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Gabr A, Williams S, Dodd S, Barton-Hanson N. Outcome of meniscal repairs in paediatric population: A tertiary centre experience. World J Orthop 2024; 15:547-553. [DOI: 10.5312/wjo.v15.i6.547] [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: 12/31/2023] [Revised: 04/05/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis. However, there is limited data in the literature on meniscal repair outcomes in skeletally immature patients.
AIM To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and adolescents.
METHODS We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January 2018. All patients were under the age of 18 at the time of surgery. Procedures were all performed by a single surgeon. Information was gathered from our hospital Electronic Patient Records system. The primary outcome measure was re-operation rate (need for further surgery on the same meniscus). Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee (IKDC), Tegner and Lysholm scores.
RESULTS We identified 59 patients who underwent 66 All-inside meniscal repairs (32 medial meniscus and 34 Lateral meniscus). Meniscal repairs were performed utilizing FasT-Fix (Smith and Nephew) implants. There were 37 males and 22 females with an average age of 14 years (range 6-16). The average follow-up time was 53 months (range 26-140). Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal repair. There were no intra-operative complications. The re-operation rate for meniscal repairs was 16.6% (11 cases) with 2 patients requiring further meniscal repairs and 9 patients underwent partial meniscectomies. The mean postoperative IKDC score was 88 (44-100), Tegner score was 7(2-10) and Lysholm score was 94 (57-100).
CONCLUSION Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.
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Affiliation(s)
- Ayman Gabr
- Department of Trauma & Orthopaedics, West Suffolk Hospital, Suffolk IP33 2QZ, United Kingdom
| | - Samson Williams
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital, Liverpool L14 5AB, United Kingdom
| | - Sophie Dodd
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital, Liverpool L14 5AB, United Kingdom
| | - Nick Barton-Hanson
- Department of Trauma and Orthopaedics, Alder Hey Children's Hospital, Liverpool L14 5AB, United Kingdom
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Brachial Plexus Birth Injury: Trends in Early Surgical Intervention over the Last Three Decades. Plast Reconstr Surg Glob Open 2022; 10:e4346. [PMID: 35620493 DOI: 10.1097/gox.0000000000004346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Early surgical management of brachial plexus birth injury has advanced owing to targeted surgical techniques and increases in specialty-centers and multi-institutional collaboration. This study seeks to determine trends in the early surgical management of BPBI over the last 30 years. Methods A systematic review was performed through MEDLINE (PubMed) identifying studies limited to the early surgical management of BPBI from 1990 to current. Patients treated after 1 year of age (ie, tendon transfers and secondary reconstructive efforts) were excluded. Diagnostic tests, age of intervention, surgical treatment modalities, and outcome scoring systems were extrapolated and compared so as to determine trends in management over time. Results Seventeen studies met criteria, summating a total of 883 patients. The most commonly reported physical examination classifications were the Mallet and AMS scoring systems. Most patients underwent neuroma excision and sural nerve autografting (n = 618, 70%) when compared with primary nerve transfers (148, 16.8%), primary nerve transfer with autografting combinations (59, 6.7%), or neurolysis alone (58, 6.6%). There was no significant change in the proportion of patients treated with sural nerve grafting, combination graft and transfer procedures, or isolated neurolysis over time. However, there has been a significant increase in the proportion of patients treated with primary nerve transfer procedures (τ b = 0.668, P < 0.01) over time. Conclusion Although neuroma excision and sural nerve autografting has been the historic gold-standard treatment for brachial plexus birth injury, peripheral nerve transfers have become increasingly utilized for surgical management.
