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Gurba JE, Weiss-Laxer NS, Haider MN, Marzo JM. Patient-reported Outcomes After Medial Meniscus Root Tear Repair Versus Other Medial Meniscus Repairs: An Exploratory Meta-analysis of Single-arm Cohorts. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202409000-00014. [PMID: 39321043 DOI: 10.5435/jaaosglobal-d-23-00293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 07/06/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION This study aimed to (1) compare patient-reported outcome measures between patients who underwent medial meniscus root tear (MMRT) repair and those who underwent other types of medial meniscus repair, and (2) identify factors associated with observed differences. METHODS A literature search identified studies reporting PROMs-knee injury and osteoarthritis outcome score (KOOS) or visual analog scale (VAS) for pain-after repair of the medial meniscus. Studies were excluded if outcomes were not separated by tear type or reported graphically, different or no outcomes reported, no repair or repair with a sutureless method, follow-up greater than 72 months, case report, and systematic review. Patient-reported outcome measures and demographics were summarized as sample-weighted means and compared using t-tests. Mixed model linear regressions were fit predicting postoperative PROMs adjusted for tear type, preoperative PROMs, and follow-up time. F statistics of type III tests of fixed effects were compared. RESULTS Eighteen articles were included, n = 10 received MMRT repair and n = 8 other tear repairs. Postoperative values for all KOOS scores were less for the MMRT repair group compared with the other tear repair group, VAS pain was not statistically different. Tear type was a stronger predictor for postoperative PROMs than the preoperative score and duration of follow-up for all KOOS scores, but not VAS pain. On average, the MMRT repair group had shorter follow-up, more women, older age, and greater BMI. DISCUSSION All postoperative PROMs except for VAS pain were worse for patients who underwent MMRT repair compared with patients who underwent other types of medial meniscus repair. Tear type was a better predictor of postoperative PROMs despite intergroup differences in preoperative PROMs and duration of follow-up. Relative risk factors for MMRT compared with other types of medial meniscus tears include older age, greater BMI, and female sex.
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Affiliation(s)
- Jared E Gurba
- From the UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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Sherman SL, Askew N, Nherera LM, Searle RJ, Flanigan DC. An All-Suture-Based Technique for Meniscal Repair Is Cost-Effective in Comparison to Partial Meniscectomy for Horizontal Cleavage Tears. Arthrosc Sports Med Rehabil 2024; 6:100847. [PMID: 38379597 PMCID: PMC10877196 DOI: 10.1016/j.asmr.2023.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/17/2023] [Indexed: 02/22/2024] Open
Abstract
Purpose To determine the cost-effectiveness of meniscal repair (MR) using an all-suture-based technique when compared to partial meniscectomy (PM) for horizontal cleavage tears (HCTs) from a payor's perspective in the United States. Methods A state-transition model and cost-utility analysis were developed from a US payor's perspective to project treatment costs and quality-adjusted life-years (QALYs) in a cohort of 35-year-old patients without osteoarthritis at baseline and presenting with either a lateral or medial HCT. Two outpatient costing perspectives were used, namely ambulatory surgical centers (ASCs) and hospitals. The state-transition model had 7 health states with transition probabilities, costs, and utilities obtained from the existing literature. Cost-effectiveness was assessed using a willingness-to-pay threshold of $100,000/QALY, and sensitivity analysis considered the effects of parameter uncertainty on model results. MR failure rates were focused on an all-suture-based technique; however, in a separate scenario, this study considered effectiveness data from various MR techniques and devices. Results MR dominated PM over a lifetime horizon, increasing QALYs by 0.43 per patient and decreasing the cost by $12,227 per patient within a hospital setting (and by $12,570 within an ASC). MR with an all-suture-based technique continued to be the dominant treatment when age at primary treatment was varied between 30 and 60 years. Sensitivity analysis showed that MR was not cost-effective in year 1, was cost-effective from year 2, and was cost-saving from year 6 onward from both ASC and hospital perspectives. Probabilistic sensitivity analysis found that MR was cost-effective over a lifetime horizon in 99% of 10,000 iterations on base-case analysis. Conclusions Using a lifetime horizon, this study found that from a payor's perspective, MR is a cost-saving intervention when compared with PM in patients with an HCT. Level of Evidence Level III, economic analysis.
