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Vicens MH, Pujol O, Portas-Torres I, Aguilar M, Joshi N, Minguell J, Castellet E, Casaccia M. Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes. INTERNATIONAL ORTHOPAEDICS 2024; 48:2293-2300. [PMID: 38942964 PMCID: PMC11347458 DOI: 10.1007/s00264-024-06241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/15/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE Meniscal wrapping is a fully arthroscopic technique that involves enhanced meniscal repair with a tissue-engineered collagen matrix wrapping. This study aims to investigate the feasibility of using the meniscal wrapping technique for the treatment of chronic or complex meniscal tears. The primary objective is to assess its failure rate. The secondary objectives are to analyse complication rate, functional outcomes and overall patient satisfaction. METHODS This retrospective case series study included patients who sustained chronic and complex tears undergoing meniscal wrapping with autologous liquid bone marrow injection. Failure rate was considered if the patient underwent partial or complete meniscectomy or knee replacement during the follow-up, while other unexpected knee reoperations were considered as complications. Clinical outcomes were evaluated through the IKDC score, Tegner Activity Score and Short Assessment of Patient Satisfaction. RESULTS Twenty-one patients were included (15 non-acute bucket-handle tears, three non-acute horizontal tears and three non-acute complex injuries). The failure rate was 9.5% at 33 months. The rate of other unplanned reoperations was 14.3%, but none of these complications were apparently directly related to the wrapping technique. The average postoperative IKDC was 73.3/100. No statistically significant difference was encountered between preinjury and postoperative Tegner Activity Score. The mean overall patient satisfaction was 88.3/100. CONCLUSIONS Meniscal wrapping can be safely used as an adjunctive technique to meniscal repair in such difficult-to-treat cases to preserve the meniscus. The technique achieves a low failure rate and promising results of knee function, and patient satisfaction.
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Affiliation(s)
- Marga H Vicens
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Pujol
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Irene Portas-Torres
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marc Aguilar
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Nayana Joshi
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Minguell
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Enric Castellet
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marcelo Casaccia
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Oosten JD, DiBartola AC, Wright JC, Cavendish PA, Milliron EM, Magnussen RA, Duerr RA, Kaeding CC, Flanigan DC. More Is Not Merrier: Increasing Numbers of All-Inside Implants Do Not Correlate with Higher Odds of Revision Surgery. J Knee Surg 2024; 37:361-367. [PMID: 37336501 DOI: 10.1055/a-2112-8158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The purpose of this study was to evaluate the relationship between the number of all-inside meniscal repair implants placed and the risk of repair failure. We hypothesized that the use of higher numbers of all-inside meniscus repair implants would be associated with increased failure risk. A retrospective chart review identified 351 patients who underwent all-inside meniscus repair between 2006 and 2013 by a sports medicine fellowship-trained orthopaedic surgeon at a single institution. Patient demographics (age, body mass index [BMI], sex) and surgical data (number of implants used, concomitant anterior cruciate ligament reconstruction [cACLR], and tear type/size/location) were recorded. Patients who received repairs in both menisci or who had follow-up < 1-year postoperatively were excluded. Repair failure was identified through chart review or patient interviews defined as a revision surgery on the index knee such as partial meniscectomy, total knee arthroplasty, meniscus transplant, or repeat repair. Logistic regression modeling was utilized to evaluate the relationship between the number of implants used and repair failure. A total of 227 all-inside meniscus repairs were included with a mean follow-up of 5.0 ± 3.0 years following surgery. Repair failure was noted in 68 knees (30.3%)-in 28.1% of knees with fewer than four implants and in 35.8% of knees with four or more implants (p = 0.31). No significant increase in failure was observed with increasing number of all-inside medial (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.79-1.7; p = 0.46) or lateral (OR: 0.86; 95% CI: 0.47-1.57; p = 0.63) implants after controlling for patient age, BMI, cACLR, tear type, or size. Tears of the lateral meniscus located in the red-white and white-white zones had lower odds of failure (OR: 0.14; 95% CI: 0.02-0.88; p = 0.036) than tears within the red-red zone, and patients with cACLR had lower odds of repair failure (OR: 0.40; 95% CI: 0.18-0.86, p = 0.024) than those without. The number of all-inside implants placed during meniscus tear repair did not affect the likelihood of repair failure leading to reoperation after controlling for BMI, age, tear type, size, location, and cACLR. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- James D Oosten
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jonathan C Wright
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Parker A Cavendish
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Eric M Milliron
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Duerr
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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Huang B, Yang M, Kou Y, Jiang B. Absorbable implants in sport medicine and arthroscopic surgery: A narrative review of recent development. Bioact Mater 2024; 31:272-283. [PMID: 37637087 PMCID: PMC10457691 DOI: 10.1016/j.bioactmat.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Over the past two decades, advances in arthroscopic and minimally invasive surgical techniques have led to significant growth in sports medicine surgery. Implants such as suture anchors, interference screws, and endo-buttons are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers, absorbable bioceramics, and absorbable metals. In this paper, we will provide a comprehensive summary of these absorbable materials from the perspective of clinicians, and discuss their clinical applications and related research in sport medicine.
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Affiliation(s)
- Boxuan Huang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Ming Yang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Yuhui Kou
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Baoguo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
- Medical School, Shenzhen University, Shenzhen, 518060, Guangdong, China
- Shenzhen University General Hospital, Shenzhen, 518055, Guangdong, China
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Panchal KA, Moharana AK, Angrish S, Ts D. A Single-Centre, Retrospective, Observational Study to Assess Safety and Functional Outcomes of Arthroscopic Meniscal Repair Using Surestitch All Inside Implant. Cureus 2023; 15:e38221. [PMID: 37252500 PMCID: PMC10224793 DOI: 10.7759/cureus.38221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The meniscus plays a vital role in maintaining knee stability. It acts as a shock absorber and knee filler. The incidence of meniscal tears is estimated to be 60 per 100,000 people. Due to lack of awareness among patients, only 10% of the meniscus tears were treated through partial or total meniscectomy. Recently, the concept of meniscus preservation surgery has emerged to preserve early degeneration of the knee joint. In the current retrospective study, safety and functional outcomes of arthroscopic meniscal repair surgery using Surestitch All inside implants (Sironix Arthroscopy Solutions, Healthium Medtech Limited, Bengalaru, India) were assessed. Methods Fifty-two patients who underwent arthroscopic meniscal repair surgery between January 2019 to July 2022 at Epic Hospital in Gujarat, India, were enrolled in the study. Retrospective data including demographics, injury details, surgery details, and post-surgery complications were collected from the medical records of the patients. Then, the patients were followed up telephonically to document safety and functional outcomes using patient-reported instruments such as International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity level, and Lysholm knee score. Results The recruited patients had the mean age, height, and weight of 37.56 ± 12.52 years, 167.61 ± 7.28 cm, and 75.87 ± 10.7 kgs, respectively. Seventy-one percent of patients were male and 29% were female. Majority of the patients had the routine of doing mild exercise. During pre-surgery representations, medial meniscal tear was observed in majority of patients. The mean length of the tear was 1.32 ± 0.84 cm. In addition, patients were also diagnosed with anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) tears, and osteochondral defects. Surgeries for meniscal repair were performed using Surestitch All inside implant. In patient-reported outcomes, the mean IKDC, SANE, and Lysholm scores were 81.72 ± 14.23, 94.02 ± 13.79, and 93.32 ± 14.63, respectively. When the mean Tegner scores of pre-injury and post-surgery periods were compared, this resulted in no significant difference (p>0.05) in the activity levels of the patients. Conclusion Based on our findings, arthroscopic meniscal repair with Surestitch All inside meniscal repair implant provides satisfactory and favorable functional outcomes with no remarkable adverse events.
