1
|
Kuhn AW, Brophy RH. Meniscus Injuries in Soccer. Sports Med Arthrosc Rev 2024; 32:156-162. [PMID: 39087705 DOI: 10.1097/jsa.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Soccer is considered the most popular sport in the world. The game involves frequent agile maneuvers, such as rapid accelerations/decelerations and pivoting, and carries an inherent risk of high-speed collisions, which can lead to lower extremity injury. Knee and meniscus injuries can cause significant pain and disability, precluding participation in the sport. Understanding the diagnosis and management of meniscal injuries in soccer players is essential to the care of these athletes. This paper reviews meniscal anatomy, biomechanics, and mechanisms of injury; discusses the work-up, diagnosis, and management of meniscus injuries; and reports on rehabilitation, return to sport, and outcomes after meniscal injuries in soccer players.
Collapse
Affiliation(s)
- Andrew W Kuhn
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | | |
Collapse
|
2
|
Dzidzishvili L, Jackson GR, Allende F, Mameri ES, Allahabadi S, Chahla J. Meniscal Radial Tears Repaired With All-Inside and Inside-Out Techniques Result in Improved Clinical Outcome Scores, but Inside-Out Repairs May Be Associated With Higher Failure Rates Clinically and on Second-Look Arthroscopy: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00496-1. [PMID: 38992511 DOI: 10.1016/j.arthro.2024.06.046] [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: 01/27/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To compare patient-reported outcomes (PROs), failure, and healing rates after all-inside (AI) repair versus inside-out (IO) repair for the treatment of meniscal radial tears. METHODS A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the Scopus, PubMed, and Embase computerized databases. Level of Evidence I through IV human clinical studies evaluating PROs and/or the incidence of failure and healing after AI versus IO repairs for meniscal radial tears were included. Clinical failure was defined by the presence of joint-line tenderness; a positive McMurray test; and mechanical symptoms, such as locking, catching, or giving way. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria and the Modified Coleman Methodology Score. RESULTS Ten studies published from 2008 to 2023 comprising 205 patients were identified, including 142 patients who underwent AI repair and 63 patients who underwent IO repair for radial meniscus tears. Postoperative Lysholm and Tegner scores ranged from 90.8 to 95.6 and 5.7 to 8.2, respectively, in the AI repair group, compared with 86.9 to 94.2 and 6 to 7.5, respectively, in the IO repair group. All patients exceeded published values for minimal clinically important difference for the Lysholm score. Clinical failure ranged from 0% to 40% in the AI group and 0% to 62.5% in the IO group. Healing assessments on second-look arthroscopy revealed failure rates ranging from 0% to 13.3% in the AI group and 0% to 39% in the IO group. Complete and partial healing ranged from 28.6% to 92.3% in the AI group and from 25% to 70% in the IO group. Chondral damage on second-look arthroscopy ranged from 0% to 95% in the IO group and 0% to 57.7% in the AI group. Postoperative complications ranged from 0% to 2% within the AI group, whereas no complications were reported in the IO group. No implant-related complications were reported in any study group. CONCLUSIONS Both all-inside and inside-out repairs for meniscal radial tears demonstrated improved PROs; however, current literature suggests that the IO technique may have higher failure rates both clinically and on second-look arthroscopy. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Lika Dzidzishvili
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; Department of Orthopaedic Surgery, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Felicitas Allende
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A..
