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Sadoghi P, Widhalm HK, Fischmeister MF, Leitner L, Leithner A, Fischerauer SF. Delayed Meniscus Repair Lowers the Functional Outcome of Primary ACL Reconstruction. J Clin Med 2024; 13:1325. [PMID: 38592690 PMCID: PMC10931753 DOI: 10.3390/jcm13051325] [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: 12/22/2023] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Our purpose was to evaluate whether the time of intervention and the type of meniscus surgery (repair vs. partial meniscectomy) play a role in managing anterior cruciate ligament (ACL) reconstructions with concurrent meniscus pathologies. METHODS We performed a prospective cohort study which differentiated between early and late ACL reconstructions with a cut-off at 3 months. Patients were re-evaluated after 2 years. RESULTS Thirty-nine patients received an operation between 2-12 weeks after the injury, and thirty patients received the surgery between 13-28 weeks after trauma. The strongest negative predictive factor of the International Knee Documentation Committee subjective knee form in a hierarchical regression model was older age (ß = -0.49 per year; 95% CI [-0.91; -0.07]; p = 0.022; partial R2 = 0.08)). The strongest positive predictive factor was a higher preoperative Tegner score (ß = 3.6; 95% CI [0.13; 7.1]; p = 0.042; partial R2 = 0.07) and an interaction between meniscus repair surgery and the time of intervention (ß = 27; 95% CI [1.6; 52]; p = 0.037; partial R2 = 0.07), revealing a clinical meaningful difference as to whether meniscus repairs were performed within 12 weeks after trauma or were delayed. There was no difference whether partial meniscectomy was performed early or delayed. CONCLUSIONS Surgical timing plays a crucial role when surgeons opt for a meniscus repair rather than for a meniscectomy.
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Affiliation(s)
- Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (P.S.); (L.L.); (A.L.)
| | - Harald K. Widhalm
- Clinical Division of Traumatology, Department of Orthopedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria;
| | | | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (P.S.); (L.L.); (A.L.)
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (P.S.); (L.L.); (A.L.)
| | - Stefan F. Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; (P.S.); (L.L.); (A.L.)
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Migliorini F, Asparago G, Oliva F, Bell A, Hildebrand F, Maffulli N. Greater rate of return to play and re-injury following all-inside meniscal repair compared to the inside-out technique: a systematic review. Arch Orthop Trauma Surg 2023; 143:6273-6282. [PMID: 37284879 PMCID: PMC10491517 DOI: 10.1007/s00402-023-04933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Inside-out and all-inside arthroscopic meniscal repairs are widely performed. However, it remains unclear which method promotes greater clinical outcomes. This study compared inside-out versus all-inside arthroscopic meniscal repair in terms of patient-reported outcome measures (PROMs), failures, return to play, and symptoms. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. Two authors independently performed the literature search by accessing the following databases: PubMed, Google Scholar, and Scopus in February 2023. All clinical studies which investigated the outcomes of all-inside and/or inside-out meniscal repair were considered. RESULTS Data from 39 studies (1848 patients) were retrieved. The mean follow-up was 36.8 (9 to 120) months. The mean age of the patients was 25.8 ± 7.9 years. 28% (521 of 1848 patients) were women. No difference was found in PROMs: Tegner Activity Scale (P = 0.4), Lysholm score (P = 0.2), and International Knee Document Committee score (P = 0.4) among patients undergoing meniscal repair with all inside or inside-out techniques. All-inside repairs showed a greater rate of re-injury (P = 0.009) but also a greater rate of return to play at the pre-injury level (P = 0.0001). No difference was found in failures (P = 0.7), chronic pain (P = 0.05), reoperation (P = 0.1) between the two techniques. No difference was found in the rate of return to play (P = 0.5) and to daily activities (P = 0.1) between the two techniques. CONCLUSION Arthroscopic all-inside meniscal repair may be of special interest in patients with a particular interest in a fast return to sport, while, for less demanding patients, the inside-out suture technique may be recommended. High-quality comparative trials are required to validate these results in a clinical setting. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany.