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Leafblad ND, Keyt LK, Cook CS, Smith PA, Stuart MJ, Krych AJ. Good Surgical Outcomes After Concomitant Repair of Double Radial Tears of the Lateral Meniscus and Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2021; 3:e989-e996. [PMID: 34430877 PMCID: PMC8365194 DOI: 10.1016/j.asmr.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe double radial tears of the lateral meniscus (LM), report early clinical treatment outcomes, and determine reoperation and failure rates. Methods Twenty-one (N = 21) consecutive cases of arthroscopic-treated lateral meniscus double radial tears treated between 2012 and 2018 were reviewed, including 15 males (71.4%) and 6 females (28.6%). Meniscus repairs were all performed at the time of anterior cruciate ligament (ACL) reconstruction. Patients with associated fractures or prior surgeries were excluded. Concomitant injuries were reported, as were preinjury and postoperative Tegner scores, preoperative and postoperative visual analogue pain scale (VAS) scores, and postoperative International Knee Documentation Committee (IKDC) subjective scores. Reoperation and failure rates were documented. Results Twenty-one (N = 21) tears were located in the posterior horn of the meniscus near the root attachment; 15 (71.4%) underwent all-inside repair, 4 (19.0%) underwent transtibial pull-through repair, 1 (4.8%) was partially debrided, and 1 (4.8%) was left untreated. Twenty-one tears (N = 21) were in the body of the meniscus; 7 (33.3%) were repaired, 7 (33.3%) were partially debrided, and 7 (33.3%) were left untreated. Thirteen patients (62%) had associated medial collateral ligament (MCL) injuries. Mean follow-up was 2.6 years. VAS at rest and with activity improved by 2.1 points (P < .001) and 3.1 points (P = .017) after surgery. The mean postoperative Tegner activity score was 6.4, and the mean IKDC score was 83.2 at final follow-up. Reoperation was required in 5 patients (23.8%), and the surgical treatment failed in 1 patient (4.7%). Conclusions Double radial tears of the LM are uncommon injuries that occur in the setting of ACL tears, usually combined with MCL injury. The variety of surgical treatment techniques have a low failure rate at short-term follow-up. Patients tend to have good clinical outcomes with improvement in pain and overall function after surgically treating these injuries with simultaneous ACL reconstruction. Level of Evidence Level IV, therapeutic study, case series
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Affiliation(s)
- Nels D Leafblad
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lucas K Keyt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Corey S Cook
- Columbia Orthopaedic Group, Columbia, Missouri, U.S.A
| | | | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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4
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A new scoring system for prediction of meniscal repair in traumatic meniscal tears has its limitations. Knee Surg Sports Traumatol Arthrosc 2020; 28:3597-3598. [PMID: 31858170 DOI: 10.1007/s00167-019-05825-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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5
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Korpershoek JV, de Windt TS, Vonk LA, Krych AJ, Saris DBF. Does Anterior Cruciate Ligament Reconstruction Protect the Meniscus and Its Repair? A Systematic Review. Orthop J Sports Med 2020; 8:2325967120933895. [PMID: 32782901 PMCID: PMC7388123 DOI: 10.1177/2325967120933895] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) tear and meniscal injury often co-occur. The protective effect of early ACL reconstruction (ACLR) on meniscal injury and its repair is not clear. Critical literature review can support or change clinical strategies and identify gaps in the available evidence. Purpose: To assess the protective effect of ACLR on the meniscus and provide clinical guidelines for managing ACL tears and subsequent meniscal injury. We aimed to answer the following questions: (1) Does ACLR protect the meniscus from subsequent injury? (2) Does early ACLR reduce secondary meniscal injury compared with delayed ACLR? (3) Does ACLR protect the repaired meniscus? Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed through use of MEDLINE and Embase electronic databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included ACL, reconstruction, and meniscus. Studies describing primary ACLR and nonoperative treatment in adult patients were included, as well as studies indicating timing of ACLR. The included articles were assessed individually for risk of bias through use of the modified Cochrane Risk of Bias and MINORS (Methodological Index for Nonrandomized Studies) tools. Results: One level 2 randomized controlled trial and several level 3 and 4 studies indicated a protective effect of ACLR on meniscal injury compared with nonoperative treatment. There was weak (level 3) evidence of the protective effect of early ACLR on the meniscus. Meniscal repair failure was less frequent in patients with ACL reconstruction than in patients with ACL deficiency (level 4). Conclusion: The evidence collected in this review suggests a protective effect of ACLR for subsequent meniscal injury (level 2 evidence). ACLR should be performed within 3 months of injury (level 3 evidence). Meniscal injury requiring surgical repair in the ACL-deficient knee should be treated with repair accompanied by ACLR (level 3 evidence). The paucity of level 2 studies prevents the formation of guidelines based on level 1 evidence. There is a strong clinical need for randomized or prospective trials to provide guidelines on timing of ACLR and meniscal repair.