| |
Collapse
|
3
|
Desai SS, Czerwonka N, Farah O, Ruberto RA, Mueller JD, Ferrer X, Chahla J, Trofa DP, Swindell HW. Neither All-Inside, nor Inside-Out, nor Outside-In Repair Demonstrates Superior Biomechanical Properties for Vertical Meniscal Tears: A Systematic Review of Human Cadaveric Studies. Arthroscopy 2024:S0749-8063(24)00297-4. [PMID: 38880182 DOI: 10.1016/j.arthro.2024.03.049] [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: 11/20/2023] [Revised: 03/10/2024] [Accepted: 03/27/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To systematically review the literature regarding the biomechanical properties of different repair techniques and fixation methods for vertically oriented meniscal tears. METHODS Human cadaveric studies evaluating the biomechanical properties of different repair techniques for vertically oriented meniscal tears were identified using the PubMed, EMBASE, and Cumulative Index to Nursing & Allied Health databases. Primary outcomes included load to failure, displacement, stiffness, peak contact pressure, and contact area of repaired menisci. Repair techniques from included studies were reclassified into a total of 19 distinct all-inside (AI), inside-out (IO), or outside-in (OI) techniques. RESULTS Sixteen studies were included (420 total menisci). Contact pressure and area were restored to intact-state values across all 5 compressive load studies at low knee flexion angles but not at greater knee flexion angles (i.e., >60°). There were no significant differences in contact pressure or area between AI, IO, and OI techniques across all studies. Some studies demonstrated statistically significant advantages in tensile properties with IO techniques when compared with AI techniques, whereas others found AI techniques to be superior. No studies directly compared tensile properties of OI techniques with those of AI or IO techniques. Vertical mattress suture configurations resulted in significantly greater load to failure and decreased displacement compared with horizontal mattress configurations in 67% of studies comparing the 2 techniques. There was no difference in the rate of tissue failure in AI (66.97%), IO (60.38%), or OI (66.67%, χ2 = 0.83, P = .66) techniques. CONCLUSIONS Contact mechanics are reliably restored after repair of vertical meniscal tears at low flexion angles but inconsistently restored at greater flexion angles, regardless of technique. Vertical mattress configurations outperformed horizontal mattress configurations under tensile load. There are conflicting data regarding the comparison of tensile properties between AI and IO techniques. Ultimately, neither AI, IO, nor OI repair demonstrated superior biomechanical properties in the present literature. CLINICAL RELEVANCE Several repair techniques demonstrate favorable biomechanical properties for vertical meniscal tears under tensile and compressive loads. Neither AI, IO, nor OI repair techniques demonstrate superior biomechanical properties at this time.
Collapse
Affiliation(s)
- Sohil S Desai
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A..
| | - Natalia Czerwonka
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Omar Farah
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - R Alex Ruberto
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - John D Mueller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Xavier Ferrer
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Hasani W Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| |
Collapse
|
4
|
Reiter CR, Wyatt PB, O'Neill CN, Satalich JR, O'Connell RS, Vap AR. Increased Age, Operative Time, American Society of Anesthesiologists Classification, Functional Dependency, and Comorbidity Burden Are Risk Factors for Adverse Events After Meniscectomy and Meniscus Repair: 10-Year Analysis of 64,223 Patients. Arthroscopy 2024; 40:1848-1855. [PMID: 37967730 DOI: 10.1016/j.arthro.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE To use the National Surgical Quality Improvement Program (NSQIP) database to identify risk factors for 30-day adverse events and hospital readmission following isolated and unilateral meniscectomy or meniscus repair. METHODS A retrospective review of the NSQIP database from the years 2012 to 2021 identified all patients undergoing isolated, unilateral meniscectomy or meniscus repair. Multivariable analyses were performed for each procedure to identify patient characteristics associated with any adverse event (AAE) or unplanned hospital readmission within 30 days of surgery. RESULTS From 2012 to 2021, 59,450 (93%) patients underwent meniscectomy, and 4,773 (7%) patients underwent meniscus repair. Overall adverse event rate was 0.95% after meniscectomy and 1.40% after repair. Risk factors for AAE after meniscectomy included increased age (odds ratio [OR] = 1.010; P = .009), increased operative time (OR = 1.003; P = 0.011), American Society of Anesthesiologists (ASA) class IV (OR = 2.048; P = .045), functional dependency (OR = 3.527; P = .001), and current smoking (OR = 1.308; P = .018). Risk factors for AAE after meniscus repair included age (OR = 1.024; P = .016), operative time (OR = 1.004; P = .038), and bleeding disorders (OR = 7.000; P = .014). ASA class III increased risk of hospital readmission after both procedures (OR = 1.906; P = .008; OR = 4.101; P = .038), and medical comorbidities of heart failure (OR = 3.924; P = .016), hypertension (OR = 1.412; P = .011), and chronic obstructive pulmonary disease (OR = 2.350; P < .001) increased readmission risk after meniscectomy only. CONCLUSIONS Per analysis of the American College of Surgeons (ACS)-NSQIP database, surgical treatment of meniscal tears in the knee has been performed frequently over the past 10 years, with meniscectomies comprising over 90% of cases. Increased age and operative time were associated with a modest risk of adverse events after both meniscectomy and meniscus repair. Increased comorbidity burden, evidenced by ASA class, dependent functional status, current smoking, and systemic medical conditions, such as heart failure, hypertension, chronic obstructive pulmonary disease, and bleeding disorders, greatly increased rates of unfavorable outcomes within 30 days of meniscus surgery. LEVEL OF EVIDENCE Level III, retrospective prognostic comparative investigation.