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke On Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England
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Andress BD, Irwin RM, Puranam I, Hoffman BD, McNulty AL. A Tale of Two Loads: Modulation of IL-1 Induced Inflammatory Responses of Meniscal Cells in Two Models of Dynamic Physiologic Loading. Front Bioeng Biotechnol 2022; 10:837619. [PMID: 35299636 PMCID: PMC8921261 DOI: 10.3389/fbioe.2022.837619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/24/2022] [Indexed: 12/14/2022] Open
Abstract
Meniscus injuries are highly prevalent, and both meniscus injury and subsequent surgery are linked to the development of post-traumatic osteoarthritis (PTOA). Although the pathogenesis of PTOA remains poorly understood, the inflammatory cytokine IL-1 is elevated in synovial fluid following acute knee injuries and causes degradation of meniscus tissue and inhibits meniscus repair. Dynamic mechanical compression of meniscus tissue improves integrative meniscus repair in the presence of IL-1 and dynamic tensile strain modulates the response of meniscus cells to IL-1. Despite the promising observed effects of physiologic mechanical loading on suppressing inflammatory responses of meniscus cells, there is a lack of knowledge on the global effects of loading on meniscus transcriptomic profiles. In this study, we compared two established models of physiologic mechanical stimulation, dynamic compression of tissue explants and cyclic tensile stretch of isolated meniscus cells, to identify conserved responses to mechanical loading. RNA sequencing was performed on loaded and unloaded meniscus tissue or isolated cells from inner and outer zones, with and without IL-1. Overall, results from both models showed significant modulation of inflammation-related pathways with mechanical stimulation. Anti-inflammatory effects of loading were well-conserved between the tissue compression and cell stretch models for inner zone; however, the cell stretch model resulted in a larger number of differentially regulated genes. Our findings on the global transcriptomic profiles of two models of mechanical stimulation lay the groundwork for future mechanistic studies of meniscus mechanotransduction, which may lead to the discovery of novel therapeutic targets for the treatment of meniscus injuries.
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Affiliation(s)
| | - Rebecca M. Irwin
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Ishaan Puranam
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Brenton D. Hoffman
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Cell Biology, Duke University, Durham, NC, United States
| | - Amy L. McNulty
- Department of Pathology, Duke University, Durham, NC, United States
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
- *Correspondence: Amy L. McNulty,
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Excellent medium-term survival of an all-inside tensionable knotted suture device justifies repair of most meniscal tears encountered during reconstructive knee ligament surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:1714-1721. [PMID: 32767078 DOI: 10.1007/s00167-020-06189-w] [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: 11/29/2019] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE All-inside meniscal repair devices have evolved to allow surgeons to undertake complex repairs in a timely and efficient manner. This is advantageous in active patients, where meniscus preservation is critical in preserving joint function and stability. The aim of the study was to evaluate the failure rate of all-inside meniscal repair performed in patients undergoing reconstructive ligament surgery using a particular meniscal repair device. METHODS Patients were identified using a single-site prospectively maintained patient registry. Primary outcome was failure, defined as return to surgery with documented failure of repair. Complication rates and functional scores were also recorded. Patients in whom meniscal repair failure was identified were further assessed, to identify any common features. RESULTS Over an 8-year period, 323 patients underwent meniscal repair at the time of ligament reconstruction, compared to 244 meniscectomies. Of these, 286 patients underwent repair using an all-inside suture device. One-hundred and twenty-seven repairs were to the medial meniscus only, 124 were lateral, and in 35 patients both menisci were repaired. Follow-up was to a median of 51.5 months. There were 31 (9.7%) failures reported at a median of 22 months post-operatively (IQR 13.5-41.5). Medial repair failures were seen more frequently than lateral (13.6% versus 5.6% OR 2.62 95% CI 1.17-5.88 p = 0.022). Failure of ACL reconstruction was associated with meniscal repair failure (OR 5.83 95% CI 1.55-21.95 p = 0.0039). Multi-ligament reconstruction was undertaken in 70/286 patients receiving meniscal repair and was not associated with failure (OR 1.3 95% CI 0.57-2.98 p = 0.51). Mode number of all-inside sutures used was 3 in both medial and lateral repairs (Range 1-9 lateral; 1-7 medial). CONCLUSIONS All-inside repair is a safe and versatile technique which can be used in the majority of meniscal tears encountered during ligament reconstruction with excellent mid-term success. Failure is seen more commonly in medial sided repairs and with failure of ACL reconstruction. LEVEL OF EVIDENCE IV.