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Affiliation(s)
| | | | - Sachin Angrish
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
| | - Deepak Ts
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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Does Accelerated Rehabilitation Provide Better Outcomes Than Restricted Rehabilitation in Postarthroscopic Repair of Meniscal Injury? J Sport Rehabil 2023; 32:335-345. [PMID: 36476967 DOI: 10.1123/jsr.2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/25/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
CONTEXT Meniscal injury is a common pathology, and the postoperative rehabilitation program is essential to patients after surgery. However, the optimal rehabilitation plan after meniscus suture is still controversial. OBJECTIVE To compare the clinical outcomes between accelerated rehabilitation and restricted programs in patients with meniscus suture (with or without anterior cruciate ligament reconstruction, ACLR). EVIDENCE ACQUISITION Four databases, including PubMed, Ovid, Embase, and the Cochrane Library, were searched up to November 2021. This study only included studies comparing the clinical outcomes between accelerated (immediate range of motion and weight-bearing) and restricted rehabilitation (immobilization and progressive weight-bearing) for meniscus suture. All selected studies were divided into 2 subgroups: isolated meniscus suture or combined with ACLR. The Lysholm score, Tegner score, and Knee Injury and Osteoarthritis Outcome Score were evaluated in simple meniscus sutures no less than 1 year. Failure rate was evaluated in both groups, and the tunnel enlargement was additionally evaluated in patients who underwent ACLR. EVIDENCE SYNTHESIS Eleven studies with 612 patients were eligible for analysis. The accelerated group included 4 studies with 330 participants, while the restricted group included 7 studies with 282 participants. For the patients after isolated meniscus suture, the accelerated group achieved higher Lysholm scores (mean difference = -4.66; 95% confidence interval, -8.6 to -0.73; P = .02; I2 = 88%) than the restricted group. For the patients after meniscus suture with ACLR, patients undergoing accelerated rehabilitation were associated with a significantly larger tibial tunnel enlargement in the anterior-posterior view (mean difference = -7.08; 95% confidence interval, -10.92 to -3.24; P = .0003; I2 = 0%) and lateral view (mean difference = -10.33; 95% confidence interval, -16.9 to -3.75; P = .002; I2 = 17%). CONCLUSION This meta-analysis evaluated the effects of postoperative rehabilitation in either accelerated or restricted programs in patients with meniscus lesions after repair. A significant higher mean self-reported function was discovered at final follow-ups in the accelerated group. However, a significant increase in tibial tunnel enlargement was also found in accelerated group.
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Owens BD. The Gold Standard. Am J Sports Med 2023; 51:577-578. [PMID: 36856286 DOI: 10.1177/03635465231155446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Kale S, Deore S, Gunjotikar A, Singh S, Ghodke R, Agrawal P. Arthroscopic meniscus repair and augmentation with autologous fibrin clot in Indian population: A 2-year prospective study. J Clin Orthop Trauma 2022; 32:101969. [PMID: 36035781 PMCID: PMC9403567 DOI: 10.1016/j.jcot.2022.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION This study was proposed to evaluate the efficacy of fibrin clot augmentation in meniscal tear using inside-out meniscal repair. METHODS A total of 35 patients with meniscus tears were operated on with inside-out meniscus repair and fibrin clot augmentation. Patients were evaluated preoperatively and postoperatively with clinical criteria, Lysholm knee scoring system, and MRI. RESULTS Out of the total 35 cases, 5 cases were lost to follow-up. Clinical improvement was observed in 29 out of 30 patients (96.6%). The mean Lysholm score improved significantly from 67.63 ± 6.55 points preoperatively to 92.0 ± 2.9 points postoperatively (P < 0.05) in 3 years follow-up. Follow-up MRI in all patients revealed complete healing except in 1 case where the patient presented with recurrence of symptoms such as pain and locking which resolved with partial meniscectomy. Paraesthesia in the anterior part of the knee was observed in 2 cases. (6.6%). CONCLUSION We conclude that fibrin clot augmentation is a good cost-effective modality of treatment for repairable meniscus tears to preserve the meniscus and decrease the point contact pressure on the condyles which may prevent the early occurrence of osteoarthritis.
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Affiliation(s)
- Sachin Kale
- Department of Orthopaedics, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, India
| | - Sandeep Deore
- Department of Orthopaedics, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, India
| | - Aditya Gunjotikar
- Department of Orthopaedics, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, India
| | - Sushmit Singh
- Department of Orthopaedics, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, India,Corresponding author. Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Sector 5, Nerul, Navi Mumbai, Maharashtra 400706, India.
| | - Rahul Ghodke
- Department of Orthopaedics, YMT College and Hospital, Navi Mumbai, India
| | - Parth Agrawal
- Department of Orthopaedics, Dr. D Y Patil Medical College, Nerul, Navi Mumbai, India
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Nepple JJ, Block AM, Eisenberg MT, Palumbo NE, Wright RW. Meniscal Repair Outcomes at Greater Than 5 Years: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2022; 104:1311-1320. [PMID: 35856932 DOI: 10.2106/jbjs.21.01303] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair. METHODS We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model. RESULTS A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54). CONCLUSIONS Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Andrew M Block
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Noel E Palumbo
- Washington University School of Medicine, St. Louis, Missouri
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Chan CX, Silas C, Ifran NN, Mok YR, Krishna L. Risk Factors for New Meniscal Tears following Anterior Cruciate Ligament Reconstruction. J Knee Surg 2022; 35:529-533. [PMID: 32898900 DOI: 10.1055/s-0040-1716361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aims to compare the rate of meniscal tears after anterior cruciate ligament (ACL) reconstruction in patients who have undergone concomitant meniscal repair during the index procedure with that in patients who have not undergone such surgery. It also evaluates other risk factors, such as age, gender, race, body mass index (BMI), site of concomitant meniscal surgery, and ACL graft failure. This is a retrospective study conducted at a large tertiary public hospital. Patients who underwent primary anterior cruciate ligament reconstruction (ACLR) surgery with or without concomitant meniscal repair from 2011 to 2016 were identified. Patients with old meniscal tears and previous meniscal surgeries were excluded. The aforementioned demographical, injury, and surgical details were obtained and analyzed using univariate and multivariate logistic regression analysis. Our study cohort included 754 patients. Primary ACLR surgery was performed with meniscal repair in 172 (22.8%) of the patients, with meniscectomy in 202 (26.8%) of the patients, and without concomitant meniscal surgery in 380 (50.4%) of the patients. A total of 81 (10.7%) patients developed meniscal tears after the index procedure. Such tears occurred in 12.2% (21 of 172) of the patients who had undergone concomitant meniscal repair during the index ACLR, and in 10.3% (60 of 582) of the patients who had not undergone concomitant meniscal repair (p = 0.30). On multivariate analysis, only ACL graft failure was significantly associated with new meniscal tears (p < 0.001, odds ratio 18.69, 95% confidence interval 9.18-38.05). ACL graft failure is the only independent risk factor for meniscal tears after ACLR surgery in our large cohort of patients. Concomitant meniscal repair was not an associated risk factor.