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Affiliation(s)
- Seth L. Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California, U.S.A
| | - Neil Askew
- Smith & Nephew, Fort Worth, Texas, U.S.A
| | | | | | - David C. Flanigan
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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Schweizer C, Hanreich C, Tscholl PM, Blatter S, Windhager R, Waldstein W. Meniscal Repair Outcome in 3829 Patients With a Minimum Follow-up From 2 Years Up to 5 Years: A Meta-analysis on the Overall Failure Rate and Factors Influencing Failure. Am J Sports Med 2024; 52:822-831. [PMID: 37022676 DOI: 10.1177/03635465231158385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND The importance of meniscal repair is widely accepted because of the association of loss of meniscal tissue with the development of early-onset knee arthritis. Many factors influencing the results of meniscal repair have been reported, but results remain controversial. PURPOSE This meta-analysis determines the pooled meniscal repair failure rate of studies with a minimum follow-up of 2 years up to 5 years, with a mean follow-up of 43 months. Moreover, selected failure-influencing factors are analyzed. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed and Scopus were searched for studies published between January 2000 and November 2021 reporting on meniscal repair outcome with a minimum follow-up of 24 months. The overall pooled failure rate and pooled failure rates for possible predictors were calculated. Random-effect models were used to pool failure rates, and effect estimates in the form of odds ratios with 95% CIs were established. RESULTS The initial literature search identified 6519 studies. A total of 51 studies met the inclusion criteria. In total, 3931 menisci were included with an overall failure rate of 14.8%. Subgroup analysis revealed a significantly lower failure rate for meniscal repair with concomitant anterior cruciate ligament (ACL) reconstruction compared with knees without any reported injury to the ACL (8.5% vs 14%; P = .043). The pooled failure rate for lateral meniscal repair was significantly lower than that for medial meniscal repair (6.1% vs 10.8%; P = .031). Pooled failure rates of all-inside and inside-out repair were not significantly different (11.9% vs 10.6%; P > .05). CONCLUSION This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. Meniscal repair remains a procedure with a high failure rate, especially within the first 2 postoperative years. This review and meta-analysis also identified clinically relevant factors associated with favorable outcomes such as concomitant ACL reconstruction or repair of the lateral meniscus. All-inside meniscal repair with the latest-generation devices yields failure rates of <10%. The failure mechanism and the time of failure is poorly documented; further studies are needed for a better understanding of the retear mechanism.
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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, Geneva, Switzerland; ReFORM (Reseau Francophone Olympique de la Recherche en Médecine du Sport), IOC Research Centre for Prevention of Injury and Protection of Athlete Health
| | - Samuel Blatter
- Division of Orthopedics and Trauma Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - 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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Cavendish PA, Coffey E, Milliron EM, Barnes RH, Flanigan DC. Horizontal Cleavage Tear Meniscal Repair Using All-Inside Circumferential Compression Sutures. Arthrosc Tech 2023; 12:e1319-e1327. [PMID: 37654892 PMCID: PMC10466186 DOI: 10.1016/j.eats.2023.03.024] [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: 01/30/2023] [Revised: 03/16/2023] [Accepted: 03/29/2023] [Indexed: 09/02/2023] Open
Abstract
Horizontal cleavage meniscus tears occur more frequently in older patient populations with degenerative changes within the meniscus. Traditionally, they have been managed with nonsurgical interventions or with partial meniscectomy. As increasing evidence demonstrates the link between partial meniscectomy and progressive osteoarthritis with these types of tears, as well as worse long-term outcomes and reduced cost savings, surgical repair of horizontal cleavage meniscal tears has increased in appropriate patients. This technique article highlights the evaluation, indications, and preferred repair technique for horizontal cleavage tears in appropriately selected patients.