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Postoperative rehabilitation and outcomes following arthroscopic isolated meniscus repairs: A systematic review. Phys Ther Sport 2020; 45:76-85. [PMID: 32688294 DOI: 10.1016/j.ptsp.2020.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to review the current literature on rehabilitation protocols following arthroscopic meniscus repair. METHODS A systematic literature review was performed of Medline, Scopus, and Web of Science databases to identify relevant articles from January 1990 to April 2019. Search terms were (meniscus OR meniscal repair) AND (repaired OR repair) AND (rehabilitation OR physiotherapy OR physical therapy). Each study was independently scored for methodological research quality level using the Modified Coleman Methodology Score (MCMS). The following variables were extracted from each study: publication year, study type, evidence level, subject demographics, injury mechanism, meniscus tear type, surgical procedure, rehabilitation program [immobilization, weight bearing, ROM progression, therapeutic exercises, length of follow-up, patient-reported outcome measurements, return to sport timing/criteria and failure rate/criteria. RESULTS Eighteen studies met the inclusion criteria. The overall MCMS was moderate 59.5 ± 11.7 (range = 42-90). The average MCMS score for postoperative rehabilitation was 4.7 ± 1.18. Only 1 (5.6%) study was a prospective randomized controlled trial and 14 studies (78%) had retrospective designs. Fourteen (78%) studies suggested that return to sports should occur between 3 and 6 months post-surgery. Early range of motion and immediate weight-bearing had no influence over patient-reported outcomes or failure rates for vertical meniscus tear repairs. CONCLUSION Low MCMS scores, primarily retrospective study designs and poorly described postoperative rehabilitation protocols made it difficult to design an evidence-based therapeutic rehabilitation program for patients following arthroscopic repair of an isolated meniscus tear. An arthroscopic isolated meniscal tear repair rehabilitation protocol is being attempted to present based on a synopsis of existing evidence.
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Espejo-Reina A, Aguilera J, Espejo-Reina MJ, Espejo-Reina MP, Espejo-Baena A. One-Third of Meniscal Tears Are Repairable: An Epidemiological Study Evaluating Meniscal Tear Patterns in Stable and Unstable Knees. Arthroscopy 2019; 35:857-863. [PMID: 30704886 DOI: 10.1016/j.arthro.2018.08.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze, in a long series of patients with knee injuries, the meniscal tear patterns in both stable and unstable knees to ascertain the exact proportion of such injuries that could have been repaired. METHODS A descriptive cross-sectional study was undertaken by reviewing the clinical reports of arthroscopic knee operations carried out in 1 hospital. A total of 2,066 consecutive patients were included in the study. An analysis of clinical and anatomical data of knee lesions, including the shape of the meniscal tears and the surrounding injuries, was performed. RESULTS Out of all meniscal tears, 34.9% were found to be repairable, a figure that rose to 55.6% in those tears accompanied by anterior cruciate ligament injuries; 37% of meniscal tears in male patients were repairable, and 28% in their female counterparts; 38.2% of medial meniscal tears were repairable and 30.6% in their lateral counterparts. The most frequently encountered injury was the complex tear (46.9%). CONCLUSIONS Our study concludes that, according to current standard indications, 34.9% of all meniscal injuries offer the potential for repair. Where the injury is also accompanied by anterior cruciate ligament damage, the proportion of repairable tears rises to 55.6%. This information should increase the interest for meniscal preservation in the future. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - José Aguilera