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Affiliation(s)
- Chloe Xiaoyun Chan
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System Singapore, Singapore
| | - Christian Silas
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System Singapore, Singapore
| | - Nadia Nastassia Ifran
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System Singapore, Singapore
| | - Ying Ren Mok
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System Singapore, Singapore
| | - Lingaraj Krishna
- Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Hospital, National University Health System Singapore, Singapore
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Schweizer C, Hanreich C, Tscholl PM, Ristl R, Apprich S, Windhager R, Waldstein W. Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta-analysis with a minimum follow-up of 5 years. Knee Surg Sports Traumatol Arthrosc 2022; 30:2267-2276. [PMID: 34671817 PMCID: PMC9206598 DOI: 10.1007/s00167-021-06770-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many reports of meniscus repair outcome in short-term studies, data on the long-term outcome of meniscus repair are still scarce. The purpose of this meta-analysis was to evaluate the overall failure rate of meniscus repair with a minimum follow-up of 5 years. Additionally, possible factors influencing meniscus repair outcome were assessed. METHODS PubMed and Scopus were searched for studies of the last 20 years reporting on meniscus repair outcome with a minimum follow-up of 5 years. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search terms used for this study were ([meniscus OR meniscal] AND repair). Titles and abstracts were evaluated by two authors independently. Using meta package of R (version 3.6.2), random-effect models were performed to pool failure rates. Subgroup analyses were performed and effect estimates in form of an odds ratio with 95% CIs were established. RESULTS In total, 12 studies with 864 patients were included. Degenerative tears were excluded in two studies and one study only included traumatic meniscus tears. Other studies did not state whether the cause of meniscus tear was degenerative or traumatic. Studies reporting meniscus repair outcome on root repairs, revision anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. Revision surgery was used as failure definition in all included studies. The overall failure rate of meniscal repair at a mean follow-up of 86 months was 19.1%. There was no significant difference in meniscus repair outcome when performed in combination with anterior cruciate ligament reconstruction compared to isolated meniscus repair (18.7% vs. 28%; n.s.) or when performed on the lateral meniscus compared to the medial meniscus (19.5% vs. 24.4%; n.s.). There was no significant difference of meniscus repair outcome between vertical/longitudinal tears and bucket-handle tears (n.s.). Thirty-six percent of meniscus repair failures occur after the second postoperative year. The only significant finding was that inside-out repair results in a lower failure rate compared to all-inside repair (5.6% vs. 22.3%; p = 0.009) at 5 years. CONCLUSION The overall meniscus repair failure rate remains nineteen percent in long-term studies. The cause of failure is poorly documented, and it remains unclear whether failure of the meniscus repair itself or additional adjacent tears lead to revision surgery. Despite the given technical advantages of all-inside repair devices, this meta-analysis cannot demonstrate superior outcomes compared to inside-out or outside-in repair at 5 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Carola Hanreich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philippe M. Tscholl
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, ReFORM (Reseau Francophone Olympique de la Recherche en Médecine du Sport), IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Geneva, Switzerland
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
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Stelzeneder B, Trabauer BM, Aldrian S, Stelzeneder D, Juras V, Albrecht C, Hajdu S, Platzer P, Trattnig S. Evaluation of Meniscal Tissue after Meniscal Repair Using Ultrahigh Field MRI. J Knee Surg 2021; 34:1337-1348. [PMID: 32268408 DOI: 10.1055/s-0040-1709135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The study evaluates the meniscal tissue after primary meniscal suturing using 7-Tesla (T) magnetic resonance imaging with T2* mapping at 6 and 12 months after surgery to investigate the differences between repaired meniscal tissue and healthy meniscal tissue in the medial and lateral compartment. This prospective study included 11 patients (9m/2f) with a mean age of 30.6 years (standard deviation 9.0). Patients with a meniscal tear that was treated arthroscopically with meniscus suturing, using an all-inside technique, were included. All patients and seven healthy volunteers were imaged on a 7-T whole-body system. T2* mapping of the meniscus was applied on sagittal slices. Regions-of-interest were defined manually in the red and white zone of each medial and lateral meniscus to measure T2*-values. In the medial posterior and medial anterior horn similar T2*-values were measured in the red and white zone at 6- and 12-month follow-up. Compared with the control group higher T2*-values were found in the repaired medial meniscus. After 12-months T2*-values decreased to normal values in the anterior horn and remained elevated in the posterior horn. In the red zone of the lateral posterior horn a significant decrease in the T2*-values (from 8.2 milliseconds to 5.9 milliseconds) (p = 0.04), indicates successful repair; a tendency toward a decrease in the white zone between the 6 and 12 months follow-up was observed. In the red zone of the lateral anterior horn the T2*-values decreased significantly during follow-up and in the white zone of the lateral anterior horn T2*-values were comparable. In comparison to the control group higher T2*-values were measured at 6-months; however, the T2*-values showed comparable values in the repaired lateral meniscus after 12 months. The T2* mapping results of the current study indicated a better healing response of the red zone of the lateral posterior horn compared with the medial posterior horn.
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Affiliation(s)
- Beate Stelzeneder
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Michael Trabauer
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.,Landeskliniken Holding Korneuburg-Stockerau, Stockerau, Austria
| | - Silke Aldrian
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - David Stelzeneder
- Department of Orthopaedics and Trauma Surgery, Hanusch-Krankenhaus, Vienna, Austria.,Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Vladimir Juras
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Imaging Methods, Institute of Measurement Science, Bratislava, Slovakia
| | - Christian Albrecht
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.,I. Orthopaedic Department, Orthopaedic Hospital Speising GmbH, Vienna, Austria
| | - Stefan Hajdu
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Patrick Platzer
- Department of Trauma Surgery and Sports Traumatology, University Hospital St. Poelten, St. Poelten, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Vint H, Quartley M, Robinson JR. All-inside versus inside-out meniscal repair: A systematic review and meta-analysis. Knee 2021; 28:326-337. [PMID: 33482623 DOI: 10.1016/j.knee.2020.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/25/2020] [Accepted: 12/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Meniscal repair using all-inside devices has garnered popularity compared to inside-out repair, yet few studies directly compare the two techniques in terms meniscal healing rates, surgical time, patient outcomes and incidence of complications. METHODS A systematic literature review was performed using the Medline, Cochrane and Embase databases. English-language studies comparing all-inside and inside-out arthroscopic meniscal repair techniques directly were included. Randomised controlled trials (RCTs) and observational studies with at least 10 patients in each treatment arm were included. Meta-analyses were performed using a fixed effect (when I2 < 50%) or random effects model (I2 ≥ 50%). RESULTS A total of 1042 studies were identified with seven being sui for inclusion (n = 505 patients). These comprised of one RCT two prospective and four retrospective, comparative, observational studies. Meta-analyses demonstrated that there was a significant reduction in operating time favouring all-inside repair (ratio of means [ROM] 0.62, 95% confidence interval [CI] 0.48-0.79; p = 0.0002) based on 3 studies (n = 208 patients). Based on 5 studies (n = 370 patients), there was no significant difference in meniscal healing rates between the groups (OR 1.26, 95% CI 0.52-3.10; p = 0.61). Nerve injury was more common after inside-out repair. There was a 85% reduction in the odds of nerve injury with the all-inside technique (OR 0.15, 95% CI 0.05-0.47; p = 0.0013). A qualitative data analysis suggested no difference in functional outcomes between the two techniques. CONCLUSIONS All-inside meniscal repair is associated with reduced operative time and a lower odds of nerve injury complications compared to inside-out repair, without compromising meniscal healing or functional results.
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Affiliation(s)
- Helen Vint
- Avon Orthopaedic Centre, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Megan Quartley
- Smith and Nephew, Department of Evidence Analysis, Smith and Nephew, Croxley Park Building 5, Hatters Lane, Watford, Hertfordshire WD18 8YE, UK
| | - James R Robinson
- Avon Orthopaedic Centre, North Bristol NHS Trust, Brunel Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
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Kimura Y, Sasaki E, Yamamoto Y, Sasaki S, Tsuda E, Ishibashi Y. Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up. Am J Sports Med 2020; 48:3525-3533. [PMID: 33125263 DOI: 10.1177/0363546520967670] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. PURPOSE To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. STUDY DESIGN Case series; Level of evidence, 4. METHODS Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). RESULTS The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection (P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. CONCLUSION Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.
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Affiliation(s)
- Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Mine T, Ihara K, Kawamura H, Shinohara M, Kuriyama R, Tominaga Y. Migration of a Meniscal Repair Implant Mimicking Meniscal Injury. Open Orthop J 2020. [DOI: 10.2174/1874325002014010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Complications after arthroscopic meniscal suture repair have been reported. Migration of a meniscal repair implant mimicking meniscal injury is rare. A 28-year-old female had undergone Anterior Cruciate Ligament (ACL) reconstruction at another hospital 12 years ago . The remaining instability after ACL reconstruction resulted in medial meniscal damage, wear and narrowing in the posterior third. The H-fix that was used in the meniscal repair became detached, exposing the inside of the knee joint. Meniscal repair is a successful procedure in conjunction with ACL reconstruction. However, when knee instability after ACL reconstruction remains, the choice of meniscal repair implants may lead to potential complications even after long-term clinical follow-up.
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Wright RW, Huston LJ, Haas AK, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Pennings JS, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Steven J Svoboda L, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort. Am J Sports Med 2020; 48:2978-2985. [PMID: 32822238 PMCID: PMC8171059 DOI: 10.1177/0363546520948850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. PURPOSE To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. RESULTS In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. CONCLUSION Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.
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16
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Abstract
From once being labelled as a functionless remain of leg muscle, extensive scientific investigations in recent decades have described the meniscus as one of the most crucial structures of the knee. The incidence of meniscal injuries is on the rise and can be attributed to the increased participation of youth in sporting activities. MRI continues to be the imaging modality of choice, and surgical management is the mainstay of treatment for meniscal tears. Arthroscopic partial meniscectomy (APM) is currently the most performed orthopedic procedure around the globe. However, recent studies have conclusively shown that outcomes after an APM are no better than the outcomes after a sham/placebo surgery. Meniscal repair is now being touted as a viable and effective alternative. Meniscal repair aims to achieve meniscal healing while completely avoiding the adverse effects of partial meniscectomy. Meniscal repairs have grown in popularity over the past three decades and have proved to be a much more efficient alternative to partial meniscectomy. It is now increasingly recommended to attempt meniscal repair in all repairable tears, especially in young and physically active patients. Partial Meniscal implants have also shown excellent outcomes in long-term studies, but its efficacy in acute settings still requires further research. Research performed on various techniques of meniscal regeneration looks promising, and regenerative medicine appears to be the way forward. This review aims to critically discuss the current understanding of the meniscus, its role in biomechanics of the knee joint, and the current methods used to diagnose and manage meniscal tears.
