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Wang H, Wu J, Yang L, Liu S, Sui X, Guo Q, Chen M. Surgical Therapy and Tissue Engineering for Meniscal Repair. TISSUE ENGINEERING. PART B, REVIEWS 2024. [PMID: 39083434 DOI: 10.1089/ten.teb.2024.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Meniscal damage is one of the prevalent causes of knee pain, swelling, instability, and functional compromise, frequently culminating in osteoarthritis (OA). Timely and appropriate interventions are crucial to relieve symptoms and prevent or delay the onset of OA. Contemporary surgical treatments include total or partial meniscectomy, meniscal repair, allograft meniscal transplantation, and synthetic meniscal implants, but each presents its specific limitations. Recently, regenerative medicine and tissue engineering have emerged as promising fields, offering innovative prospects for meniscal regeneration and repair. This review delineates current surgical methods, elucidating their specific indications, advantages, and disadvantages. Concurrently, it delves into state-of-the-art tissue engineering techniques aimed at the functional regenerative repair of meniscus. Recommendations for future research and clinical practice are also provided.
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Affiliation(s)
- Hao Wang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
- Chinese PLA General Hospital, Institute of Orthopedics, The First Medical Center, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Jie Wu
- Department of Orthopedics, General Hospital of Chinese PLA, Eighth Medical Center, Beijing, China
| | - Liupu Yang
- Chinese PLA General Hospital, Institute of Orthopedics, The First Medical Center, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Shuyun Liu
- Chinese PLA General Hospital, Institute of Orthopedics, The First Medical Center, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Xiang Sui
- Chinese PLA General Hospital, Institute of Orthopedics, The First Medical Center, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Quanyi Guo
- Chinese PLA General Hospital, Institute of Orthopedics, The First Medical Center, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and War Injuries PLA, Beijing, China
| | - Mingxue Chen
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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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. [PMID: 38947260 PMCID: PMC11212529 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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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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Tomihara T, Hashimoto Y, Okazaki S, Nishino K, Taniuchi M, Takigami J, Tsumoto S, Katsuda H. Bone-patellar tendon-bone autograft is associated with a higher rate of return to preinjury levels of performance in high-level athletes than anterior cruciate ligament reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 2024; 32:1384-1395. [PMID: 38558484 DOI: 10.1002/ksa.12144] [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: 11/09/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL-R) for athletes when ACL graft rupture is a career-threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL-R using bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft in high-level athletes with a minimum postoperative follow-up of 24 months. METHODS This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL-R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow-ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow-ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury. RESULTS Ninety-nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL-R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty-three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300-5.160; p = 0.007) was associated with a higher potential for RTP after ACL-R. The incidence of ACL graft rupture after ACL-R decreased with BPTB (OR, 0.861; 95% CI, 0.770-0.962; p = 0.009). CONCLUSIONS The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL-R using HT autograft. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Yusuke Hashimoto
- Department of Sport Sciences, Osaka University of Health and Sport Sciences, Sennan-gun, Japan
| | - Shiro Okazaki
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | - Kazuya Nishino
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | | | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Shuko Tsumoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Habikino, Japan
| | - Hiroshi Katsuda
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
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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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Tomihara T, Hashimoto Y, Takahashi S, Taniuchi M, Takigami J, Tsumoto S, Shimada N. Analyses of associated factors with concomitant meniscal injury and irreparable meniscal tear at primary anterior cruciate ligament reconstruction in young patients. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 32:12-17. [PMID: 37206084 PMCID: PMC10189348 DOI: 10.1016/j.asmart.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/19/2023] [Accepted: 04/06/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose Although several factors related to the concomitant meniscal injury at anterior cruciate ligament reconstruction (ACL-R) have been investigated in a general population, few studies have identified the risk factors of meniscal tear severity in young patients in which the majority of ACL tears occur. The purpose of this study was to analyze the associated factors with meniscal injury and irreparable meniscal tear and the timeline for medial meniscal injury at ACL-R in young patients. Methods A retrospective analysis of young patients (13 to 29 years of age) who underwent ACL-R by a single surgeon from 2005 to 2017 was conducted. Predictor variables (age, sex,body mass index [BMI], time from injury to surgery [TS], and pre-injury Tegner activity level) for meniscal injury and irreparable meniscal tear were analyzed with multivariate logistic. Results Four hundred and seventy-three consecutive patients with an average of 31.2 months post-operative follow-up were enrolled in this study. The risk factors for medial meniscus injury were TS (<= 3 months) (odds ratio [OR], 3.915; 95% CI, 2.630-5.827; P < .0001) and higher BMI (OR, 1.062; 95% CI, 1.002-1.125; P = 0.0439). The presence of irreparable medial meniscal tears correlated with higher BMI (OR, 1.104; 95% CI, 1.011-1.205; P = 0.0281). Conclusion An increased time from ACL tear to surgery of 3 months was strongly associated with an increased risk of medial meniscus injury, but not related to irreparable medial meniscal tear at primary ACL reconstruction in young patients. Level of Evidence Level IV.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
- Corresponding author.