- Laboratorio de Fotobiología Dermatológica, Centro de Investigaciones Médico-Sanitarias, and Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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Tagliero AJ, Desai VS, Kennedy NI, Camp CL, Stuart MJ, Levy BA, Dahm DL, Krych AJ. Seventeen-Year Follow-up After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction in a Pediatric and Adolescent Population. Am J Sports Med 2018; 46:3361-3367. [PMID: 30422671 DOI: 10.1177/0363546518803934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies have shown good and excellent clinical and radiographic results after meniscal repair. Limited published information exists on the long-term outcomes, however, especially in a pediatric and adolescent population. PURPOSE To determine long-term results of meniscal repair and concomitant anterior cruciate ligament (ACL) reconstruction in a pediatric and adolescent population. Specifically, the aims were to determine the clinical success rate of meniscal repair with concomitant ACL reconstruction, compare results with midterm outcomes, and analyze risk factors for failure. STUDY DESIGN Case series; Level of evidence, 4. METHODS Cases of meniscal repair with concomitant ACL reconstruction between 1990 and 2005 were reviewed among patients aged ≤18 years. Patient demographics, injury history, and surgical details were recorded, and risk factors for failure were analyzed. Physical examination findings and clinical outcomes at latest available follow-up were collected. Subjective knee outcomes were compared with midterm results. Descriptive statistics and univariate analysis were used to evaluate the available data. RESULTS Forty-seven patients (30 females, 17 males) with a mean age of 16 years (SD, 1.37) and a mean follow-up of 16.6 years (SD, 3.57) were included in this study. Overall, 13 patients (28%) failed meniscal repair and required repeat surgery at the time of final follow-up. Of the 13 failures, 9 underwent a subsequent meniscectomy; 2, meniscectomy and revision ACL reconstruction; 1, meniscal repair and revision ACL reconstruction; and 1, meniscal repair and subsequent meniscectomy. Mean International Knee Documentation Committee scores improved from 47.9 preoperatively to 87.7 postoperatively ( P < .01), and the mean score at long-term follow-up (87.7) did not significantly differ from that at the midterm follow-up (88.5) at a mean 7.4 years ( P = .97). Mean Tegner Activity Scale scores improved from 1.9 preoperatively to 6.3 postoperatively ( P < .01) and decreased from 8.3 at preinjury to 6.3 at final long-term follow-up ( P < .01). CONCLUSION In conclusion, the long-term overall clinical success rate (failure-free survival) was 72% for repair of pediatric and adolescent meniscal tears in the setting of concomitant ACL reconstruction. Patients reported excellent knee subjective outcome scores that remained favorable when compared with midterm follow-up.
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Affiliation(s)
- Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vishal S Desai
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas I Kennedy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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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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DeFroda SF, Bokshan SL, Boulos A, Owens BD. Variability of online available physical therapy protocols from academic orthopedic surgery programs for arthroscopic meniscus repair. PHYSICIAN SPORTSMED 2018; 46:355-360. [PMID: 29571265 DOI: 10.1080/00913847.2018.1457933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the variability of arthroscopic meniscus repair rehabilitation protocols. METHODS Arthroscopic meniscus repair rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME) accredited orthopedic surgery programs available online were included for review. Data collection was performed to evaluate recommended weight bearing status and immobilization as well as the presence or absence of recommended therapies, goals for progression of range of motion, functional milestones, and activity initiation time points within each protocol. RESULTS Out of 162 institutions available for review, 24 (14.8%) institutions made their protocol available on their website, with 28 total protocols available. Initially following repair, 14 (50%) of the protocols allow for weight bearing as tolerated (WBAT). Of the 14 protocols, which do not allow immediate weightbearing, average time to WBAT was 4.7 ± 1.8 weeks. On average, immobilization was recommended for 6.5 ± 2.1 weeks (range 4-12 weeks). A large majority of protocols gave recommendations for flexion to 90 degrees (24 protocols, range 1-8 weeks), as well as full range of motion (22 protocols, range 6-16 weeks). Active range of motion was recommended to begin at 0-6 weeks (average 3.8 ± 1.9 weeks). Lastly, only 14 protocols (50%) gave an actual return to sport, with an average return recommended at 21.9 ± 3.4 weeks (range 12-24). CONCLUSION A minority of ACGME-accredited orthopedic surgery programs make their meniscus repair rehabilitation protocols available online. Furthermore, protocols were found to be highly variable. This discrepancy may lead to confusion among therapists and patients.
