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Pawelczyk J, Fanourgiakis I, Feil S, Siebold M, Kougioumtzis I, Siebold R. Good mid- to long-term outcomes after meniscus bucket-handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction. J Exp Orthop 2024; 11:e12093. [PMID: 39015340 PMCID: PMC11250138 DOI: 10.1002/jeo2.12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
Purpose To evaluate mid- to long-term clinical outcomes after arthroscopic bucket-handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). Methods A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty-five patients with an average follow-up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post-operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. Results The failure rate was 9%. Medial BHMT repair showed superior post-operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post-operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow-up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post-operative outcome measures was observed but did not reach statistical significance for most items. Conclusion Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow-up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level of Evidence Level IV (retrospective case series).
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Affiliation(s)
- Johannes Pawelczyk
- International Center for Orthopedics, ATOS ClinicHeidelbergGermany
- Ruprecht Karl UniversityHeidelbergGermany
| | | | - Sven Feil
- International Center for Orthopedics, ATOS ClinicHeidelbergGermany
| | - Maja Siebold
- International Center for Orthopedics, ATOS ClinicHeidelbergGermany
| | | | - Rainer Siebold
- International Center for Orthopedics, ATOS ClinicHeidelbergGermany
- Institute for Anatomy and Cell BiologyRuprecht Karl UniversityHeidelbergGermany
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Tripon M, Praz C, Ferreira A, Drigny J, Reboursière E, Hulet C. Clinical outcome of iterative meniscal suture after ACL reconstruction at a minimum of 2 years' follow-up. Orthop Traumatol Surg Res 2024; 110:103754. [PMID: 37951303 DOI: 10.1016/j.otsr.2023.103754] [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] [Received: 10/05/2022] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Failure rates in meniscal suture associated to ACL reconstruction range from 10 to 26.9%, often leading to meniscectomy. In young patients, the wish to conserve the meniscus may lead to iterative suture, if the lesion allows. There are no data available for clinical results of repeat meniscal suture at the same site as the primary lesion in a stabilized knee. The immediate socioeconomic cost, compared to meniscectomy, needs to be taken into account, and benefit needs to be demonstrated. The main aim of the present study was to assess the rate of secondary meniscectomy after iterative meniscal suture in stabilized knees. The study hypothesis was that failure rates are higher in iterative isolated meniscal suture after ligament reconstruction than in primary repair. MATERIAL AND METHODS This single-center retrospective study analyzed patients receiving iterative meniscal suture on stable knee, between 2009 and 2019, with a minimum 26 months' follow-up. Twenty-three patients were analyzed: 15 male, 8 female; mean age at iterative suture, 28.1±7.9 years (range, 14-49 years); mean BMI, 24.2±2.9kg/m2 (range, 19-31). Mean time to recurrence was 38.9±25.1 months (range, 6-93 months). Initial ACL graft used the patellar ligament in 69.6% of cases (n=16) and the hamstrings in 30.4% (n=7). Mean differential laximetry before iterative suture was 1.7±0.3mm (range, 1.2-2.3mm). Iterative suture was in the medial meniscus in 69.6% of cases (16/23) and in the lateral meniscus in 30.4% (7/23). Risk factors for failure, defined by requirement for meniscectomy, were assessed. Functional results were assessed on Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Tegner score. RESULTS The failure rate was 48% (11/23), incorporating all lesions together. Bucket-handle tear was most frequently associated with failure (91%; p<0.01). There was significant improvement after iterative suture in subjective IKDC score (51.6±15.2 vs. 81.3±15.6; p<0.001) and KOOS scores: symptoms and stiffness, 66.6±13.7 vs. 91.1±7.53 (p<0.001); pain, 79.2±12.7 vs. 93.4±7.4 (p<0.01); function, 91.3±11.2 vs. 97.9±4.44 (p<0.001); quality of life, 38.1±23.2 vs. 62.3±30.1 (p<0.001). CONCLUSION The failure rate for iterative meniscal suture on stabilized knee was 48%. Bucket-handle tear was a major risk factor for failure (91%). Despite these high failure rates, functional results systematically improved. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Martin Tripon
- Département de chirurgie orthopédique et traumatologique, CHU de Caen Normandie, avenue de la Côte de Nacre, 14033 Caen, France.