Collapse
Affiliation(s)
- Charles R Reiter
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A..
| | - Phillip B Wyatt
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Conor N O'Neill
- Duke University Health System, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - James R Satalich
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Robert S O'Connell
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| | - Alexander R Vap
- Virginia Commonwealth University Health System, Department of Orthopaedic Surgery, Richmond, Virginia, U.S.A
| |
Collapse
|
5
|
Schippers P, Buschmann V, Wunderlich F, Afghanyar Y, Fischer S, Wegner E, Drees P, Gercek E, Eckhard L. Bucket-Handle Meniscal Tears Might Not Be an Urgency: The Time to Meniscus Repair Does Not Seem to Affect the Mid-Term Outcome-A Retrospective Study of Sixty Tears with a Mean Follow-Up of 6 Years. J Clin Med 2024; 13:3048. [PMID: 38892759 PMCID: PMC11172473 DOI: 10.3390/jcm13113048] [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: 04/17/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Bucket-handle meniscal tears are mostly treated arthroscopically. However, there is no clear evidence as to whether the time to surgery impacts the outcome and whether or not lesions should be treated urgently. Methods: Sixty patients were interviewed about the current status of their knee with a mean follow-up of 6.1 years (SD = 3.5). Forty-one patients underwent meniscus repair, and fifteen patients received partial resections. The primary outcome was the rate of reoperation after meniscus repair. Secondary outcomes were pain at rest and during exercise, return to sports, and Tegner and Lysholm scores. Results: The average time to surgery was 14.4 days, with no significant impact of surgical timing on the rate of reoperation. Furthermore, no significant differences were found in pain levels, return to sports, or Tegner and Lysholm scores based on the timing of surgery. Conclusions: In our cohort, the time to surgery was not a prognostic factor for the reoperation rate or postoperative outcome in repairing bucket-handle meniscal tears. Therefore, arthroscopic repair should not be performed in an emergency setting but conducted after careful planning by experienced arthroscopy surgeons. Regarding the return to sports, postoperative factors such as rehabilitation protocols or surgical techniques could be more important than the time to surgery.
Collapse
Affiliation(s)
- Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
| | - Victoria Buschmann
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
| | - Felix Wunderlich
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
| | - Yama Afghanyar
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
| | - Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, 60389 Frankfurt, Germany
| | - Erik Wegner
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
| | - Erol Gercek
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
| | - Lukas Eckhard
- Department of Orthopedics and Traumatology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (V.B.); (F.W.); (Y.A.); (E.W.); (P.D.); (E.G.); (L.E.)