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Affiliation(s)
- Steven F DeFroda
- a Department of Orthopaedic Surgery , Brown University, Warren Alpert School of Medicine , Providence , RI , USA
| | - Steven L Bokshan
- a Department of Orthopaedic Surgery , Brown University, Warren Alpert School of Medicine , Providence , RI , USA
| | - Alex Boulos
- a Department of Orthopaedic Surgery , Brown University, Warren Alpert School of Medicine , Providence , RI , USA
| | - Brett D Owens
- a Department of Orthopaedic Surgery , Brown University, Warren Alpert School of Medicine , Providence , RI , USA
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10
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Spang Iii RC, Nasr MC, Mohamadi A, DeAngelis JP, Nazarian A, Ramappa AJ. Rehabilitation following meniscal repair: a systematic review. BMJ Open Sport Exerc Med 2018; 4:e000212. [PMID: 29682310 PMCID: PMC5905745 DOI: 10.1136/bmjsem-2016-000212] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 02/01/2023] Open
Abstract
Objective To review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery. Methods and data sources Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies. Results Seventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair. Conclusions There is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.
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Affiliation(s)
- Robert C Spang Iii
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael C Nasr
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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11
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Eberbach H, Zwingmann J, Hohloch L, Bode G, Maier D, Niemeyer P, Südkamp NP, Feucht MJ. Sport-specific outcomes after isolated meniscal repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:762-771. [PMID: 28243702 DOI: 10.1007/s00167-017-4463-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this systematic review was to assess sport-specific outcomes after repair of isolated meniscal tears. METHODS A systematic electronic search of the MEDLINE and Cochrane database was performed in May 2016 to identify studies that reported sport-specific outcomes after isolated meniscal repair. Included studies were abstracted regarding study characteristics, patient demographics, surgical technique, rehabilitation, and outcome measures. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS). RESULTS Twenty-eight studies with a total of 664 patients met the inclusion criteria. The methodological quality of the included studies was moderate, with a mean CMS of 69.7 ± 8.3. The mean patient age was 26 ± 7.2 years and 71% of patients were male. Mean preoperative Tegner score improved from 3.5 ± 0.3 to 6.2 ± 0.8 postoperatively. Comparing preinjury and postoperative Tegner scores, comparable values were observed (6.3 ± 1.1 and 5.7 ± 0.8, respectively). Return to sports on the preinjury level was achieved in 89%. Mixed-level populations returned to their preinjury activity level in 90% and professional athletes in 86%. Mean delay of return to sports varied between 4.3 and 6.5 months, with comparable results between professional and mixed-level athletes. The pooled failure rate was 21%. The failure rate was lower in professional athletes compared to mixed-level athletes (9% vs. 22%). CONCLUSION This systematic review suggests that isolated repair of meniscal tears results in good to excellent sport-specific outcomes and a high return to sports rate in both recreational and professional athletes. The failure rate is comparable to systematic reviews not focusing on sportive patients. LEVEL OF EVIDENCE Level IV systematic review of Level I to Level IV studies.
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Affiliation(s)
- Helge Eberbach
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Jörn Zwingmann
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Lisa Hohloch
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Gerrit Bode
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Dirk Maier
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Philipp Niemeyer
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany.,OCM-Clinic, Steinerstr. 6, 81369, Munich, Germany
| | - Norbert P Südkamp
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Matthias J Feucht
- Department of Orthopaedic and Trauma Surgery, Freiburg University Hospital, Hugstetter Str. 55, 79106, Freiburg, Germany
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Abstract
Native joint preservation has gained importance in recent years. This is mostly to find solutions for limitations of arthroplasty. In the knee joint, the menisci perform critical functions, adding stability during range of motion and efficiently transferring load across the tibiofemoral articulation while protecting the cartilage. The menisci are the most common injury seen by orthopedicians, especially in the younger active patients. Advances in technology and our knowledge on functioning of the knee joint have made meniscus repair an important mode of treatment. This review summarizes the various techniques of meniscus tear repair and also describes biological enhancements of healing.