| | - César Praz
- Département de chirurgie orthopédique et traumatologique, CHU de Caen Normandie, avenue de la Côte de Nacre, 14033 Caen, France
| | - Alexandre Ferreira
- Département de chirurgie orthopédique et traumatologique, CHU de Caen Normandie, avenue de la Côte de Nacre, 14033 Caen, France
| | - Joffrey Drigny
- Département de médecine du sport, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - Emmanuel Reboursière
- Département de médecine du sport, CHU de Caen, avenue de la Côte de Nacre, 14033 Caen, France
| | - Christophe Hulet
- Département de chirurgie orthopédique et traumatologique, CHU de Caen Normandie, avenue de la Côte de Nacre, 14033 Caen, France
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Louis ML, Favreau H, Maroteau G, Benad K, Praz C, Carnessechi O, Badr S, Trouillez T, Az-Eddine D, Pelletier S, Freychet B, Pineau V, Putman S. The frequency of medial meniscal repairs in stable knees during one year of arthroscopic activity (2021-2022) - comparison with a retrospective study (prior to 2017). Orthop Traumatol Surg Res 2023; 109:103676. [PMID: 37683913 DOI: 10.1016/j.otsr.2023.103676] [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] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION There has been a significant increase in the use of conservative treatment for meniscal lesions due to raised awareness around the need for meniscal preservation. However, sutures of the medial meniscus (MM) in stable knees remain less frequently used. The objective of this study was to, firstly, identify the MM suture rate over one year of activity; secondly, to identify and compare the distribution of MM sutures in stable, and stabilized, knees on this prospective series; and thirdly, to compare the evolution of practices with a retrospective series of more than 5 years follow-up. HYPOTHESIS The number of MM sutures in stable knees represents a small percentage of annual arthroscopic activity. MATERIAL AND METHODS This multicenter study was carried out in 10 reference centers participating in the 2022 symposium of the Francophone Society of Arthroscopy (Bordeaux, Caen, Lille, Lille Louvière, Lyon, Marseille, Toulouse, Saint-Étienne, Strasbourg, Versailles). This study included a prospective series on interventions performed under arthroscopy during one year of activity. The inclusion criteria were patients operated on via an arthroscopic technique and aged over 18 at the time of the operation. Demographic data, as well as the circumstances leading to the injury, were collected. A register of the lesions found was established in order to list the lesions of the MM, the lateral meniscus (LM), the anterior cruciate ligament (ACL), the associated chondral lesions; as well as the treatment performed: meniscal suture of the MM and/or LM, meniscectomy of the MM and/or LM and ligamentoplasty of the ACL. This study also included a retrospective series comprised of only MM sutures in stable knees at more than 5 years of follow-up. RESULTS Of the 4154 patients included, 1919 patients (46.2%) underwent surgery for ACL reconstruction and 2235 for arthroscopy without associated ligament surgery. MM sutures (in stable knees and in knees with ACL reconstruction) represented 14% of the overall arthroscopic activity (583 MM sutures) versus 8.6% for LM (360 sutures). In cases of ACL surgery, there were 895 associated meniscal lesions (337 LM and 558 MM) and 66% of MM tears (371 MM sutures) were sutured. In stable knees, MM tears were weaker (212 MM sutures out of 1359 lesions, i.e. 15%). Of all the arthroscopic procedures performed over the course of a year, MM suturing in stable knees represented 5.1% of the activity. Compared to the retrospective series (n=367), the patients were older (37 years versus 28 years) and the management of ramp lesions or root tears was noted. In both series, these tears were related to sports trauma in more than 70% of cases. CONCLUSION MM suturing in stable knees represents a small part of annual arthroscopic activity and it occurs less frequently than during ACL reconstruction surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marie Laure Louis
- Institut de chirurgie orthopédique et sportive, clinique Juge, groupe Almaviva recherche, Marseille, France.
