Creaking knee joint after ACL reconstruction and posterior root repair of the lateral meniscus

Introduction. A posterior root tear of the lateral meniscus is a common concomitant injury of anterior cruciate ligament (ACL) ruptures. Transtibial pull-out repair is an established surgical treatment for isolated posterior root tears. Due to the anatomical relationship, the tibial tunnel of the ACL can be used to fix the meniscus suture in a simultaneous ACL reconstruction. Case report. We report on a 43-year-old male patient who was treated with ACL reconstruction and simultaneous transtibial pullout repair of the posterior root of the lateral meniscus of the right knee joint. After 3 months the patient complained about a creaking knee joint. Revision arthroscopy showed a failure of the transtibial pull-out suture. The fiber thread of the suture was displaced into the knee joint and was responsible for the creaking sensation. Conclusion. The simultaneous use of the tibial ACL tunnel to fix the posterior root of the lateral meniscus is an efficient option. In the case of technical difficulties of tibial ACL fixation using interference screws, a separate tunnel for posterior root fixation provides a secure alternative to avoid accidental tearing of the thread of the pull-out suture.