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Affiliation(s)
- Shantanu Sudhakar Patil
- Department of Translational Medicine and Research, SRM Medical College and Hospitals, SRM University, Chennai, Tamil Nadu, India
| | - Anshu Shekhar
- The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
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O'Donnell K, Freedman KB, Tjoumakaris FP. Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review. Am J Sports Med 2017; 45:1687-1697. [PMID: 28256906 DOI: 10.1177/0363546516667578] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current postoperative rehabilitation protocols after isolated meniscal repair vary widely. No consensus exists with regard to the optimal amount of weightbearing, range of motion, or speed at which the patient progresses through the rehabilitation phases. Confounding factors including concomitant ligamentous or cartilaginous injuries have made studying isolated meniscal tears problematic. PURPOSE To systematically review and evaluate the influence of range of motion and weightbearing status during the postoperative rehabilitation period after isolated meniscal repair on clinical efficacy and outcome scores. STUDY DESIGN Systematic review. METHODS A search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials was conducted. The selection criteria for inclusion were English-language in vivo clinical studies reporting on isolated meniscal repairs utilizing an arthroscopically assisted technique that outlined the postoperative rehabilitation protocol and included at least a 2-year follow-up. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, tear type, repair technique, postoperative protocol details, clinical failures, and outcome scores were extracted from the eligible studies. Rehabilitation protocols were divided into "accelerated," "motion restricted," "weight restricted," and "dual restricted" according to the limitations placed on the treatment groups. RESULTS Fifteen studies, containing 17 different treatment groups, met the inclusion criteria. The 2 accelerated groups, 2 motion-restricted groups, 4 weight-restricted groups, and 9 dual-restricted groups showed similar efficacy in terms of clinical success and postoperative outcome scores. Early range of motion and weightbearing status showed no influence over clinical outcomes. Of the 17 groups, 13 reported a greater than 70% clinical success rate with significant variation in the tear type, fixation technique, and postoperative restrictions. CONCLUSION Early range of motion and immediate postoperative weightbearing appear to have no detrimental effect on the chances for clinical success after isolated meniscal repair. Significant variation exists between postoperative protocols, with no current consensus on the ideal parameters for weightbearing and range of motion. Studies reporting outcomes regarding isolated meniscal repair are limited. Future research should include determining the ideal combination of weightbearing and range of motion for specific tear types.
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Affiliation(s)
- Kevin O'Donnell
- Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Fotios P Tjoumakaris
- Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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15
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All-inside meniscal repair surgery: factors affecting the outcome. J Orthop Traumatol 2015; 16:245-9. [PMID: 25701256 PMCID: PMC4559536 DOI: 10.1007/s10195-015-0342-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/06/2015] [Indexed: 11/19/2022] Open
Abstract
Background Meniscal injury is currently a well-recognized source of knee dysfunction. While it would be ideal to repair all meniscus tears, the failure rate is significantly high, although it may be reduced by careful selection of the patients. Our objective was to assess the outcome of meniscal repair surgery and the role of simultaneous reconstruction of the anterior cruciate ligament (ACL). Materials and methods Retrospectively, all consecutive patients between January 2008 and 2011 who underwent meniscal repair were included. Patients were identified using the hospital database with diagnosis and procedure codes. Patient notes were reviewed, including details of the type of tear, chronicity, location, and surgery. We used symptomatic resolution as the outcome measure. Results 136 Meniscal repairs were performed in 122 patients with a mean age of 26.8 years. Mean follow-up duration was 9 months. 63 % of the patients underwent medial and 37 % underwent lateral meniscal repair, with failure rates of 19 % for medial and 12 % for lateral menisci. Ligament injuries were found in 61 % of the patients (n = 83). Failure of meniscal repair occurred in 14.5 % (n = 12) of the patients who had early ACL reconstruction and in 27 % (n = 22) of the patients who had delayed ACL reconstruction (p = 0.0006). The failure rate was found to be 13 % in patients who were younger than 25 years (61 %) and 15 % in patients who were older than 25 years (39 %). Conclusion The success rate of meniscal repair was found to be significantly better when ACL reconstruction was performed simultaneously with meniscal repair. Level of evidence Level IV.
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16
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Karuppiah SV, Majeed H, Sigamoney K, Geutjens G. Failure of meniscal repair association with late anterior cruciate ligament reconstruction. J Orthop 2015; 13:106-9. [PMID: 27053832 DOI: 10.1016/j.jor.2015.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Meniscus injury is associated with ACL (anterior cruciate ligament) injury. It would be ideal to repair all meniscus tears but failure rate is high. AIM Our objective was to assess the success of meniscus repair. METHOD All consecutive patients between Jan 2009 to Dec 2013 were retrospectively analysed. RESULTS 85 meniscus repairs were performed: 64 patients presented after 3 months (Group 1) and 21 patients had meniscus repair within 2 weeks. The failure rate group 1 was 23%-4.8% group 2 at a mean follow up of 11 months. CONCLUSION Early meniscal repair had a higher success rate. Level III evidence.