| | - Henri Favreau
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | | | - Kevin Benad
- Nord Genou, 126, rue de la Louvière, Lille, France
| | | | | | - Sammy Badr
- Service de radiologie ostéoarticulaire, CHU de Lille, Lille, France
| | - Teddy Trouillez
- Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France
| | - Djebara Az-Eddine
- Service d'orthopédie et traumatologie du centre hospitalier de Versailles André-Mignot, Versailles, France
| | - Simon Pelletier
- Clinique du sport de Bordeaux Mérignac, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Benjamin Freychet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | | | - Sophie Putman
- Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France; Metrics, université Lille-Nord de France, 59000 Lille, France
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Pelletier S, Djebara A, Freychet B, Carnessechi O, Graveleau N, Louis ML, Benad K, Praz C, Maroteau G, Badr S, Trouillez T, Favreau H, Pineau V, Putman S. Medial meniscal repair in stable knees: Survival rate and risk factors for failure at a minimum of 5 years. Orthop Traumatol Surg Res 2023; 109:103681. [PMID: 37690604 DOI: 10.1016/j.otsr.2023.103681] [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] [Received: 03/28/2023] [Revised: 08/02/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The menisci play a major role in the protection of the knee against osteoarthritis. A medial meniscus (MM) tear occurring in a stable knee is more at risk of repair failure than a suture concomitant with reconstruction of the anterior cruciate ligament. HYPOTHESIS The survival of MM sutures in stable knees depends on the type of lesion. MATERIALS AND METHODS This retrospective study was carried out as part of the 2022 Francophone Arthroscopy Society's symposium, across 10 centers (Bordeaux-Mérignac, Caen, Lille, Lille Louvière, Lyon, Marseille, Toulouse, Saint-Étienne, Strasbourg and Versailles) including medial meniscus sutures in stable knees performed before the end of 2017 (minimum 5 years of follow-up) with a collection of demographic, imaging, suture and postoperative protocol data, and a functional evaluation using the Knee injury and Osteoarthritis Outcome score (KOOS). The aim of this study was to analyze the medial meniscus sutures in stable knees and to evaluate their survival and their risk factors for failure according to the type of lesion; failure being defined by the use of a meniscectomy. RESULTS Three-hundred and sixty-seven MM sutures, including 122 bucket-handle tears, were included. The KOOS score was improved by the meniscal suture by an average of 22.2 points for each sub-score (p<0.05), with an improvement, which was more marked for the bucket-handle tears. The failure rate, defined by revision surgery by meniscectomy, was 33% on average (42% for bucket-handles tears, 26% for others). The probability of survival was reduced for bucket-handle tears (62% at 5 years versus 77% for the other types). For all lesions, the main risk factor identified for failure was immediate weight-bearing [OR=3.6 (1.62; 7.98), p=0.0016]. Smoking was a failure risk factor for bucket-handle tears [OR=5.76 (1.81; 18.35), p=0.003]. CONCLUSION MM sutures in stable knees improve knee function but present a different risk of failure depending on the type of lesion treated with a higher risk of failure for bucket-handle tears with the need for caution to be applied with regards to weight-bearing and smoking. LEVEL OF EVIDENCE IV; retrospective series.
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Affiliation(s)
- Simon Pelletier
- Clinique du sport de Bordeaux Merignac, 4, rue Georges-Negrevergne, 33700 Mérignac, France.
| | - Azeddine Djebara
- Service d'orthopédie et traumatologie, centre hospitalier de Versailles André-Mignot, 78150 Le Chesnay, France
| | - Benjamin Freychet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | | | - Nicolas Graveleau
- Clinique du sport de Bordeaux Merignac, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Marie-Laure Louis
- Institut de chirurgie orthopédique et sportive, clinique Juge, groupe Almaviva recherche, Marseille, France
| | - Kevin Benad
- Nord Genou, 126, rue de la Louvière, Lille, France
| | | | - Gaëlle Maroteau
- Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France
| | - Sammy Badr
- Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Roger-Salengro, rue Émile-Laine, 59037 Lille cedex, France
| | - Teddy Trouillez
- Service de radiologie ostéoarticulaire, CHU de Lille, Lille, France
| | - Henri Favreau
- Service d'orthopédie et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | | | - Sophie Putman
- Service de radiologie ostéoarticulaire, CHU de Lille, Lille, France; Metrics, université Lille-Nord de France, 59000 Lille, France
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Migliorini F, Pilone M, Bell A, Celik M, Konrads C, Maffulli N. Outside-in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:4257-4264. [PMID: 37314454 PMCID: PMC10471662 DOI: 10.1007/s00167-023-07475-z] [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: 03/04/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Meniscal injuries are common. Outside-in meniscal repair is one of the techniques advocated for the management of traumatic meniscal tears. This systematic review investigated the outcomes of the outside-in repair technique for the management of traumatic tears of the menisci. The outcomes of interest were to investigate whether PROMs improved and to evaluate the rate of complications. METHODS Following the 2020 PRISMA statement, in May 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed with no time constraints. All the clinical investigations which reported data on meniscal repair using the outside-in technique were considered for inclusion. Only studies which reported data on acute traumatic meniscal tears in adults were considered. Only studies which reported a minimum of 24 months of follow-up were eligible. RESULTS Data from 458 patients were extracted. 34% (155 of 458) were women. 65% (297 of 458) of tears involved the medial meniscus. The mean operative time was 52.9 ± 13.6 min. Patients returned to their normal activities at 4.8 ± 0.8 months. At a mean of 67-month follow-up, all PROMs of interest improved: Tegner scale (P = 0.003), Lysholm score (P < 0.0001), International Knee Documentation Committee (P < 0.0001). 5.9% (27 of 458) of repairs were considered failures. Four of 186 (2.2%) patients experienced a re-injury, and 5 of 458 (1.1%) patients required re-operation. CONCLUSION Meniscal repair using the outside-in technique can be effectively performed to improve the quality of life and the activity level of patients with acute meniscal tears. LEVEL OF EVIDENCE Level IV.