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Affiliation(s)
- Kavyansh Bhan
- Department of Trauma and Orthopaedics, Whipps Cross University Hospital, London, GBR
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17
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Wang Z, Xiong Y, Tang X, Li Q, Zhang Z, Li J, Chen G. An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair. BMC Musculoskelet Disord 2019; 20:614. [PMID: 31870350 PMCID: PMC6929296 DOI: 10.1186/s12891-019-2984-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND At present, most repair techniques for meniscal tears fix the meniscus directly over the capsule. This changes the normal anatomy and biomechanics and limits the activity of the meniscus during motion. We introduce an arthroscopic repair technique by suturing the true meniscus tissue without the capsule and subcutaneous tissue. METHODS After confirmation of a tear, a custom-designed meniscal repair needle first penetrates percutaneously, crossing the capsular portion and the torn meniscus, and exits from the femoral surface of one side of the torn meniscus. Then a No. 2 PDS suture is passed through the needle and retrieved through the arthroscopy portal. Next, the needle is withdrawn to the synovial margin of the meniscus and is reinserted, exiting the femoral surface of the other side of the torn meniscus. The suture is pulled out through the same portal with a grasper. Finally, arthroscopic knotting is performed. RESULTS We had 149 cases of meniscal tears repaired with this outside-in transfer all-inside technique since July 2016. CONCLUSIONS It is a simple, minimally invasive, and economical procedure that is appropriate for most parts of the meniscus except the posterior horn of the lateral meniscus, and it can be used to fix torn meniscus tissue firmly while also preserving the inherent activity of the meniscus.
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Affiliation(s)
- Zhiqiang Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.,Department of Orthopaedic Surgery, Suining Central Hospital, No. 127, West Desheng Rd., Chuanshan District, Suining, Sichuan, 629000, China
| | - Yan Xiong
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Xin Tang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Qi Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Zhong Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Jian Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
| | - Gang Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:3441-3452. [PMID: 30719542 DOI: 10.1007/s00167-019-05389-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this review was to compare the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with either meniscal repair or meniscectomy for concomitant meniscal injury. The primary hypothesis was that short-term clinical outcomes (≤ 2-year follow-up) for ACLR concomitant with either meniscal repair or resection would be similar. The secondary hypothesis was that ACLR with meniscal repair would result in better longer term outcomes compared with meniscal resection. METHODS The authors searched two online databases (EMBASE and MEDLINE) from inception until March 2018 for the literature on ACLR and concurrent meniscal surgery. Two reviewers systematically screened studies in duplicate, independently, and based on a priori criteria. Quality assessment was also performed in duplicate. The Knee injury and Osteoarthritis Outcome Score (KOOS) sub-scale scores at 2 years post-operatively were combined in a meta-analysis of proportions using a random-effects model. RESULTS Of 2566 initial studies, 25 studies satisfied full-text inclusion criteria. Mean follow-up was 2.09 years, with a total sample of 37,087 subjects including controls. The meta-analysis demonstrated equivocal results at 2 years, except for KOOS symptom scores which favoured meniscal resection over repair. Mean KT-1000 side-to-side difference (SSD) scores were 1.51 ± 0.60 mm for meniscal repair, 1.96 ± 0.36 mm for meniscal resection, and 1.58 ± 0.20 for control patients (isolated ACLR). Medial meniscal repair showed decreased anterior knee joint laxity compared to medial meniscal resection (P < 0.001). Patients with meniscal repair had higher rates of re-operation (13.3% vs 0.8% for meniscal resection, P < 0.001). CONCLUSION Patients with ACLR combined with meniscal resection demonstrate better symptoms at 2-year follow-up compared to patients with ACLR combined with meniscal repair. ACLR combined with meniscal repair results in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term, but also higher re-operation rates. LEVEL OF EVIDENCE III.
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19
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Karia M, Ghaly Y, Al-Hadithy N, Mordecai S, Gupte C. Current concepts in the techniques, indications and outcomes of meniscal repairs. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:509-520. [PMID: 30374643 PMCID: PMC6423358 DOI: 10.1007/s00590-018-2317-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
Knee arthroscopy for meniscal tears is one of the most commonly performed orthopaedic procedures. In recent years, there has been an increasing incidence of meniscal repairs, as there are concerns that meniscectomy predisposes patients to early osteoarthritis. Indications for meniscal repair are increasing and can now be performed in older patients who are active, even if the tear is in the avascular zone. Options for meniscal tear management broadly fall into three categories: non-operative management, meniscal repair or meniscectomy. With limited evidence directly comparing each of these options optimal management strategies can be difficult. Decision making requires thorough assessment of patient factors (e.g. age and comorbidities) and tear characteristics (e.g. location and reducibility). The purpose of this paper is, therefore, to review the management options of meniscal tears and summarize the evidence for meniscal tear repair.
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Affiliation(s)
- Monil Karia
- Musculoskeletal Lab, Imperial College London, London, United Kingdom.
| | - Youssef Ghaly
- Musculoskeletal Lab, Imperial College London, London, United Kingdom
| | | | - Simon Mordecai
- Orthopaedic Department, Hillingdon Hospital, London, United Kingdom
| | - Chinmay Gupte
- Musculoskeletal Lab, Imperial College London, London, United Kingdom
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Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A. Arthroscopic medial meniscal repair with or without concurrent anterior cruciate ligament reconstruction: A subgroup analysis. Knee 2018; 25:109-117. [PMID: 29162378 DOI: 10.1016/j.knee.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 10/03/2017] [Accepted: 11/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are few large-scale, long-term studies comparing medial meniscal repairs with or without concurrent anterior cruciate ligament (ACL) reconstruction. METHODS A total of 140 patients who underwent arthroscopic medial meniscal repair were divided into two groups: Group A, meniscus repair only and Group B, meniscus repair with concurrent ACL reconstruction. Clinical assessments in- cluded physical examination findings, Lysholm score, and the International Knee Documentation Committee (IKDC) form. Barret criteria were used for the clinical assessment of healing status. Magnetic resonance imaging (MRI)was obtained to confirmhealing and failure. Subgroups of participants were compared in terms of suture technique, type of tear, and location of tear. KT-2000 arthrometer testing was used for objective evaluation of anterior-posterior knee movement. RESULTS Mean follow-up duration was 61 (34-85) months. Clinical outcomes in both groups were significantly improved compared to baseline (P=0.001 vs. P=0.001); however, there was no significant between-group difference in postoperative Lysholm and IKDC scores (P=0.830). The outcomes of three participants (seven percent) in Group A and 11 (11.3%) in Group B were considered as treatment failures (P=0.55). Red-red zone tears had higher scores. Mean postoperative KT2000 arthrometer values of failed participants in Groups A and B were 4.66mm (range, four to six) and 5.2mm (range, two to seven), respectively. CONCLUSION Concurrentmedialmeniscus repair and ACL reconstruction did not have clinical superiority over meniscus repair alone. Repairs in the red-red zone appeared to be associated with better outcomes.
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Affiliation(s)
- Erdal Uzun
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey.
| | - Abdulhamit Misir
- Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopedics and Traumatology, Ahi Evran University Training and Research Hospital, Kirsehir, Turkey
| | - Soner Akkurt
- Department of Sports Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
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21
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Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A. Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears. Orthop J Sports Med 2017; 5:2325967117712448. [PMID: 28680898 PMCID: PMC5484431 DOI: 10.1177/2325967117712448] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs. PURPOSE To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated. RESULTS The mean follow-up period was 51.2 ± 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both Ps <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; P = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; P = .008). Failure rates were higher for smokers than for nonsmokers (9/24, 37.5% vs 3/56, 5.3%; P = .008). CONCLUSION Peripheral tears and early repairs have better outcomes and patient satisfaction. Smoking adversely affects meniscal healing.
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Affiliation(s)
- Erdal Uzun
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Abdulhamit Misir
- Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopedics and Traumatology, Ahi Evran University Training and Research Hospital, Kirsehir, Turkey
| | - Soner Akkurt
- Department of Sports Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
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Westermann RW, Duchman KR, Amendola A, Glass N, Wolf BR. All-Inside Versus Inside-Out Meniscal Repair With Concurrent Anterior Cruciate Ligament Reconstruction: A Meta-regression Analysis . Am J Sports Med 2017; 45:719-724. [PMID: 27159291 DOI: 10.1177/0363546516642220] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal tears are frequently repaired during anterior cruciate ligament reconstruction (ACLR). PURPOSE To systematically evaluate differences in clinical failures between all-inside and inside-out meniscal repairs performed during ACLR. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic review was perfomed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases queried included MEDLINE, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials. All English-language studies reporting failure rates after meniscal repair with either the all-inside or inside-out technique performed in conjunction with ACLR were identified between 1980 and 2015. Studies with a minimum 2-year follow-up were included. Reported outcomes, clinical meniscal repair failures, and complications were assessed. Studies were weighted according to the size of the clinical series and mean follow-up length. Inverse-variance-weighted mixed models were used to evaluate whether there was a significant difference in pooled reoperation rates between repair techniques. RESULTS In total, 21 studies met inclusion criteria. Of these, 13 studies reported outcomes after all-inside repair, and 10 studies reported outcomes after inside-out repair (2 studies reported both). A total of 1126 patients were included in the analysis. The mean (±SD) follow-up for all-inside repair was 58.64 ± 22.24 months versus 76.25 ± 31.69 months for inside-out repair ( P = .13). The clinical failure rate for all-inside meniscal repair performed concurrently with ACLR was 16% (121/744) compared with 10% (39/382) for inside-out repair, and this was found to be significant ( P = .016). Implant irritation and device migration were the most common complications reported for all-inside repair; complication rates did not differ between the groups. CONCLUSION There may be fewer early clinical failures when the inside-out technique is utilized for meniscal repair at the time of concomitant ACLR. Additional long-term studies will be useful to determine the operative success of these repairs over time.