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Affiliation(s)
| | | | - Lucienne A Vonk
- University Medical Center Utrecht, Utrecht, the Netherlands.,CO.DON AG, Teltow, Germany
| | | | - Daniel B F Saris
- University Medical Center Utrecht, Utrecht, the Netherlands.,Mayo Clinic, Rochester, Minnesota, USA
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6
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Jackson T, Fabricant PD, Beck N, Storey E, Patel NM, Ganley TJ. Epidemiology, Injury Patterns, and Treatment of Meniscal Tears in Pediatric Patients: A 16-Year Experience of a Single Center. Orthop J Sports Med 2019; 7:2325967119890325. [PMID: 31903403 PMCID: PMC6927199 DOI: 10.1177/2325967119890325] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Meniscal injuries in children continue to increase, which may be attributable to increasing levels of athletic participation and may be associated with additional injuries or need for additional surgeries. Purpose: To better understand the patterns of pediatric meniscal injuries by analyzing tear location, morphologic features, and associated injury patterns over a 16-year period. Study Design: Case series; Level of evidence, 4. Methods: Pediatric patients were identified and were included in the study if age at the time of initial surgery for meniscal tear was between 5 and 14 years for female patients and 5 and 16 years for male patients. Patients were observed until age 18, and any subsequent surgeries were noted. Demographic factors, tear type and location, associated injuries, and treatment type were analyzed. Results: Mean patient age at surgery was 13.3 years, and 37% of patients were female. A total of 1040 arthroscopic meniscal surgeries in 880 pediatric patients were evaluated. There were 160 reoperations in 138 patients, representing a reoperation rate of 15%. These included 98 reoperations on the ipsilateral knee in 88 patients and 62 operations for injuries to the contralateral knee in 50 patients; 53% of surgeries were meniscal repair, as opposed to partial meniscectomy, and the most common technique was an all-inside repair (91%). Significant differences were identified between male and female patients. Male patients were more likely to have lateral meniscus (74% vs 65%), posterior horn (71% vs 60%), peripheral (45% vs 30%), and vertical tears (31% vs 21%); concomitant ACL injury (50% vs 40%); and an associated osteochondritis dissecans lesion (7% vs 4%). Female patients were more likely to have medial meniscus (24% vs 17%), anterior horn (25% vs 15%), and degenerative tears (34% vs 26%); discoid meniscus (33% vs 24%); and isolated meniscal tears (47% vs 33%). Conclusion: This evaluation of a large series of patients has helped characterize injury patterns associated with pediatric meniscal surgeries. Most meniscal tears were repaired (53%) and were associated with additional injuries (62%), especially anterior cruciate ligament injuries (48%). More than 25% of patients had a discoid meniscus. Injury patterns differed significantly between male and female patients.
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Affiliation(s)
- Taylor Jackson
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter D Fabricant
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicholas Beck
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eileen Storey
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neeraj M Patel
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Yeo DYT, Suhaimi F, Parker DA. Factors Predicting Failure Rates and Patient-Reported Outcome Measures After Arthroscopic Meniscal Repair. Arthroscopy 2019; 35:3146-3164.e2. [PMID: 31699269 DOI: 10.1016/j.arthro.2019.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify factors that affect patient-reported outcome measures (PROMs) and failure rates after arthroscopic meniscal repair. METHODS Embase, Embase Classic, and MEDLINE were searched on August 7, 2015, December 23, 2016, and March 11, 2018, for factors associated with PROMs and failure rates after arthroscopic meniscal repair. We excluded studies that (1) were non-English language, (2) did not use human patients, (3) were nonclinical, (4) did not analyze for factors that predicted PROMs or failure rates, and (5) were below Level IV evidence. Studies were graded into higher and lower quality using the Downs and Black scale. RESULTS A total of 34 articles met our criteria, and 32 were graded. We identified 16 articles as higher quality. Among higher-quality studies, factors that significantly predicted reduced failure rates were concurrent anterior cruciate ligament reconstruction (ACLR) (n = 6) and reduced tear complexity (n = 4). Factors that did not significantly impact failure rates were side of repair (n = 8), sex (n = 7), time from injury to surgery (n = 7), age (n = 7), rim width (n = 6), and tear length (n = 5). Factors predicting better PROMs were time from injury to surgery of less than 3 months (n = 1), Outerbridge scores below grade 3 or 4 (n = 2), and reduced varus alignment (n = 2). Factors that did not significantly impact PROMs were equipment used (n = 3) and concurrent ACLR (n = 1). CONCLUSIONS Factors affecting failure rates and PROMs after arthroscopic meniscal repair were identified. However, more and higher-quality studies supported concurrent ACLR and less complex tears as predictors of lower failure rates. PROMs were negatively affected by a longer time from injury to surgery, higher Outerbridge scores, and greater varus alignment before surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
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Affiliation(s)
- Daniel Y T Yeo
- Sydney Orthopaedic Research Institute, Chatswood, Australia.