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Affiliation(s)
| | - Haroon Majeed
- Dept. of Trauma & Orthopaedic Surgery, Royal Derby Hospital NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
| | - Kohilavani Sigamoney
- Dept. of Trauma & Orthopaedic Surgery, Royal Derby Hospital NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
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17
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Walter RP, Dhadwal AS, Schranz P, Mandalia V. The outcome of all-inside meniscal repair with relation to previous anterior cruciate ligament reconstruction. Knee 2014; 21:1156-9. [PMID: 25257778 DOI: 10.1016/j.knee.2014.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/31/2014] [Accepted: 08/15/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopically assisted all-inside meniscal repair has become a popular treatment for meniscal tears. Previous studies have suggested a beneficial effect of concomitant anterior cruciate ligament reconstruction on meniscal repair outcomes. The effect of prior cruciate ligament reconstruction (predating the meniscal injury) on meniscal repair success is unreported. The aim of this study was to assess the success of meniscal repair in our practice. Further aims were to analyze the effect of concomitant- and past-anterior cruciate ligament reconstruction on meniscal repair outcomes. METHODS Retrospective review of all patients undergoing arthroscopic meniscal repair during a 53 month period was performed. Mean followup was 13.5 months (mean 6-50). The primary outcome measure was meniscal reoperation. RESULTS Sixteen of 104 patients required reoperation, giving an overall meniscal repair success rate of 85%. Patients undergoing concomitant anterior cruciate ligament reconstruction enjoyed significantly improved outcomes (91%, p=0.049), while those with a past history of anterior cruciate ligament reconstruction had significantly worse meniscal repair success rates (63%, p=0.016). CONCLUSIONS Arthroscopic meniscal repair in a selected patient group offers good success rates, especially when performed with concomitant anterior cruciate ligament reconstruction. We have identified a subgroup of patients, those with a past history of anterior cruciate ligament reconstruction predating the meniscal injury, who appear to have relatively poor outcomes from meniscal repair. Potential reasons for this finding are discussed. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- R P Walter
- The Department of Trauma and Orthopaedics, Royal Devon and Exeter Hospital, Barrack Road, EX2 5DW, United Kingdom.
| | - A S Dhadwal
- The Department of Trauma and Orthopaedics, Royal Devon and Exeter Hospital, Barrack Road, EX2 5DW, United Kingdom
| | - P Schranz
- The Department of Trauma and Orthopaedics, Royal Devon and Exeter Hospital, Barrack Road, EX2 5DW, United Kingdom
| | - V Mandalia
- The Department of Trauma and Orthopaedics, Royal Devon and Exeter Hospital, Barrack Road, EX2 5DW, United Kingdom
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Espejo-Reina A, Serrano-Fernández JM, Martín-Castilla B, Estades-Rubio FJ, Briggs KK, Espejo-Baena A. Outcomes after repair of chronic bucket-handle tears of medial meniscus. Arthroscopy 2014; 30:492-6. [PMID: 24680309 DOI: 10.1016/j.arthro.2013.12.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 12/19/2013] [Accepted: 12/30/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the outcomes after repair of chronic bucket-handle medial meniscal tears by use of magnetic resonance imaging, clinical examination, and patient-reported outcomes. METHODS A retrospective review of patients with chronic bucket-handle medial meniscal tears that had been repaired with meniscal sutures was undertaken. The following criteria for inclusion were adopted: minimum tear length of 2 cm and chronic medial meniscal tear identified at the time of arthroscopy. The tears were susceptible to dislocation with probing. Data collected included demographic, clinical, radiologic, and surgical data. Postoperative healing was assessed with the clinical criteria of Barrett et al. The International Knee Documentation Committee rating, Lysholm score, and Tegner activity level were determined, and postoperative magnetic resonance imaging was used to evaluate healing in accordance with the criteria of Henning et al. RESULTS Twenty-four patients fulfilled the inclusion criteria. The mean time from injury to surgery was 10 months (range, 2 to 60 months). Sixteen patients underwent anterior cruciate ligament reconstruction, 1 patient underwent posterior cruciate ligament reconstruction, and 6 patients underwent meniscus repair only. A median