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Alhamdi H, Foissey C, Vieira TD, Sonnery-Cottet B, Rajput V, Bahroun S, Fayard JM, Thaunat M. High failure rate after medial meniscus bucket handle tears repair in the stable knee. Orthop Traumatol Surg Res 2024; 110:103737. [PMID: 37898297 DOI: 10.1016/j.otsr.2023.103737] [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: 04/05/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND It is nowadays recommended to "Save the meniscus". This paradigm is based on the affirmation that an extended meniscectomy exposes to the risk of long-term secondary osteoarthritis and the global failure rate of a longitudinal tear repair remains low, whether it is the medial or lateral meniscus, with or without anterior cruciate ligament (ACL) reconstruction. However, each kind of lesion has to be studied separate. PURPOSE The study aimed to focus on a homogeneous population of isolated repair of the bucket handle tear (BHT) of the medial meniscus (MM) in patients with stable knees to evaluate failure rate at a minimum of three years of follow-up. The secondary objectives were to evaluate any risk factors or protective factors of failure, clinical outcomes, and secondary amount of meniscectomy in failure cases compared to the amount of meniscus fixed in the first surgery. METHODS All patients who underwent arthroscopic repair of a BHT of the MM situated in the red-on-red or red-on white (RW) zone on a stable knee between January 2010 and December 2018 were evaluated retrospectively. Failure was defined as a need for reoperation for recurrence of meniscal symptoms (pain, locking) on the medial side with per-operative confirmation of the absence of healing. The following parameters were studied: demographics (age, gender, BMI), time from injury to surgery, clinical scores (Tegner, Lysholm, International Knee Documentation Committee [IKDC]), surgical findings (extent and zone of the tear), surgical management (number and type of suture). RESULTS Thirty-nine patients were included. The mean follow-up was 77.2±24.4 [36-141] months. Twenty-seven (69%) failures were recorded. In 56% (15/27) of the reoperations, the meniscectomy amount was smaller than what it would have been done in the first surgery. All clinical scores improved significantly from pre- to post-operatively; all patients met minimal clinically important differences for all the scores. No risk factors were found significant in the multivariate analysis. CONCLUSION Repairing an isolated BHT of the MM is associated with a high failure rate. Despite the failure, we observed that the meniscectomy area was smaller than documented in the primary surgery in most of the cases and repair must still be considered as the first option. LEVEL OF EVIDENCE IV; retrospective cohort series.
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Affiliation(s)
- Hassan Alhamdi
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France; Centre Orthopédique Santy, Lyon, France
| | - Constant Foissey
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France; Centre Orthopédique Santy, Lyon, France
| | - Thais Dutra Vieira
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France; Centre Orthopédique Santy, Lyon, France
| | - Bertrand Sonnery-Cottet
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France; Centre Orthopédique Santy, Lyon, France
| | - Vishal Rajput
- The Mid Yorkshire Hospitals NHS trust, Yorkshire, United Kingdom
| | - Sami Bahroun
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France; Centre Orthopédique Santy, Lyon, France
| | - Jean Marie Fayard
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France; Centre Orthopédique Santy, Lyon, France
| | - Mathieu Thaunat
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France; Centre Orthopédique Santy, Lyon, France.
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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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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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Putman S, Lee SH. How to improve operative results in patients with meniscus and anterior cruciate ligament injuries? Orthop Traumatol Surg Res 2023; 109:103672. [PMID: 37527774 DOI: 10.1016/j.otsr.2023.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Sophie Putman
- Service d'orthopédie 2, hôpital Salengro, avenue du Professeur Émile-Laine, 59037 Lille, France; ULR 2694-METRICS, CERIM, Public Health Department, Lille University, 59000 Lille, France
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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