| | - Fairuz Suhaimi
- Department of Orthopaedics, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi Mara, Shah Alam, Malaysia
| | - David A Parker
- Sydney Orthopaedic Research Institute, Chatswood, Australia
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8
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Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:3441-3452. [PMID: 30719542 DOI: 10.1007/s00167-019-05389-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this review was to compare the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with either meniscal repair or meniscectomy for concomitant meniscal injury. The primary hypothesis was that short-term clinical outcomes (≤ 2-year follow-up) for ACLR concomitant with either meniscal repair or resection would be similar. The secondary hypothesis was that ACLR with meniscal repair would result in better longer term outcomes compared with meniscal resection. METHODS The authors searched two online databases (EMBASE and MEDLINE) from inception until March 2018 for the literature on ACLR and concurrent meniscal surgery. Two reviewers systematically screened studies in duplicate, independently, and based on a priori criteria. Quality assessment was also performed in duplicate. The Knee injury and Osteoarthritis Outcome Score (KOOS) sub-scale scores at 2 years post-operatively were combined in a meta-analysis of proportions using a random-effects model. RESULTS Of 2566 initial studies, 25 studies satisfied full-text inclusion criteria. Mean follow-up was 2.09 years, with a total sample of 37,087 subjects including controls. The meta-analysis demonstrated equivocal results at 2 years, except for KOOS symptom scores which favoured meniscal resection over repair. Mean KT-1000 side-to-side difference (SSD) scores were 1.51 ± 0.60 mm for meniscal repair, 1.96 ± 0.36 mm for meniscal resection, and 1.58 ± 0.20 for control patients (isolated ACLR). Medial meniscal repair showed decreased anterior knee joint laxity compared to medial meniscal resection (P < 0.001). Patients with meniscal repair had higher rates of re-operation (13.3% vs 0.8% for meniscal resection, P < 0.001). CONCLUSION Patients with ACLR combined with meniscal resection demonstrate better symptoms at 2-year follow-up compared to patients with ACLR combined with meniscal repair. ACLR combined with meniscal repair results in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term, but also higher re-operation rates. LEVEL OF EVIDENCE III.
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9
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Moses MJ, Wang DE, Weinberg M, Strauss EJ. Clinical outcomes following surgically repaired bucket-handle meniscus tears. PHYSICIAN SPORTSMED 2017; 45:329-336. [PMID: 28506133 DOI: 10.1080/00913847.2017.1331688] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Meniscus tears are one of the most common knee injuries. Our goal is to investigate the failure rate for surgically repaired bucket-handle meniscus tears and compare clinical outcomes of repairs that failed versus those that did not, at a minimum 2-year follow-up interval. METHODS 51 patients were identified in this retrospective cohort study who experienced bucket-handle meniscus tears that were isolated or with concomitant ACL injury. Inclusion criteria included age range from 13-55 years, confirmed bucket-handle meniscus tear by MRI and intraoperatively, and at least two-years of post-operative follow-up following index repair. Demographic data and outcome surveys were collected at a minimum of two-years follow-up after repair. RESULTS Of the 51 patients that had a bucket-handle meniscal repair, 12 (23.5%) were defined as failures (return of symptoms alongside re-tear in the same zone of the repaired meniscus within two years of surgery). No demographic variables (age, sex, and BMI smoking status, location of tear, or concomitant ACL tear) significantly correlated with failure. The mean of the Sports and Recreation KOOS was significantly lower between the non-failure (87 ± 14.4) and failure (70 ± 17.2) cohorts (p = 0.0072). The Quality of Life subscale was significantly lower between the non-failure (76 ± 15.8) and failure (57 ± 18.2) groups (p = 0.0058). There was a significant difference in the post-operative Lysholm scores (p = 0.0039) with a mean of 90 ± 9.1 for the entire cohort and means of 92 ± 8.4 and 83 ± 8.6, for non-failure and failure groups, respectively. CONCLUSIONS We found a higher failure rate (23.5%) for bucket-handle meniscus repairs at two-year follow up than has been cited in the literature, which is typically less than 20%, with significantly lower KOOS Quality of Life and Sports and Recreation subscales and Lysholm scores for the failure cohort. This is the first study to report these outcome scores solely for bucket-handle meniscus repairs, shedding light on the post-operative quality of life of patients with repair success or failure.