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Affiliation(s)
| | - Kyle R Duchman
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Natalie Glass
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Matsushita T, Nagai K, Araki D, Tanaka T, Matsumoto T, Nishida K, Kurosaka M, Kuroda R. Factors associated with the status of meniscal tears following meniscal repair concomitant with anterior cruciate ligament reconstruction. Connect Tissue Res 2017; 58:386-392. [PMID: 28102713 DOI: 10.1080/03008207.2017.1281257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are often accompanied by meniscal tears. Meniscal repair is typically performed during ACL reconstruction. However, retear of the meniscus after repair is frequent. The purpose of this study was to analyze the factors associated with meniscal healing after meniscal repair concomitant with ACL reconstruction. MATERIALS AND METHODS Eighty-seven meniscal repairs in 87 patients who received meniscal repair combined with ACL reconstruction and received second-look arthroscopy at a mean of postoperatively 15.7 months were examined retrospectively. The menisci were divided into three groups (complete heal, incomplete heal, and retear), and factors thought to affect the healing status of repaired menisci were analyzed using multivariate logistic regression analysis. RESULTS Meniscal healing was judged to be complete in 49 knees (56%), incomplete in 19 knees, (22%), and retear in 19 knees (22%). There were no significant differences among the three groups in age, sex, time from injury to operation, mean Tegner activity scale, tear location, or mean postoperative anteroposterior tibial translation on KT-1000. The mean length of the tear was significantly higher in the retear group. Additionally, the proportion patients with complete tear and the proportion with postoperative positive pivot shift test were significantly higher in the retear group than in the other groups. Multivariate logistic regression analysis showed that complete tear and positive pivot shift test were associated with retear. CONCLUSIONS These findings suggest that complete tears and residual instability are associated with retears after meniscal repair concomitant with ACL reconstruction.
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Affiliation(s)
- Takehiko Matsushita
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kanto Nagai
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Daisuke Araki
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Toshikazu Tanaka
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Tomoyuki Matsumoto
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kotaro Nishida
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Masahiro Kurosaka
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Ryosuke Kuroda
- a Department of Orthopaedic Surgery , Kobe University Graduate School of Medicine , Kobe , Japan
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Sgaglione NA. Editorial Commentary: Stay Tuned: Broadening Our Scope of Knee Meniscus Radial Tear Repairs. Arthroscopy 2016; 32:1926-7. [PMID: 27594335 DOI: 10.1016/j.arthro.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 02/02/2023]
Abstract
Repair of knee meniscus radial tears can result in clinical success. More precise and well-defined indications, surgical techniques, and outcomes are needed.
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Duchman KR, Westermann RW, Spindler KP, Reinke EK, Huston LJ, Amendola A, Wolf BR. The Fate of Meniscus Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction: A 6-Year Follow-up Study From the MOON Cohort. Am J Sports Med 2015; 43:2688-95. [PMID: 26430058 PMCID: PMC4869979 DOI: 10.1177/0363546515604622] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The management of meniscus tears identified at the time of primary anterior cruciate ligament (ACL) reconstruction is highly variable and includes repair, meniscectomy, and nontreatment. HYPOTHESIS/PURPOSE The purpose of this study was to determine the reoperation rate for meniscus tears left untreated at the time of ACL reconstruction with a minimum follow-up of 6 years. The hypothesis was that small peripheral tears identified at the time of ACL reconstruction managed with "no treatment" would have successful clinical outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group with a minimum 6-year follow-up. Patient, tear, and reoperation data were obtained for analysis. The need for reoperation was used as the primary endpoint, with analysis performed to determine patient and tear characteristics associated with reoperation. RESULTS There were 194 patients with 208 meniscus tears (71 medial, 137 lateral) left in situ without treatment with a complete follow-up for analysis. Of these, 97.8% of lateral and 94.4% of medial untreated tears required no reoperation. Sixteen tears (7.7%) left in situ without treatment underwent subsequent reoperation: 9 tears (4.3%) underwent reoperation in the setting of revision ACL reconstruction, and 7 tears (3.4%) underwent reoperation for an isolated meniscus injury. The patient age was significantly lower in patients requiring reoperation, while tears measuring ≥10 mm more frequently required reoperation. CONCLUSION Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at a minimum 6-year follow-up for 97.8% and 94.4% of tears, respectively. These findings re-emphasize the low reoperation rate after the nontreatment of small, peripheral lateral meniscus tears while noting less predictable results for medial meniscus tears left without treatment.
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Affiliation(s)
- Kyle R. Duchman
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, US
| | - Robert W. Westermann
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, US
| | | | - Emily K. Reinke
- Vanderbilt University Medical Center, Nashville, Tennessee, US
| | - Laura J. Huston
- Vanderbilt University Medical Center, Nashville, Tennessee, US
| | - Annunziato Amendola
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, US
| | | | - Brian R. Wolf
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, US,Corresponding Author: Brian R. Wolf, MD, MS, University of Iowa, Department of Orthopaedics and Rehabilitation, 200 Hawkins Dr., 01008 JPP, Iowa City, IA 52242,
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Stegen L, Kitshoff AM, Van Goethem B, Vandekerckhove P, de Rooster H. Intralaryngeal thyroarytaenoid lateralisation using the Fast-Fix 360 system: a canine cadaveric study. Vet Rec Open 2015; 2:e000125. [PMID: 26392907 PMCID: PMC4567165 DOI: 10.1136/vetreco-2015-000125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/17/2015] [Accepted: 06/29/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Laryngeal paralysis is a condition in which failure of arytaenoid abduction results in a reduced rima glottidis cross-sectional area. The most commonly performed surgical techniques rely on unilateral abduction of the arytaenoid, requiring a lateral or ventral surgical approach to the larynx. Aims and objectives The aim of the study was to investigate a novel minimally invasive intralaryngeal thyroarytaenoid lateralisation technique, using the Fast-Fix 360 meniscal repair system. Materials and methods Larynges were harvested from large breed canine cadavers. With the aid of Kirschner wires placed between the centre of the vocal process and the centre of an imaginary line between the cranial thyroid fissure and the cricothyroid articulation, the mean insertion angle was calculated. Results The Fast-Fix 360 delivery needle inserted intralaryngeally (n=10), according to a simplified insertion angle (70°), resulted in thyroid penetration (>2.5 mm from margin) in all patients. The Fast-Fix was applied unilaterally at 70° with the first toggle fired on the lateral aspect of the thyroid cartilage and inside the laryngeal cavity on retraction. The suture was tightened. Preprocedural (61.06±9.21 mm2) and postprocedural (138.37±26.12 mm2) rima glottidis cross-sectional area was significantly different (P<0.0001). The mean percentage increase in rima glottidis cross-sectional area was 125.96 per cent (±16.54 per cent). Conclusion Intralaryngeal thyroarytaenoid laterlisation using the Fast-Fix 360 meniscal repair system ex vivo increased the rima glottidis cross-sectional area significantly.