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Affiliation(s)
- Parker A. Cavendish
- Department of Orthopaedics, Jameson Crane Sports Medicine Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Emily Coffey
- Department of Orthopaedics, Jameson Crane Sports Medicine Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Eric M. Milliron
- Department of Orthopaedics, Jameson Crane Sports Medicine Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Ryan H. Barnes
- Department of Orthopaedics, Jameson Crane Sports Medicine Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - David C. Flanigan
- Department of Orthopaedics, Jameson Crane Sports Medicine Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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Mallory N, Qin C, Gibbs D, Milliron E, Cavendish P, Magnussen RA, Flanigan DC. Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00006. [PMID: 37561839 DOI: 10.2106/jbjs.rvw.23.00042] [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: 08/12/2023]
Abstract
» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.
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Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles Qin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Milliron
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Parker Cavendish
- 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
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Lipson SE, Morris A, Chan FJ. The "Under, Over" Technique for Repair of a Peripheral Bucket-Handle Meniscus Tear With Circumferential Compression Stitches. Arthrosc Tech 2023; 12:e1139-e1143. [PMID: 37533922 PMCID: PMC10390879 DOI: 10.1016/j.eats.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/02/2023] [Indexed: 08/04/2023] Open
Abstract
The benefits of preserving the meniscus are well-established. Several arthroscopic meniscal repair techniques have been described, such as the inside-out, outside-in, and all-inside. All-inside self-retrieving suture devices can be used to repair vertical, horizontal, and radial tears. However, this technique becomes difficult with large tears, as the jaw of the device cannot reach the peripheral edge of the meniscal tear. We present an all-inside technique using circumferential compression stitches to address large peripheral meniscus tears.
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Affiliation(s)
- Sophie E. Lipson
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Allyn Morris
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Ferdinand J. Chan
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, U.S.A
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Thor JEH, Lim GYC, Hui JHP, Lee DYH. Do meniscal repairs with meniscus cyst do better than meniscectomy?-a systematic review of meniscal cyst treatment. ANNALS OF JOINT 2022; 8:8. [PMID: 38529257 PMCID: PMC10929322 DOI: 10.21037/aoj-22-29] [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: 07/17/2022] [Accepted: 11/22/2022] [Indexed: 03/27/2024]
Abstract
Background This systematic review aims to determine the best modality for the management of meniscal cysts and its associated meniscus tear; whether the meniscal cyst treated via arthroscopy or open methods and whether meniscal debridement or repair achieves better results. Methods This systematic review was performed using PRISMA guidelines. A literature search of PubMed, EMBASE and Cochrane was carried out in July 2020 using the search terms 'meniscal cyst' and 'treatment'. All clinic studies that included filters for papers in the last 20 years, English language, and meniscal cysts found in humans were included. Studies that contained case reports, were in any language other than English, and with subjects that were not humans were excluded. The methodology quality assessment was performed through the modified Coleman methodology score (CMS). Results A total of 166 results were obtained from PubMed, Cochrane library and EMBASE. Of them, 12 duplicates were identified across the databases and removed from consideration. Six papers were found relevant from EMBASE in which 1 was eventually included in this paper. In total, 12 papers were used in this study. The weighted mean age of the patients was 35.1 years, with total of 523 meniscal cysts, of which 488 of these cysts are associated with meniscal tears (93.31%). The studies included performed cystectomies and/or decompression of meniscal cysts while some left the meniscal cyst alone and dealt with the meniscal lesion instead. All clinical scores showed significant improvement following surgical procedures. Conclusions Both arthroscopic and open methods can be used for meniscal cysts treatment. Open cystectomy rather than decompression seemed to confer lower risk of cyst recurrences and complications. It is inconclusive to whether meniscal repair or meniscus debridement influenced recurrence and outcome scores. A recommendation for meniscus repair cannot be made due to insufficient high-quality level I or II trials.
