clinical presentation characterized by knee articular block without apparent cause. In all cases, poplíteomeniscal fascicles were repaired with meniscal sutures, with complete resolution of the symptoms and without post-surgical complications.

Conclusion The management of the hypermobile meniscus syndrome is based on clinical suspicion and the discarding of other pathologies as the underlying cause of the symptomatology. Surgical management with meniscal sutures has been shown to restore the normal biomechanics of the posterolateral compartment of the knee, achieving complete resolution of symptoms.

Level of evidence Case series IV.

Palabras clave

rodilla - hipermóvil menisco lateral - romperse la rodilla

Keywords

knee - hypermobile lateral meniscus - snapping knee

• Bibliografía

• 1 Suganuma J, Inoue Y, Tani H, Sugiki T, Sassa T, Shibata R. Reconstruction of the Popliteomeniscal Fascicles for Treatment of Recurrent Subluxation of the Lateral Meniscus. Arthrosc Tech 2017; 6 (02) e283-e290
• 2 Ahn JH, Lee SH, Kim KI, Nam J. Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus. Knee Surg Sports TraumatolArthrosc 2018; 26 (03) 787-792
• 3 Higgins H. The Geniculate Articular Surfaces of the Femur and Tibia. J AnatPhysiol 1895; 29 (Pt 4): 574-582.1 , 1
• 4 Cohn AK, Mains DB. Popliteal hiatus of the lateral meniscus. Anatomy and measurement at dissection of 10 specimens. Am J Sports Med 1979; 7 (04) 221-226
• 5 Zappia M, Reginelli A, Chianca V. , et al. MRI of popliteo-meniscal fasciculi of the knee: a pictorial review. Acta Biomed 2018; 89 (1-S): 7-17
• 6 Terry GC, LaPrade RF. The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med 1996; 24 (06) 732-739
• 7 Sussmann PS, Simonian PT, Wickiewicz TL, Warren RF. Development of the popliteomeniscal fasciculi in the fetal human knee joint. Arthroscopy 2001; 17 (01) 14-18
• 8 Simonian PT, Sussmann PS, van Trommel M, Wickiewicz TL, Warren RF. Popliteomeniscal fasciculi and lateral meniscal stability. Am J Sports Med 1997; 25 (06) 849-853
• 9 LaPrade RF, Konowalchuk BK. Popliteomeniscal fascicle tears causing symptomatic lateral compartment knee pain: diagnosis by the figure-4 test and treatment by open repair. Am J Sports Med 2005; 33 (08) 1231-1236
• 10 Simonian PT, Sussmann PS, Wickiewicz TL. , et al. Popliteomeniscal fasciculi and the unstable lateral meniscus: clinical correlation and magnetic resonance diagnosis. Arthroscopy 1997; 13 (05) 590-596
• 11 De Smet AA, Asinger DA, Johnson RL. Abnormal superior popliteomeniscal fascicle and posterior pericapsular edema: indirect MR imaging signs of a lateral meniscal tear. AJR Am J Roentgenol 2001; 176 (01) 63-66
• 12 Sakai H, Sasho T, Wada Y. , et al. MRI of the popliteomeniscal fasciculi. AJR Am J Roentgenol 2006; 186 (02) 460-466
• 13 Camarillo M, Johnson DL. Popliteomeniscal fascicle tears. Orthopedics 2014; 37 (03) 187-190
• 14 Kimura M, Shirakura K, Hasegawa A, Kobayashi Y, Udagawa E. Anatomy and pathophysiology of the popliteal tendon area in the lateral meniscus: 1. Arthroscopic and anatomical investigation. Arthroscopy 1992; 8 (04) 419-423
• 15 Higuchi H, Kimura M, Kobayashi A, Hatayama K, Takagishi K. A novel treatment of hypermobile lateral meniscus with monopolar radiofrequency energy. Arthroscopy 2004; 20 (Suppl. 02) 1-5
• 16 Ohtoshi K, Kimura M, Kobayashi Y, Higuchi H, Kikuchi S. Arthroscopic thermal shrinkage for hypermobile lateral meniscus. Am J Sports Med 2004; 32 (05) 1297-1301
• 17 Shin HK, Lee HS, Lee YK, Bae KC, Cho CH, Lee KJ. Popliteomeniscal fascicle tear: diagnosis and operative technique. Arthrosc Tech 2012; 1 (01) e101-e106
• 18 Van Steyn MO, Mariscalco MW, Pedroza AD, Smerek J, Kaeding CC, Flanigan DC. The hypermobile lateral meniscus: a retrospective review of presentation, imaging, treatment, and results. Knee Surg Sports TraumatolArthrosc 2016; 24 (05) 1555-1559
• 19 LaPrade RF. Arthroscopic evaluation of the lateral compartment of knees with grade 3 posterolateral knee complex injuries. Am J Sports Med 1997; 25 (05) 596-602
• 20 Kamiya T, Suzuki T, Otsubo H. , et al. Midterm outcomes after arthroscopic surgery for hypermobile lateral meniscus in adults: Restriction of paradoxical motion. J Orthop Sci 2018; 23 (06) 1000-1004
• 21 Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM. Meniscal movement. An in-vivo study using dynamic MRI. J Bone Joint Surg Br 1999; 81 (01) 37-41
• 22 Steinbacher G, Alentorn-Geli E, Alvarado-Calderón M, Barastegui D, Álvarez-Díaz P, Cugat R. Meniscal fixation is a successful treatment for hypermobile lateral meniscus in soccer players. Knee Surg Sports TraumatolArthrosc 2019; 27 (02) 354-360
• 23 Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med 1982; 10 (02) 90-95
• 24 Arnoczky SP, Warren RF. The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med 1983; 11 (03) 131-141
• 25 Henning CE, Lynch MA, Clark JR. Vascularity for healing of meniscus repairs. Arthroscopy 1987; 3 (01) 13-18
• 26 Arendt EA, Fontboté CA, Rohr SR. Displacing lateral meniscus masquerading as patella dislocation. Knee Surg Sports TraumatolArthrosc 2014; 22 (10) 2315-2319