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Affiliation(s)
- Ludo Stegen
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, University of Ghent, 133 Salisburylaan, Merelbeke, 9820, Belgium ; Tiergesundheitszentrum Gruβendorf Tierärztliche Klinik für Kleintiere, 2 Wiechmanns Eck 2, Bramsche, 49565, Germany
| | - Adriaan M Kitshoff
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, University of Ghent, 133 Salisburylaan, Merelbeke, 9820, Belgium
| | - Bart Van Goethem
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, University of Ghent, 133 Salisburylaan, Merelbeke, 9820, Belgium
| | | | - Hilde de Rooster
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, University of Ghent, 133 Salisburylaan, Merelbeke, 9820, Belgium
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Abstract
CONTEXT Optimal rehabilitation after meniscal repair remains controversial. OBJECTIVE To review the current literature on weightbearing status after meniscal repairs and to provide evidence-based recommendations for postoperative rehabilitation. DATA SOURCES MEDLINE (January 1, 1993 to July 1, 2014) and Embase (January 1, 1993 to July 1, 2014) were queried with use of the terms meniscus OR/AND repair AND rehabilitation. STUDY SELECTION Included studies were those with levels of evidence 1 through 4, with minimum 2 years follow-up and in an English publication. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Demographics and clinical and radiographic outcomes of meniscus repair at a minimum of 2 years follow-up were extracted. RESULTS Successful clinical outcomes ranged from 70% to 94% with conservative rehabilitation. More recent studies using an accelerated rehabilitation protocol with full weightbearing and early range of motion reported 64% to 96% good results. CONCLUSION Outcomes after both conservative (restricted weightbearing) protocols and accelerated rehabilitation (immediate weightbearing) yielded similar good to excellent results; however, lack of similar objective criteria and consistency among surgical techniques and existing studies makes direct comparison difficult.
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Affiliation(s)
| | | | - Michael Le
- Carolinas Medical Center, Charlotte, North Carolina
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Long-term outcomes of all-inside meniscal repair. Knee Surg Sports Traumatol Arthrosc 2015; 23:219-24. [PMID: 23740324 DOI: 10.1007/s00167-013-2553-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/29/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The mean reported healing rate after meniscal repair is 60% of complete healing, 25% of partial healing and 15% of failure. However, partially or incompletely healed menisci are often asymptomatic in the short term. It is unknown whether the function of the knee with a partially or incompletely healed meniscus is disturbed in the long term. The purpose of this study was to assess the long-term outcomes of meniscal repairs according to the initial rate of healing. METHODS Forty-one consecutive meniscal repairs were performed between 2002 and 2003. The median age at the time of surgery was 22 years (9-40). There were 25 medial and 16 lateral menisci. When present, all ACL lesions underwent reconstruction (61.3% of cases). According to Henning's criteria, by Arthro-CT at 6 months, twenty cases had healed completely, seven partially healed and four cases healed incompletely. RESULTS At a mean follow-up of 114 ± 10 months, 31 patients were retrospectively followed for clinical and imaging assessments. Objective IKDC score was good in 92% of the cases (17 IKDC A, 8 B and 2 C). The mean KOOS distribution was as follows: pain 94.3 ± 9; symptoms 90.9 ± 15; daily activities 98.7 ± 2; sports activities 91.1 ± 14; and quality of life 91.5 ± 15. Twenty-three patients displayed no signs of osteoarthritis when compared to the non-injured knee, six patients had grade 1 osteoarthritis and two grade 2. The subjective IKDC score did not decrease with time (ns). Moreover, there were no differences between lateral and medial menisci (ns), in stable or stabilised knees (ns). The initial meniscal healing rate did not significantly influence clinical or imaging outcomes (ns). Four patients with no healing underwent a meniscectomy (12.9%). CONCLUSION Arthroscopic all-inside meniscal repair with hybrid devices may provide long-term protective effects, even if the initial healing is incomplete. LEVEL OF EVIDENCE Case series, Level IV.
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29
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Rue JP, Pickett A. Meniscal repair and transplantation in the military active-duty population. Clin Sports Med 2014; 33:641-53. [PMID: 25280614 DOI: 10.1016/j.csm.2014.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- John-Paul Rue
- Uniformed Services University of the Health Services, Bethesda, MD, USA; Department of Orthopaedics and Sports Medicine, Naval Health Clinic Annapolis, US Naval Academy, 250 Wood Road, Annapolis, MD 21402-5050, USA.
| | - Adam Pickett
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA
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Westermann RW, Wright RW, Huston LJ, Wolf BR, Wolf BR. Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 2014; 42:2184-92. [PMID: 25023440 PMCID: PMC4451057 DOI: 10.1177/0363546514536022] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal repair is commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. No large-scale, prospective multicenter studies have evaluated the long-term success and patient-oriented outcomes after combined ACLR and meniscal repair. PURPOSE To define the operative success and patient-oriented outcome scores 6 years after combined meniscal repair and ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All ipsilateral primary ACLR and meniscal repair cases from a multicenter study group between 2002 and 2004 were selected. Validated patient-oriented outcome instruments were completed at 3 time points: preoperatively and then 2 and 6 years after the index procedure. Subsequent ipsilateral knee reoperations were confirmed by operative reports to evaluate for the failure of meniscal repairs. RESULTS In total, 286 patients with 1440 primary ACLRs underwent concurrent meniscal repairs (298 meniscal repairs). Of these, 235 (82.2%) were available for follow-up at 6 years (154 medial, 72 lateral, and 9 both lateral and medial meniscal repairs). Repaired menisci most commonly involved the peripheral one third of the meniscus (84%); patterns were typically longitudinal (84%) or displaced bucket-handle (10%), with a mean length of 16.5 ± 5.8 mm. Overall, the meniscal repair failure rate was 14% (medial: 21/154; lateral: 10/72; both: 2/9) at 6 years. Medial repairs failed earlier than lateral repairs (2.1 vs 3.7 years, respectively; P = .01). Significant improvements in outcome scores were sustained at 6-year follow-up. No differences in the suture number or type were detected between repair failures and successes. The rate of meniscal reoperations was higher in patients who underwent repair compared with those who did not have an identified meniscal injury at the time of ACLR (P < .01. CONCLUSION Concurrent meniscal repair with ACLR is associated with failure rates approximating 14% at 6-year follow-up. Improvements in patient-oriented outcome scores were sustained at 6-year follow-up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscal repair.
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Affiliation(s)
| | - RW Wright
- Washington University at St. Louis, St. Louis, MO
| | - LJ Huston
- Vanderbilt University Medical Center, Nashville, TN
| | | | - BR Wolf
- University of Iowa, Iowa City, IA
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Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based approach. World J Orthop 2014; 5:233-241. [PMID: 25035825 PMCID: PMC4095015 DOI: 10.5312/wjo.v5.i3.233] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/05/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.
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Abstract
The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Keun Ho Park
- Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Abstract
Lesions in the meniscus occur particularly in young, active patients in the nonvascularized area which, consequently have a bad intrinsic healing capacity. This has a large impact on the mobility and function of the knee joint. Lesions, and partial lesions, lead to the progression of osteoarthritis over time in a large proportion of patients. The only clinical treatment for severe cases so far is an allograft donor meniscus, which is used mostly in patients with severe osteoarthritis with a completely destroyed meniscus. However, this technique still has to be considered as experimental and, thus, is not yet used on a routine basis. Various technical solutions have been advocated to repair meniscus lesions. One solution is to perform a partial meniscectomy and insert a collagen meniscus implant (CMI) at the site of the lesion. However, the initial mechanical properties of the collagen scaffold are inferior to the native meniscus. Therefore, it is only possible to perform a CMI implantation if the peripheral rim of the meniscus is still intact. Histology of preclinical and clinical biopsies of the implanted CMI demonstrated a repopulation of the scaffold by fibrous tissue and in time a remodeling of the fibrous tissue into fibrocartilaginous-like tissue. Based on histology, the ingrowth of new tissue into the CMI might occur by a process of synovial overgrowth, but other mechanisms of revitalization are also possible. Although some clinical studies demonstrated improvement in outcome scores, the number of patients was small in all studies and the positive effect on the prevention of progression of osteoarthritis was not compared with control groups.
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Affiliation(s)
- Pieter Buma
- Orthopedic Research Laboratory, Radboud University, Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Sonnery-Cottet B, Mortati R, Gadea F, Thaunat M, Moyere F, Chouteau J. Osteolysis of the tibial plateau after meniscal repair with hybrid suture anchor. Knee Surg Sports Traumatol Arthrosc 2013; 21:2137-40. [PMID: 23138233 DOI: 10.1007/s00167-012-2296-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Preservation of the meniscus and consideration for repair is important when treating meniscal tears. Many techniques for repair have been described. At present, all-inside, suture anchor-based meniscal repair systems are widely used. Arthroscopic all-inside hybrid meniscal suturing has been shown to have a low complication rate as the suture anchors remain outside the capsule leaving only the suture material inside the joint. Complications such as chondrolysis or arthrolysis have not been reported with these devices until now. The purpose of our study is to highlight the risks of osteochondral damage if these devices persist intra-articularly. LEVEL OF EVIDENCE IV.