of 5 sutures (range, 3 to 6 sutures) were used for repair. Four cases (all of which had undergone meniscus repair only) required revision. Complete healing was achieved in 83% of cases according to the criteria of Barrett et al. The mean follow-up time was 48 months (range, 24 to 112 months). An International Knee Documentation Committee rating of A or B was achieved in the 20 patients who did not require revision. The median Lysholm score was 95 (range, 92 to 100). The median Tegner activity level before injury was 7, and it remained unchanged after surgery in all cases. CONCLUSIONS This study showed that repair of chronic bucket-handle meniscal tears can lead to good clinical outcomes and a relatively low (17%) failure rate. In addition, repairs of isolated meniscal tears had a significantly higher risk of failure than repairs performed in conjunction with anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
| | | | - Belén Martín-Castilla
- Hospital Universitario Virgen de la Victoria, Málaga, Spain; Hospital Parque San Antonio, Málaga, Spain
| | | | - Karen K Briggs
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Alejandro Espejo-Baena
- Hospital Universitario Virgen de la Victoria, Málaga, Spain; Hospital Parque San Antonio, Málaga, Spain
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Bouyarmane H, Beaufils P, Pujol N, Bellemans J, Roberts S, Spalding T, Zaffagnini S, Marcacci M, Verdonk P, Womack M, Verdonk R. Polyurethane scaffold in lateral meniscus segmental defects: clinical outcomes at 24 months follow-up. Orthop Traumatol Surg Res 2014; 100:153-7. [PMID: 24332925 DOI: 10.1016/j.otsr.2013.10.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Segmental tissue loss in the lateral meniscus is associated with pain and increased risk of osteoarthritis even when indications have been carefully considered. HYPOTHESIS Repairing the defect using a novel biodegradable scaffold will reduce pain and restore the knee function. METHODS In this prospective multicenter study, a total of 54 patients (37 males/17 females; mean age: 28 years [16-50]) were enrolled. All patients presented with postmeniscectomy syndrome and segmental lateral meniscus loss, and were treated with a polyurethane biodegradable scaffold (Actifit(®), Orteq) implanted arthroscopically. Clinical outcomes were assessed at 6, 12 and 24 months using Visual Analogue Scale (VAS), International Knee Documentation Committee Score (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS VAS decreased from 5.5 at baseline to 3.6 at 6 months, 3.4 at 12 months and 2.9 at 24 months. IKDC improved from 47.0 at baseline to 60.2, 67.0 and 67.0 at 6, 12 and 24 months. All KOOS subscores improved between baseline and 24 months. DISCUSSION Clinical results of this study demonstrate clinically and statistically significant improvements of pain and function scores (VAS, IKDC, and all KOOS subscales except sport), at the 6 months follow-up and on all clinical outcomes at the 2-year follow-up. The Actifit(®) scaffold is safe and effective in treating lateral meniscus defects. LEVEL OF EVIDENCE IV continuous prospective multicenter study.
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Affiliation(s)
- H Bouyarmane
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Université Versailles-Saint Quentin, rue de Versailles, 78150 Le Chesnay, France; Orthopaedic Surgery Center, 71, boulevard d'Anfa, Casablanca 20060, Morocco
| | - P Beaufils
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Université Versailles-Saint Quentin, rue de Versailles, 78150 Le Chesnay, France.
| | - N Pujol
- Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Université Versailles-Saint Quentin, rue de Versailles, 78150 Le Chesnay, France
| | - J Bellemans
- Catholic University Hospitals, Langdorp, Belgium
| | - S Roberts
- Orthopaedic Hospital, Oswestry, United Kingdom
| | - T Spalding
- University Hospitals, Coventry, United Kingdom
| | | | - M Marcacci
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P Verdonk
- Antwerpen Orthopaedic center, Antwerp, Belgium
| | - M Womack
- Orteq Sports Medicine, London, United Kingdom
| | - R Verdonk
- Ghent University Hospital, Ghent, Belgium
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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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Knights CB, Gentry C, Bevan S. Partial medial meniscectomy produces osteoarthritis pain-related behaviour in female C57BL/6 mice. Pain 2012; 153:281-292. [DOI: 10.1016/j.pain.2011.09.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 09/08/2011] [Accepted: 09/09/2011] [Indexed: 11/24/2022]
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