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Affiliation(s)
- Michael J Moses
- a Department of Orthopaedic Surgery, Division of Sports Medicine , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
| | - David E Wang
- a Department of Orthopaedic Surgery, Division of Sports Medicine , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
| | - Maxwell Weinberg
- a Department of Orthopaedic Surgery, Division of Sports Medicine , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
| | - Eric J Strauss
- a Department of Orthopaedic Surgery, Division of Sports Medicine , New York University Langone Medical Center, Hospital for Joint Diseases , New York , NY , USA
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10
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Vertullo CJ, Wijenayake L, Grayson JE. A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees. Arthrosc Tech 2016; 5:e297-302. [PMID: 27354950 PMCID: PMC4912608 DOI: 10.1016/j.eats.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/04/2016] [Indexed: 02/03/2023] Open
Abstract
It is customary to perform medial meniscus repair before anterior cruciate ligament (ACL) graft placement when undertaken as a combined procedure. However, in chronic ACL-deficient knees, intraoperative anterior tibiofemoral translation can cause the medial meniscus repair to be more technically challenging. Intraoperative anterior tibiofemoral translation can both reduce the visualization of the medial meniscus and make its reduction unstable. An operative sequence alteration of ACL graft placement and tensioning before medial meniscal repair improves medial meniscus visualization in chronically ACL-deficient knees by using the ACL graft's ability to prevent anterior tibiofemoral translation. The technique sequence is as follows: (a) the medial meniscus is reduced, (b) ACL reconstruction is undertaken using a hamstring graft without final tibia fixation,
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Affiliation(s)
- Christopher J. Vertullo
- Knee Research Australia, Gold Coast, Australia,Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Australia,Address correspondence to Christopher J. Vertullo, M.B.B.S., F.R.A.C.S., F.A.OrthoA., Orthopaedic Surgery Sports Medicine Center, 8-10 Carrara Street, Benowa, Gold Coast, Queensland 4217, Australia.Orthopaedic Surgery Sports Medicine Center8-10 Carrara StreetBenowaGold CoastQueensland 4217Australia
| | | | - Jane E. Grayson
- Department of Kinesiology and Health Science, Stephen F. Austin State University, Nacogdoches, Texas, U.S.A
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11
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Rue JP, Pickett A. Meniscal repair and transplantation in the military active-duty population. Clin Sports Med 2014; 33:641-53. [PMID: 25280614 DOI: 10.1016/j.csm.2014.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- John-Paul Rue
- Uniformed Services University of the Health Services, Bethesda, MD, USA; Department of Orthopaedics and Sports Medicine, Naval Health Clinic Annapolis, US Naval Academy, 250 Wood Road, Annapolis, MD 21402-5050, USA.
| | - Adam Pickett
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA
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12
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Westermann RW, Wright RW, Huston LJ, Wolf BR, Wolf BR. Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 2014; 42:2184-92. [PMID: 25023440 PMCID: PMC4451057 DOI: 10.1177/0363546514536022] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal repair is commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. No large-scale, prospective multicenter studies have evaluated the long-term success and patient-oriented outcomes after combined ACLR and meniscal repair. PURPOSE To define the operative success and patient-oriented outcome scores 6 years after combined meniscal repair and ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All ipsilateral primary ACLR and meniscal repair cases from a multicenter study group between 2002 and 2004 were selected. Validated patient-oriented outcome instruments were completed at 3 time points: preoperatively and then 2 and 6 years after the index procedure. Subsequent ipsilateral knee reoperations were confirmed by operative reports to evaluate for the failure of meniscal repairs. RESULTS In total, 286 patients with 1440 primary ACLRs underwent concurrent meniscal repairs (298 meniscal repairs). Of these, 235 (82.2%) were available for follow-up at 6 years (154 medial, 72 lateral, and 9 both lateral and medial meniscal repairs). Repaired menisci most commonly involved the peripheral one third of the meniscus (84%); patterns were typically longitudinal (84%) or displaced bucket-handle (10%), with a mean length of 16.5 ± 5.8 mm. Overall, the meniscal repair failure rate was 14% (medial: 21/154; lateral: 10/72; both: 2/9) at 6 years. Medial repairs failed earlier than lateral repairs (2.1 vs 3.7 years, respectively; P = .01). Significant improvements in outcome scores were sustained at 6-year follow-up. No differences in the suture number or type were detected between repair failures and successes. The rate of meniscal reoperations was higher in patients who underwent repair compared with those who did not have an identified meniscal injury at the time of ACLR (P < .01. CONCLUSION Concurrent meniscal repair with ACLR is associated with failure rates approximating 14% at 6-year follow-up. Improvements in patient-oriented outcome scores were sustained at 6-year follow-up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscal repair.
