Anatomic All-Inside Repair of the Anteroinferior and Posterosuperior Popliteomeniscal Fascicles for Hypermobile Lateral Meniscus.

Abstract

Hypermobile lateral meniscus refers to abnormal mobility of an otherwise morphologically normal meniscus without obvious tears, causing lateral knee pain due to catching or locking of the lateral meniscus during flexion. The most common cause is rupture or elongation of the popliteomeniscal fascicles (PMFs), which connect the lateral meniscus to the joint capsule around the popliteus tendon. Hypermobile lateral meniscus is most commonly managed with simple, minimally invasive all-inside meniscal repair techniques or inside-out suture techniques. However, nonanatomic suturing not only results in unphysiologic repair but may also compromise popliteus tendon function. We describe a simple all-inside technique using a standard all-inside meniscal fixation device to anatomically repair the anteroinferior and posterosuperior PMFs. This approach reproduces the native fascicular anatomy while avoiding perforation of the popliteus tendon. The technique restores lateral meniscal stability, minimizes the risk of iatrogenic popliteus tendon injury, and does not require additional posterior portals or graft harvesting, allowing it to be performed with commonly available devices.