- Praxis für Gelenkchirurgie Bad Kreuznach, 55543 Bad Kreuznach, Germany
| |
Collapse
|
6
|
Chahla J, Knapik DM, Jawanda H, Allende F, Rivarola H, McCormick JR, LaPrade RF, Jackson GR. Meniscal Radial Tears: A Classification System Based on Tear Morphology. Arthrosc Tech 2024; 13:102888. [PMID: 38584632 PMCID: PMC10995731 DOI: 10.1016/j.eats.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/04/2023] [Indexed: 04/09/2024] Open
Abstract
Appropriate management of radial meniscal tears is complex, with continued efforts focused on optimizing diagnostic methods for identification to help dictate treatment, especially as surgical indications for repair have expanded, coupled with improvements in surgical techniques and instrumentation. Currently, no standardized classification system for radial meniscal tears exists, limiting the ability to accurately characterize injury patterns and guide surgical decision-making.
Collapse
Affiliation(s)
- Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Harkirat Jawanda
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Felicitas Allende
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Horacio Rivarola
- Department of Orthopaedic Surgery, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
7
|
Oladeji LO, Reynolds G, Nuelle CW, DeFroda SF. Securing the Root: Meniscus Root Repair with Rip Stop and Cannulated Drilling. Arthrosc Tech 2023; 12:e1665-e1672. [PMID: 37942109 PMCID: PMC10627872 DOI: 10.1016/j.eats.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Meniscal root pathology has garnered increased attention over the past decade. Meniscal root tears are considered to essentially represent a meniscus-deficient state, which has led to a rise in the surgical fixation of this pathology. Meniscus root tears are classified as either radial tears within 1 cm of the root insertion, or a direct avulsion of meniscal root. These injuries are important to recognize because they contribute to impaired joint mechanics and rapid articular cartilage degeneration. Given this, there remains significant interest in identifying novel surgical techniques that may facilitate better surgical repair and enhance patient outcomes. The purpose of this technical note is to describe a surgical technique for a medial meniscus root ripstop repair with cannulated drilling. This technique is simple and reproducible, while also allowing for the augmentation of potentially poor tissue quality.
Collapse
Affiliation(s)
- Lasun O. Oladeji
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Grace Reynolds
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri Columbia, Columbia, Missouri, USA
| |
Collapse
|
8
|
Kita K, Kusano M, Tsujii A, Ohori T, Tanaka Y, Nakamura N, Nakata K. Meniscal Circumferential Fiber Augmentation: A Biomechanical Arthroscopic Meniscal Repair Technique. Arthrosc Tech 2023; 12:e1673-e1678. [PMID: 37942099 PMCID: PMC10627964 DOI: 10.1016/j.eats.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Radial tears of the human knee meniscus result in the loss of circumferential hoop stress and are highly correlated with knee degeneration. Although a variety of surgical techniques are available to repair radial meniscal tears, including inside-out, outside-in, and all-inside techniques, conventional repair techniques focus only on stabilizing the damaged portion. This Technical Note describes a biomechanical meniscus repair technique of meniscal circumferential fiber augmentation, concomitant with conventional repair, to promote meniscal healing from a biomechanical perspective.
Collapse
Affiliation(s)
- Keisuke Kita
- Department of Othropaedic Sports Medicine, JCHO Osaka Hospital, Osaka, Japan
| | - Masashi Kusano
- Department of Othropaedic Sports Medicine, JCHO Osaka Hospital, Osaka, Japan
| | - Akira Tsujii
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yudai Tanaka
- Department of Othropaedic Sports Medicine, JCHO Osaka Hospital, Osaka, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science, University, Osaka, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| |
Collapse
|
9
|
Milliron EM, Moews L, Cavendish PA, Barnes RH, Flanigan DC. Anterolateral Radial Meniscus Tear Repair using Traction Suture and Super-Hashtag Technique. Arthrosc Tech 2023; 12:e1347-e1353. [PMID: 37654885 PMCID: PMC10466241 DOI: 10.1016/j.eats.2023.04.003] [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: 01/31/2023] [Revised: 03/18/2023] [Accepted: 04/11/2023] [Indexed: 09/02/2023] Open
Abstract
Radial meniscus tears occur commonly as traumatic tears in younger patients, as well as in association with concomitant degenerative changes. Traditional management of these tears has centered around partial meniscectomy; however, there has been a more recent trend toward preserving the meniscus and attempting repair. Because of the gapping and displacement that frequently occurs with these tears, repair is often challenging and is done under high amounts of tension. The following article describes a technique using a traction suture to aid in maintaining reduction throughout repair. This is followed by the use of a combination of techniques to form a "super-hashtag" configuration of both vertical and horizontal mattress sutures, leading to a secure repair under little tension.