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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 Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
| | - Marco Pilone
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Michael Celik
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Christian Konrads
- Department of Orthopaedics and Traumatology, Helios Hanseatic Hospital Stralsund, Stralsund, Germany
- Medical Faculty, University of Tübingen, 72076 Tübingen, 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
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG London, England
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Kalifis G, Raoulis V, Panteliadou F, Liantsis A, D'Ambrosi R, Hantes M. Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk. Knee Surg Sports Traumatol Arthrosc 2022; 30:2209-2214. [PMID: 34741626 DOI: 10.1007/s00167-021-06787-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/25/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Outcomes after repair of bucket-handle meniscal tears tend to be satisfying in the short-term follow-up. However, the literature is scarce regarding long-term data following repair of bucket-handle meniscal tears. The aim of this study was to assess long-term follow-up outcomes, focusing on knee osteoarthritis (OA) development and failure rate, and determine risk factors associated with failure. METHODS This is a retrospective cohort study, including all patients with bucket-handle tears within 4 mm of the menisco-synovial junction, who underwent meniscal repair, either isolated or combined with anterior cruciate ligament reconstruction (ACLR) between 2004 and 2015. A combination of all-inside, outside-in, and inside-out repair technique was used in all patients. Patients over 40 years old, concomitant multi-ligamentous injuries, and severe cartilage lesions documented intraoperatively were excluded. During the follow-up, a meniscus was considered healed using Barrett's criteria, while knee OA evaluation was performed according to Kellgren-Lawrence (KL) classification using standing knee radiographs. Patients were assessed preoperatively as well as postoperatively in terms of knee function using International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS In total, the inclusion criteria were met by 66 patients. Median age at the time of operation was 21.9 years (13-39). Median follow-up was 114 (62-176) months. Total failure rate was approximately 33% at median time of 19 (6-39) months. Osteoarthritis was statistically significantly more prevalent in patients with failed repairs (mean KL score: 2.09) in comparison to patients with successful repairs (mean KL score: 0.54) p = 0.001. In addition, successful repairs were associated with higher KOOS score as compared with failed repairs (mean ± SD, 89.6 ± 4.6 vs 77.8 ± 4.9 p < 0.001), higher IKDC score (mean ± SD, 88.2 ± 5.1 vs 79.2 ± 5.2 p < 0.001), and Lysholm score (mean ± SD, 90.3 ± 5.3 vs 78.4 ± 7.8 p < 0.001). Patients with medial meniscus repair had 4.8 higher relative likelihood of failure compared to lateral meniscus [p = 0 .014, OR = 4.8 (95% Cl 1.2, 18.6)]. Patients over 16 years old had 5.7 higher relative likelihood of failure [p = 0 .016, OR = 5.7 (95% Cl 0.04, 0.85)]. Concurrent ACLR did not have a significant effect on the postoperative outcomes. CONCLUSION A high rate of clinical failure was observed after meniscal repair of bucket-handle tears. However, successful treatment led to lower rates of knee OA development and better knee function, approximately 10 years postoperatively. Meniscal repair of bucket-handle tears is recommended to improve knee function and prevent knee OA in young patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- George Kalifis
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Vasilios Raoulis
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Frideriki Panteliadou
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Athanasios Liantsis
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | | | - Michael Hantes
- Department of Orthopedic Surgery, Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece.
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