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Affiliation(s)
- Jessica Eng Hsia Thor
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
| | - Gennie Yan Cen Lim
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Dave Yee Han Lee
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
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Mameri ES, Verdejo FG, Dasari SP, Kerzner B, Shah S, Kasson LB, Khan ZA, Fortier LM, Damodar D, Gursoy S, Chahla J. Repair of a Horizontal Cleavage Tear of the Lateral Meniscus with Circumferential Compression Stitches and Marrow Venting Augmentation. Arthrosc Tech 2022; 11:e1937-e1944. [PMID: 36457397 PMCID: PMC9705603 DOI: 10.1016/j.eats.2022.07.008] [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: 05/08/2022] [Accepted: 07/14/2022] [Indexed: 11/21/2022] Open
Abstract
Horizontal cleavage tears (HCTs) are challenging meniscal tear patterns, as they split the meniscus into inferior and superior leaflets, while also involving the central, less vascular portions of the meniscus. Circumferential compression sutures using an all-inside self-retrieving suture passing device like the Novostitch Pro (Smith & Nephew, Andover, MA) have demonstrated the ability to create stable repair constructs with uniform compression across both leaflets in the setting of HCTs. Additionally, biological augmentation of meniscal repairs using a marrow venting procedure (MVP) has demonstrated superior clinical outcomes relative to isolated meniscal repairs. Thus, the purpose of this technical note is to outline our procedure for implementing circumferential compression sutures and biologic augmentation using an MVP for repairing an HCT of the lateral meniscus.
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Affiliation(s)
| | | | | | - Benjamin Kerzner
- Address correspondence to Benjamin Kerzner, B.S., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite 300, Chicago, IL 60612, U.S.A..
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Block AM, Eisenberg MT, Inclan PM, Nepple JJ. Treatment Trends in Meniscal Pathology in the Setting of Concomitant ACL Injuries in Pediatric and Young Adult Patients: An Insurance Database Study. Am J Sports Med 2022; 50:2367-2373. [PMID: 35647786 DOI: 10.1177/03635465221098141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal pathology is commonly encountered in the setting of anterior cruciate ligament (ACL) rupture and is increasingly common in the pediatric and adolescent population. Studies have shown that over half of individuals presenting with ACL rupture will have concurrent meniscal pathology. PURPOSE To define trends in the utilization of meniscal procedures (ie, meniscus repair vs partial meniscectomy) and short-term complications in pediatric and young adult patients with meniscal pathology in the setting of a concurrent ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The IBM MarketScan Commercial Database was utilized to identify ACL reconstruction procedures performed between 2006 and 2018 for individuals aged 5 to 30 years. Annual proportions of meniscectomy and meniscal repair were analyzed, and short-term complications were compared between pediatric/adolescent patients (aged 5-17 years) and young adults (aged 18-30 years). RESULTS An overall 40,736 records of individuals <18 years old with ACL tears were included. The pediatric/adolescent population had a significantly lower proportion of concomitant meniscal procedures (56.8%; 23,149/40,736) than the young adult population (59.7%; 33,764/56,515; P < .01). From 2006 to 2018, utilization of meniscal repair in the setting of ACL reconstruction steadily increased (20.1% to 35.1% [+15 percentage points], P < .01), while the proportion with meniscectomy decreased (34.4% to 21.3% [-13.1 percentage points], P < .01). There was no difference in rate of reoperation for repeat meniscal repair or meniscectomy in the pediatric/adolescent population for those undergoing meniscal repair versus meniscectomy within 180 days of primary surgery (1.7% [188/10,766] vs 1.5% [186/12,383]; P = .14). CONCLUSION From 2006 to 2018, the proportion of patients receiving ACL reconstruction with concomitant meniscal repair increased (20.1% to 35.1%) while the proportion with meniscectomy decreased (34.4% to 21.3%) in the pediatric/adolescent population. Meniscal repair was not associated with a higher 180-day rate of reoperation for repeat meniscal repair or meniscectomy than meniscectomy in the setting of ACL reconstruction.
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Affiliation(s)
- Andrew M Block
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Matthew T Eisenberg
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Paul M Inclan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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