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Affiliation(s)
| | - RW Wright
- Washington University at St. Louis, St. Louis, MO
| | - LJ Huston
- Vanderbilt University Medical Center, Nashville, TN
| | | | - BR Wolf
- University of Iowa, Iowa City, IA
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Simultaneous avulsion fracture of the posterior medial and posterior lateral meniscus root: a case report and review of the literature. Arch Orthop Trauma Surg 2014; 134:509-14. [PMID: 24337588 DOI: 10.1007/s00402-013-1915-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Indexed: 10/25/2022]
Abstract
Injuries of the meniscus roots are increasingly recognized as a serious knee joint pathology. An avulsion fracture of the meniscus root is a rare variant of this injury pattern. In this article, a case of a traumatic simultaneous avulsion fracture of both the posterior medial and posterior lateral meniscus root associated with a tear of the anterior cruciate ligament is presented. Both avulsion fractures were treated by indirect arthroscopic transtibial pullout fixation of the bony fragment. Based on the findings of our literature review, root avulsion fractures seem to be more common in young male patients after an acute trauma to the knee joint.
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Abstract
Historically, treatment of meniscus tears consisted of complete meniscectomy. Over the past few decades, however, the long-term morbidities of meniscal removal, namely the early development of knee osteoarthritis, have become apparent. Thus, management of meniscal tears has trended toward meniscal preservation. Recent technological advances have made repairs of the meniscus easier and stronger. In addition, adjunctive therapies used to enhance the healing process have advanced greatly in the past few years. Today, with increased understanding of the impact of meniscal loss and the principles of meniscal repair and healing, meniscal preservation is viewed as an increasingly realistic and important goal in the management of meniscus tears.
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Wasserstein D, Dwyer T, Gandhi R, Austin PC, Mahomed N, Ogilvie-Harris D. A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction. Am J Sports Med 2013; 41:349-55. [PMID: 23263297 DOI: 10.1177/0363546512471134] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Evidence for the success of a meniscal repair performed alone versus combined with anterior cruciate ligament reconstruction (ACLR) is equivocal. No large-scale comparative studies exist regarding this issue. HYPOTHESIS In the general population, meniscal repair in a presumed stable knee has the same rate of reoperation as meniscal repair performed with ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All meniscal repairs performed with ACLR in Ontario, Canada, between July 2003 and March 2008 in patients aged 15 to 60 years were identified using administrative billing, diagnostics, and procedural coding. This cohort was matched 1:1 for sex, age, and calendar year of surgery with a cohort of patients who underwent meniscal repair alone. The McNemar test of matched pairs was used to compare reoperation rates (debridement or repair) within 2 years of the index procedure. Conditional logistic regression analysis was used to identify potential risk factors for reoperation among unmatched patient (socioeconomic status surrogate, comorbidity) and provider (surgeon volume, academic hospital status) factors. RESULTS Of 1332 patients who underwent meniscal repair and ACLR, 1239 (93%) were matched with patients who underwent meniscal repair alone. The rate of meniscal reoperation was 9.7% in the combined cohort compared with 16.7% in the repair alone cohort (P < .0001). In the regression analysis, only ACLR was protective against meniscal reoperation (odds ratio, 0.57; P < .0001). Surgeon volume of meniscal repair did not influence outcome. CONCLUSION A meniscal repair performed in conjunction with ACLR carries a 7% absolute and 42% relative risk reduction of reoperation after 2 years compared with isolated meniscal repair.
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Affiliation(s)
- David Wasserstein
- University of Toronto Orthopaedic Sports Medicine at Women's College Hospital, 399 Bathurst St., 437, 1 East Wing, Toronto, ON, Canada, M5T2S8.
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