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Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am 2012; 94:2222-7. [PMID: 23318612 PMCID: PMC3528023 DOI: 10.2106/jbjs.k.01584] [Citation(s) in RCA: 232] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Meniscal repair offers the potential to avoid the long-term articular cartilage deterioration that has been shown to result after meniscectomy. Failure of the meniscal repair can occur several years postoperatively. Limited evidence on the long-term outcomes of meniscal repair exists. METHODS We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of five years postoperatively. Pooling of data and meta-analysis with a random-effects model were performed to evaluate the results. RESULTS Thirteen studies met the inclusion criteria. The pooled rate of meniscal repair failure (reoperation or clinical failure) was 23.1% (131 of 566). The pooled rate of failure varied from 20.2% to 24.3% depending on the status of the anterior cruciate ligament (ACL), the meniscus repaired, and the technique utilized. The rate of failure was similar for the medial and the lateral meniscus as well as for patients with an intact and a reconstructed ACL. CONCLUSIONS A systematic review of the outcomes of meniscal repair at greater than five years postoperatively demonstrated very similar rates of meniscal failure (22.3% to 24.3%) for all techniques investigated. The outcomes of meniscal repair at greater than five years postoperatively have not yet been reported for modern all-inside repair devices.
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Affiliation(s)
- Jeffrey J. Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, West Pavilion 1130, St. Louis, MO 63010. E-mail address for R.W. Wright:
| | - Warren R. Dunn
- Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, 1215 21st Avenue South, Nashville, TN 37232
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, West Pavilion 1130, St. Louis, MO 63010. E-mail address for R.W. Wright:
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Hagino T, Ochiai S, Watanabe Y, Senga S, Wako M, Ando T, Sato E, Haro H. Clinical results of arthroscopic all-inside lateral meniscal repair using the Meniscal Viper Repair System. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 24:99-104. [DOI: 10.1007/s00590-012-1138-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
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Tuman J, Haro MS, Foley S, Diduch D. All-inside meniscal repair devices and techniques. Expert Rev Med Devices 2012; 9:147-57. [PMID: 22404776 DOI: 10.1586/erd.11.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Techniques and devices for meniscal repair are evolving, including for all-inside meniscal repair. The first-generation all-inside meniscal repair devices were simplistic in design, but their technical difficulties and risks led to the development of second-generation devices. These devices employed the suture anchor concept for repair and confirmed the safety of use through standard anterior arthroscopic portals. Third-generation devices introduced the idea of rigid, bioabsorbable materials; unfortunately, these demonstrated higher failure and complication rates compared with other repair techniques. They were also limited in their ability to adjust compression and tension across the repair. Now, fourth-generation devices have been developed that are flexible, suture-based, and allow for variable compression and retensioning across the tear. Each device has its own specifications and technical nuances. With a comprehensive understanding of the current devices available, the industry and surgeons may continue in the development of safer, more successful, user-friendly and cost-effective all-inside devices.
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Affiliation(s)
- Jeff Tuman
- UVA Department of Orthopedic Surgery, 500 Ray C Hunt Drive, Box 800159, Charlottesville, VA 22908, USA
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Gallacher PD, Gilbert RE, Kanes G, Roberts SNJ, Rees D. Outcome of meniscal repair prior compared with concurrent ACL reconstruction. Knee 2012; 19:461-3. [PMID: 21550806 DOI: 10.1016/j.knee.2011.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 03/31/2011] [Accepted: 04/03/2011] [Indexed: 02/02/2023]
Abstract
Meniscal tears are commonly associated with traumatic rupture of the anterior cruciate ligament (ACL). At our centre, if a patient presents with locked knee in conjunction with an ACL injury we perform an initial arthroscopy to remove the cause of locking and schedule ACL reconstruction once a full range of motion has returned. The aim of this study was to assess the outcome of meniscal tears stabilised prior to ACL reconstruction. We identified 24 patients who underwent repair of a torn meniscus before having their ACL reconstruction (group 1). As a comparison group we identified 148 patients who underwent meniscal repair at the time of ACL reconstruction (group 2). Twelve of the patients in group 1 underwent meniscectomy, seven at the time of reconstruction and five subsequently. This gives a success rate of 50% (12/24) in the ACL deficient patients. In comparison forty two of the patients in group 2 went on to have a meniscectomy representing a success of 72% (106/148). The odds ratio for meniscectomy in an ACL deficient meniscal repair is 2.52 (95% CI 1.07-5.97) and there is a relative risk of 1.76 (95% CI 1.05-2.63). The difference in success of the meniscal repair between the groups was significant (Fisher's exact test p=0.05). Meniscal repair and delayed ACL reconstruction is more likely to fail than a combined repair and ACL reconstruction.
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Affiliation(s)
- P D Gallacher
- Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, United Kingdom.
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Noyes FR, Barber-Westin SD. Management of meniscus tears that extend into the avascular region. Clin Sports Med 2012; 31:65-90. [PMID: 22108660 DOI: 10.1016/j.csm.2011.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Frank R Noyes
- Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, OH 45242, USA
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Affiliation(s)
- Eric D Bava
- Plano Orthopedic Sports Medicine and Spine Center, TX 75093, USA
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Noyes FR, Chen RC, Barber-Westin SD, Potter HG. Greater than 10-year results of red-white longitudinal meniscal repairs in patients 20 years of age or younger. Am J Sports Med 2011; 39:1008-17. [PMID: 21278428 DOI: 10.1177/0363546510392014] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A prospective longitudinal investigation was conducted to determine the long-term outcome of single longitudinal meniscal repairs extending into the central avascular region in patients aged 20 years or younger. PURPOSE To determine the long-term success rate and reoperation rate of meniscal repairs extending into the avascular zone. STUDY DESIGN Case series; Level of evidence, 4. METHODS Thirty-three meniscal repairs were performed using an inside-out multiple vertical divergent suture technique. A concomitant anterior cruciate ligament reconstruction was done in 18 patients. The mean follow-up was 16.8 years (range, 10.1-21.9 years). The long-term success rate was determined in 29 repairs (88%) by the presence of normal or nearly normal parameters from 2 validated knee rating systems, assessment of magnetic resonance imaging and weightbearing posteroanterior radiographs by independent physicians, and follow-up arthroscopy when required. A 3 Tesla magnetic resonance imaging scanner with cartilage-sensitive pulse sequences was used, and T2 mapping was performed. A comparison was made between the short-term (mean, 4 years) and long-term outcomes. RESULTS Eighteen (62%) of the meniscal repairs had normal or nearly normal characteristics in all of the parameters assessed. Six repairs (21%) required partial arthroscopic resection, 2 had loss of joint space on radiographs, and 3 that were asymptomatic failed according to magnetic resonance imaging criteria, for a total of 11 documented failures (38%). There was no significant difference in the mean articular cartilage T2 scores in the healed menisci between the involved and contralateral tibiofemoral compartments in the same knee. There were no significant differences between short- and long-term evaluations for pain, swelling, jumping, patient knee condition rating, or the overall Cincinnati rating score. CONCLUSIONS A chondroprotective joint effect was demonstrated in the healed menisci repairs, which warrants the procedure in select patients. The long-term evaluation of the anterior cruciate ligament-reconstructed knees with concurrent successful meniscal repairs demonstrated a low rate of radiographic arthritis.
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Affiliation(s)
- Frank R Noyes
- Cincinnati Sportsmedicine Research and Education Foundation, Cincinnati, Ohio, USA
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Tengrootenhuysen M, Meermans G, Pittoors K, van Riet R, Victor J. Long-term outcome after meniscal repair. Knee Surg Sports Traumatol Arthrosc 2011; 19:236-41. [PMID: 20953762 DOI: 10.1007/s00167-010-1286-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 09/16/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE the purpose of this study was to analyse the clinical and radiological results of meniscal repairs and identify factors that correlate with the success of this procedure. METHODS a retrospective review of 119 meniscal repairs was completed. The average follow-up was 70 months. Successful meniscal repairs were observed critically in terms of radiographic changes and clinical outcomes and compared with failed meniscal repairs. RESULTS the overall success rate of meniscal repairs was 74%. Meniscal repairs that were performed within 6 weeks of injury had better results (83%) than late repairs (52%). The best results were obtained with the inside-out technique using #0 PDS suture (80%) compared to all-inside Biofix arrows (70%) and combined repairs (63%). Patients with associated ACL injury had a better chance of a successful outcome, but this was only significant when the ACL was reconstructed at the time of repair (P < 0.05). Those patients who had failed meniscal repair had increased radiographic osteoarthritic changes (81%) on long-term follow-up compared to patients with successful repair (14%). CONCLUSION this retrospective study shows the clinical and radiological importance of meniscal repair. Successful results in this study were associated with younger age and earlier repair using inside-out technique. Furthermore, increased success was seen in meniscal repairs performed in association with ACL reconstruction.
