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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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Dzidzishvili L, Berreta RS, Jackson GR, Mowers CC, Cotter EJ, Allahabadi S, Chahla J. All-Inside and Inside-Out Repair Techniques for Bucket-Handle Meniscus Tears Both Result in Improved Patient Outcomes and a Broad Range of Failure Rates: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00065-3. [PMID: 38311264 DOI: 10.1016/j.arthro.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare patient-reported outcomes, failure rates, risk factors for failure, and complications in patients with bucket-handle meniscus tears (BHMTs) undergoing repair with inside-out (IO) versus all-inside (AI) techniques. METHODS A literature search was performed using the PubMed, Embase, and Scopus databases from database inception to August 2023 according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria consisted of Level I to IV clinical studies published in the past 10 years with greater than 2 years of follow-up that evaluated patient-reported outcome scores and/or the incidence of failure after IO or AI repairs for BHMTs. Clinical studies not reporting outcomes or failure rates, older studies using outdated implants, animal studies, reviews, letters to the editor, case reports, cadaveric studies, and articles not written in the English language or with English-language translation were excluded. Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) criteria. Outcomes were reported as ranges and qualitatively compared. RESULTS A total of 16 studies published from 2013 to 2023, consisting of 1,062 patients with BHMTs, were identified. Thirteen studies (14 cohorts, 649 patients) reported on AI repair (mean age range, 23.7-32 years) and 7 studies (7 cohorts, 413 patients) reported on IO repair (mean age range, 16.7-34.6 years). Both groups had improved postoperative Lysholm and Tegner scores. Decreased range of motion was the most commonly reported complication in the AI group (range, 2.6%-4%), whereas adhesions for arthrofibrosis were the most commonly reported complication in the IO group (n = 12; range, 6%-7.9%). The overall reported failure rate ranged from 6.9% to 20.5% within the AI group and from 0% to 20% within the IO group. CONCLUSIONS AI and IO repair techniques for BHMTs both result in improved Lysholm and Tegner scores. However, broad ranges of failure are reported in the literature, with overall failure rates ranging from 6.9% to 20.5% after AI repair and from 0% to 20% after IO repair. Younger age and isolated medial BHMT repair are the most frequently reported risk factors for the AI technique, whereas postoperative stiffness is the most frequently reported complication after both repair techniques. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Lika Dzidzishvili
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Rodrigo Saad Berreta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Colton C Mowers
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Eric J Cotter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A..
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Muench LN, Achtnich A, Krivec L, Diermeier T, Woertler K, Braun S, Imhoff AB, Willinger L. Clinical outcome and healing rate after meniscal bucket handle tear repair. BMC Musculoskelet Disord 2022; 23:1063. [PMID: 36471335 PMCID: PMC9721037 DOI: 10.1186/s12891-022-06037-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Reports combining patient-reported outcome measures, clinical evaluation, and radiographic assessment of postoperative healing after arthroscopic repair of bucket-handle meniscal tears (BHMT) are scarce. METHODS Patients who underwent arthroscopic repair for acute traumatic BHMTs between October 2011 and March 2016 with a minimum follow-up of two years were included. Postoperative outcome scores comprised the International Knee Documentation Society Score (IKDC), Lysholm score, Tegner activity score (TAS), and visual analog scale (VAS) for pain. Clinical meniscal healing failure was assessed according to Barrett's criteria. Side-to-side difference in knee laxity was measured using KT-2000. Radiographic healing was assessed by 3-Tesla magnetic resonance imaging (MRI) and classified according to Henning's criteria at final follow-up. RESULTS Forty patients with a mean age of 32.0 ± 11.5 years were available for follow-up after 51.8 ± 14.3 months. Revision surgery by means of arthroscopic partial meniscectomy was performed in four patients (10%) prior to the follow-up visit. The clinical healing rate was 83.3% at final follow-up. Mean IKDC score was 82.8 ± 13.8 and Lysholm score was 77.4 ± 24.8. Of all patients, 87.5% reached or exceeded the patient-acceptable symptomatic state (PASS) criteria for the IKDC score at final follow-up. The median TAS was 6 and VAS for pain was 0.46 ± 0.9. Side-to-side difference in knee laxity was higher in patients with concomitant ACL reconstruction (2.1 ± 2.7 mm) compared to isolated BHMTs (1.0 ± 2.0 mm). MR examination showed 69.4% healed, 25.0% partially healed, and 5.6% unhealed menisci. CONCLUSION Patients who underwent repair for acute traumatic BHMTs achieved good to excellent clinical outcome along with a high rate of meniscal healing at a minimum follow-up of two years. Clinical and radiological healing rates were similarly satisfactory and most patients exceeded the PASS criteria for the IKDC score. Patients were able to reach a high postoperative activity level. LEVEL OF EVIDENCE Case Series; IV.
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Affiliation(s)
- Lukas N. Muench
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Andrea Achtnich
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Lukas Krivec
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Theresa Diermeier
- grid.460088.20000 0001 0547 1053Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Klaus Woertler
- grid.6936.a0000000123222966Department of Radiology, Klinikum rechts der Isar, TU Munich, Munich, Germany
| | - Sepp Braun
- grid.487341.dGelenkpunkt - Sports- and Joint Surgery Innsbruck, Innsbruck, Austria ,UMIT - OSMI- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University UMIT, Hall/ Tirol, Austria
| | - Andreas B. Imhoff
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
| | - Lukas Willinger
- grid.6936.a0000000123222966Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaningerstr. 22 , 81675 Munich, Germany
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