Collapse
Affiliation(s)
- Eric M. Milliron
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - Logan Moews
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - Parker A. Cavendish
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - Ryan H. Barnes
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| | - David C. Flanigan
- Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, U.S.A
| |
Collapse
|
10
|
Zsidai B, Dadoo S, Fox MA, Kaarre J, Grandberg C, Greiner JJ, Musahl V. Arthroscopic all-inside repair of challenging meniscus tears. J ISAKOS 2023; 8:210-212. [PMID: 36924826 DOI: 10.1016/j.jisako.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/16/2023]
Abstract
Meniscus tears are prevalent in isolation and in combination with anterior cruciate ligament (ACL) injury. Meniscus lesions can be difficult to access and often display complex tear patterns, which result in technical challenges for the operating surgeon during surgical treatment. The aim of this video article is to demonstrate technical tips and tricks for performing all-inside repair of challenging meniscus tears. The presented techniques are indicated in young, physically active patients with symptomatic tears of the lateral and medial menisci, with or without concomitant ACL injury. The procedure is performed using standard anterolateral and anteromedial arthroscopic portals for direct visualization of complex meniscus tear patterns and all-inside instrument access. A suture passing device is used for the placement of suture loops for meniscus root repair. All-inside repair devices are used to repair the radial meniscal tears along the native circumferential fibers using a horizontal mattress suture configuration, with curved devices to achieve optimal access to challenging tears affecting the anterior and posterior aspects at the mid-body of the meniscus. Repair of radial tears at the avascular zone of the meniscus may be augmented with an autologous fibrin clot delivered using an arthroscopic cannula.
Collapse
Affiliation(s)
- Bálint Zsidai
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden.
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, 15203, USA
| | - Michael A Fox
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, 15203, USA
| | - Janina Kaarre
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
| | - Camila Grandberg
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, 15203, USA
| | - Justin J Greiner
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 40530, Sweden
| |
Collapse
|
11
|
Simonetta R, Russo A, Palco M, Costa GG, Mariani PP. Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. World J Orthop 2023; 14:171-185. [PMID: 37155506 PMCID: PMC10122773 DOI: 10.5312/wjo.v14.i4.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/22/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
Over the years, several studies demonstrated the crucial role of knee menisci in joint biomechanics. As a result, save the meniscus has become the new imperative nowadays, and more and more studies addressed this topic. The huge amount of data on this topic may create confusion in those who want to approach this surgery. The aim of this review is to provide a practical guide for treatment of meniscus tears, including an overview of technical aspects, outcomes in the literature and personal tips. Taking inspiration from a famous movie directed by Sergio Leone in 1966, the authors classified meniscus tears in three categories: The good, the bad and the ugly lesions. The inclusion in each group was determined by the lesion pattern, its biomechanical effects on knee joint, the technical challenge, and prognosis. This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a reader-friendly narrative review of an otherwise difficult topic. Furthermore, the authors provide a concise premise to deal with some aspects of menisci phylogeny, anatomy and biomechanics.
Collapse
Affiliation(s)
- Roberto Simonetta
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatology Unit, Umberto I Hospital, Enna 94100, Italy
| | - Michelangelo Palco
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro 88100, Italy
| | | | - Pier Paolo Mariani
- Department of Orthopaedic and Traumatology, Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Roma 00135, Italy
| |
Collapse
|