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Affiliation(s)
- Mike Tengrootenhuysen
- Department of Orthopaedic Surgery, University Hospital Antwerp, 2650 Edegem, Belgium.
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Abstract
Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wrestling, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.
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Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, UK.
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Musahl V, Jordan SS, Colvin AC, Tranovich MJ, Irrgang JJ, Harner CD. Practice patterns for combined anterior cruciate ligament and meniscal surgery in the United States. Am J Sports Med 2010; 38:918-23. [PMID: 20436052 DOI: 10.1177/0363546509357900] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of the study was to compare frequency of meniscal repair to partial meniscectomy in patients undergoing anterior cruciate ligament reconstruction using the American Board of Orthopaedic Surgeons (ABOS) database. HYPOTHESES (1) Practice patterns are similar with respect to geographic region. (2) Surgeons with fellowship training perform more meniscal repairs compared with general orthopaedic practitioners. (3) Younger patients are more likely to be treated with meniscal repair at the time of anterior cruciate ligament reconstruction. (4) The frequency of meniscal repair in conjunction with anterior cruciate ligament reconstruction has increased over time. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Information was extracted from the ABOS database from 2002 orthopaedic surgeons who sat for the part II examination from 2003 to 2007. The database was queried for all patients who underwent anterior cruciate ligament reconstruction (Current Procedural Terminology [CPT] code 29888) without or with meniscectomy (CPT 29881) or meniscal repair (CPT 29882). Factors affecting meniscal surgery that were investigated included patient age, geographic region of practice, fellowship training, and declared subspecialty of the surgeon. RESULTS On average there were 52,000 cases per year registered in the ABOS database, approximately 1700 of whom underwent anterior cruciate ligament reconstruction. Meniscal repair was most frequently performed in the Southwest region (18.6%, P < .001) and least frequently in the Northwest region (11.3%, P < .001). Combined anterior cruciate ligament reconstruction and meniscal repair was performed significantly more often by fellowship-trained surgeons (17%) than by surgeons with other fellowship training (12%) or no fellowship training (12%, P < .001) and in patients younger than age 25 years (19%) compared with those age 40 years and older (8%, P <.001). Meniscal repair was performed in 13.9% of anterior cruciate ligament reconstructions in 2003 and in 16.4% of anterior cruciate ligament reconstructions in 2007 (P > .05). CONCLUSION Combined anterior cruciate ligament reconstruction with meniscal repair was more frequent for younger patients and by surgeons with sports fellowship training. Concomitant meniscal repair is performed by fellowship-trained surgeons in this study in only 18% of anterior cruciate ligament reconstructions.
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Affiliation(s)
- Volker Musahl
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15203, USA
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Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR. Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 2010; 26:67-75. [PMID: 20117629 DOI: 10.1016/j.arthro.2009.07.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effectiveness of all-inside repair of posterior lateral meniscus root full-thickness tears with preoperative and postoperative magnetic resonance imaging (MRI) and to propose a system of classifying posterior lateral meniscus root tears. METHODS From June 2003 to March 2007, 27 (6.95%) of a consecutive series of 388 anterior cruciate ligament reconstructions had a concomitant posterior lateral meniscus root tear. Of the patients, 25 (92.6%) were followed up for a more than 1 year. There were 22 male and 3 female patients, with a mean age of 28.8 years. The mean timing of surgery after injury was 40.8 months. The preoperative and postoperative MRI scans were analyzed and compared. We classified posterior lateral meniscus root tears according to arthroscopic findings. RESULTS There was no postoperative effusion, joint-line tenderness, or positive McMurray provocation testing observed at the last follow-up. No statistically significant improvement was observed in the coronal plane in the 18 follow-up MRI scans (P = .096); however, sagittal extrusion improved significantly (P = .007). Posterior lateral meniscus root tears were classified based on arthroscopic findings: type I, oblique flap; type II, T shape; type III, longitudinal cleavage; or type IV, chronic inner loss. A type I tear was found in 7 patients, type II in 4, type III in 4, and type IV in 10. CONCLUSIONS After repair of posterior lateral meniscus root tears, MRI showed that the displaced lateral meniscus was reduced, mainly in the sagittal plane. Posterior lateral meniscus root tears were classified based on arthroscopic findings: type I, oblique flap; type II, T shape; type III, longitudinal cleavage; or type IV, chronic inner loss.
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Affiliation(s)
- Jin Hwan Ahn
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Stärke C, Kopf S, Petersen W, Becker R. Meniscal repair. Arthroscopy 2009; 25:1033-44. [PMID: 19732643 DOI: 10.1016/j.arthro.2008.12.010] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 12/07/2008] [Accepted: 12/09/2008] [Indexed: 02/02/2023]
Abstract
The meniscus plays an important role in preventing osteoarthritis of the knee. Repair of a meniscal lesion should be strongly considered if the tear is peripheral and longitudinal, with concurrent anterior cruciate ligament reconstruction, and in younger patients. The probability of healing is decreased in complex or degenerative tears, central tears, and tears in unstable knees. Age or extension of the tear into the avascular area are not exclusion criteria. Numerous repair techniques are available, and suture repair seems to provide superior biomechanical stability. However, the clinical success rate does not correlate well with the mechanical strength of the repair technique. Biologic factors might be of greater importance to the success of meniscal repair than the surgical technique. Therefore, the decision on the most appropriate repair technique should not rely on biomechanical parameters alone. Contemporary all-inside repair systems have decreased the operating time and the level of surgical skill required. Despite the ease of use, there is a potential for complications because of the close proximity of vessels, nerves, and tendons, of which the surgeon should be aware. There is no clear consensus on postoperative rehabilitation. Weight bearing in extension would most likely not be crucial in typical longitudinal lesions. However, higher degrees of flexion, particularly with weight bearing, give rise to large excursions of the menisci and to shear motions, and should therefore be advised carefully. Long-term studies show a decline in success rates with time. Further studies are needed to clarify the factors relevant to the healing of the menisci. Tissue engineering techniques to enhance the healing in situ are promising but have not yet evolved to a practicable level.
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Affiliation(s)
- Christian Stärke
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Abstract
All-inside meniscal repair has gained widespread popularity over recent years. The devices and techniques have rapidly evolved, resulting in increased ease of use and reduced surgical times and risk to the neurovascular structures. Despite these advances, inside-out suture repairs remain the current gold standard, with proven long-term results. All-inside techniques must continue to be compared to inside-out meniscal repair.
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Abstract
The meniscus plays a critical role in load transmission, stability and energy dissipation in the knee joint. Loss of the meniscus leads to joint degeneration and osteoarthritis. An increased understanding of the degenerative changes that occur after meniscectomy made clear that it is beneficial to save as much meniscal tissue as possible. Meniscal repair has become a standard procedure, and partial resection of damaged menisci should be performed as sparingly as possible. However, not all damaged menisci can be treated by partial resection or by repair, making a total meniscectomy inevitable. In these cases, replacement of the resected meniscal tissue by an implant might avoid the articular cartilage degeneration. Different types of meniscal substitutes, such as allografts, collagen, permanent synthetic scaffolds, and biodegradable scaffolds, have been used in experimental and clinical studies. This review highlights the research on these meniscal substitutes and shows that current research is mainly focused on a biological tissue-engineering approach either with or without additional cell-seeding techniques.
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Affiliation(s)
- Tony G van Tienen
- Orthopedic Research Laboratory, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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DeHaan A, Rubinstein RA, Baldwin JL. Evaluation of success of a meniscus repair device for vertical unstable medial meniscus tears in ACL-reconstructed knees. Orthopedics 2009; 32:orthopedics.38346. [PMID: 19388621 DOI: 10.3928/01477447-20090401-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed the success of meniscus repair with the FasT-Fix meniscus repair device for vertical unstable medial meniscus tears at the time of anterior cruciate ligament (ACL) reconstruction. A repair failure was defined as patients having medial knee symptoms leading to a subsequent arthroscopy confirming a tear at the repair site. Objective follow-up was obtained on 27 patients at a mean of 3.1 years postoperatively (range, 2-5 years). Two of 22 repairs (9%) in the red-red vascular zone and 4 of 5 repairs (80%) in the red-white vascular zone retore at the repair site at an average of 9 months postoperatively (range, 3-20 months). The results of this study showed a high failure rate (22%) of unstable vertical medial meniscus repairs with ACL reconstruction, especially for repairs done to tears in the red-white vascular zone.
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Affiliation(s)
- Alex DeHaan
- Portland Knee Clinic, Portland, Oregon 97213, USA
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