Widening of the popliteal hiatus on magnetic resonance imaging leads to recurrent subluxation of the lateral meniscus

Abstract

PURPOSE: This study was undertaken to elucidate the clinical significance of widening of the popliteal hiatus on magnetic resonance imaging (MRI), and to document the clinical results and technical aspects of arthroscopic repair of this finding. METHODS: Included are 82 knees after arthroscopic surgery, divided according to arthroscopic diagnosis into group A, hypermobility of lateral meniscus, 8 knees; group B, tear of the anterior horn of the lateral meniscus, 32 knees; and group C, no abnormality of the lateral meniscus, 36 knees with medial meniscal tears and 6 with other conditions. Popliteal hiatus diameter was measured and the popliteal hiatus/lateral tibial plateau (LTP) ratio was calculated on preoperative sagittal and coronal MRI. At arthroscopy, the widened popliteal hiatus in group A was tightened anteriorly by outside-in or all-inside suture and posteriorly with all-inside suture. Outcomes were evaluated with MRI, Lysholm, Tegner and VAS scores. RESULTS: The preoperative diameter of the popliteal hiatus and the popliteal hiatus/LTP ratio were significantly larger in group A than in groups B and C (p < 0.05) on both views. Threshold popliteal hiatus/LTP values of 0.16 and 0.18 on the sagittal and coronal views demonstrated diagnostic discrimination, and these values were significantly reduced after arthroscopy in Group A. Lysholm and Tegner scores were improved after tightening of the popliteal hiatus, while VAS scores reduced (all p < 0.05). CONCLUSION: Widening of the popliteal hiatus on MRI may lead to recurrent subluxation of the lateral meniscus. Arthroscopic anterior and posterior tightening of the popliteal hiatus was a safe and effective treatment. LEVEL OF EVIDENCE: II.