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatoshi Taniuchi
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Shuko Tsumoto
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, 583-0875, Japan
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Rohde MS, Shea KG, Dawson T, Heyworth BE, Milewski MD, Edmonds EW, Adsit E, Wilson PL, Albright J, Algan S, Beck J, Bowen R, Brey J, Cardelia M, Clark C, Crepeau A, Edmonds EW, Ellington M, Ellis HB, Fabricant P, Frank J, Ganley T, Green D, Gupta A, Heyworth BE, Latz K, Mansour A, Mayer S, McKay S, Milewski M, Niu E, Pacicca D, Parikh S, Rhodes J, Saper M, Schmale G, Schmitz M, Shea K, Storer S, Wilson PL, Ellis HB. Age, Sex, and BMI Differences Related to Repairable Meniscal Tears in Pediatric and Adolescent Patients. Am J Sports Med 2023; 51:389-397. [PMID: 36629442 DOI: 10.1177/03635465221145939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The incidence of meniscus tears and ACL tears in pediatric patients continues to rise, bringing to question the risk factors associated with these injuries. As meniscus tears are commonly repaired in pediatric populations, the epidemiology of repairable meniscus tears is an important for consideration for surgeons evaluating treatment options. PURPOSE To describe meniscal tear patterns in pediatric and adolescent patients who underwent meniscal repair across multiple institutions and surgeons, as well as to evaluate the relationship between age, sex, and body mass index (BMI) and their effect on the prevalence, type, and displacement of repaired pediatric meniscal tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS Data within a prospective multicenter cohort registry for quality improvement, Sport Cohort Outcome Registry (SCORE), were reviewed to describe repaired meniscal tear patterns. All consecutive arthroscopic meniscal repairs from participating surgeons in patients aged <19 years were analyzed. Tear pattern, location, and displacement were evaluated by patient age, sex, and BMI. A subanalysis was also performed to investigate whether meniscal tear patterns differed between those occurring in isolation or those occurring with a concomitant anterior cruciate ligament (ACL) injury. Analysis of variance was used to generate a multivariate analysis of specified variables. Sex, age, and BMI results were compared across the cohort. RESULTS There were 1185 total meniscal repairs evaluated in as many patients, which included 656 (55.4%) male and 529 (44.6%) female patients. Patients underwent surgery at a mean age of 15.3 years (range, 5-19 years), with a mean BMI of 24.9 (range, 12.3-46.42). Of the 1185 patients, 816 (68.9%) had ACL + meniscal repair and 369 (31.1%) had isolated meniscal repair. The male patients underwent more lateral tear repairs than the female patients (54.3% to 40.9%; P < .001) and had a lower incidence of medial tear repair (32.1% vs 41.4%; P < .001). Patients with repaired lateral tears had a mean age of 15.0 years, compared with a mean age of 15.4 years for patients with repaired medial or bilateral tears (P = .001). Higher BMI was associated with "complex" and "radial" tear repairs of the lateral meniscus (P < .001) but was variable with regard to medial tear repairs. CONCLUSION In pediatric and adolescent populations, the data suggest that the surgical team treating knees with potential meniscal injury should be prepared to encounter more complex meniscal tears, commonly indicated in those with higher BMI, while higher rates of lateral meniscal tears were seen in male and younger patients. Future studies should analyze correlates for meniscal repair survival and outcomes in this pediatric cohort undergoing knee surgery.
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Affiliation(s)
- Matthew S Rohde
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Kevin G Shea
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Timothy Dawson
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Benton E Heyworth
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Eric W Edmonds
- Rady Children's Hospital, Division of Orthopaedic Surgery, San Diego, California, USA
| | | | - Philip L Wilson
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | | | - Jay Albright
- Children's Hospital Colorado, Department of Orthopedics, Aurora, Colorado, USA
| | - Sheila Algan
- Oklahoma Children's Hospital, Department of Orthopedic Surgery, Oklahoma City, Oklahoma, USA
| | - Jennifer Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Richard Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Jennifer Brey
- Norton Children's Orthopedics of Louisville, Department of Orthopedics, Louisville, Kentucky, USA
| | - Marc Cardelia
- Children's Hospital of the King's Daughters, Department of Orthopedics and Sports Medicine, Norfolk, Virginia, USA
| | - Christian Clark
- OrthoCarolina Pediatric Orthopaedic Center, Charlotte, North Carolina, USA
| | - Allison Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, Connecticut, USA; UConn Health, Division of Sports Medicine, Department of Orthopedics, Farmington, Connecticut, USA
| | - Eric W Edmonds
- Rady Children's Hospital, Division of Orthopaedic Surgery, San Diego, California, USA
| | - Matt Ellington
- Central Texas Pediatric Orthopedics, Department of Orthopedics, Austin, Texas, USA; Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | - Peter Fabricant
- Hospital for Special Surgery, Division of Pediatric Orthopaedic Surgery, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Jeremy Frank
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Ted Ganley
- Children's Hospital of Philadelphia, Sports Medicine and Performance Center, Philadelphia, Pennsylvania, USA
| | - Dan Green
- Hospital for Special Surgery, Division of Pediatric Orthopaedic Surgery, New York, New York, USA
| | - Andrew Gupta
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Benton E Heyworth
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Kevin Latz
- Children's Mercy, Department of Orthopedics-Sports Medicine, Kansas City, Missouri, USA
| | - Alfred Mansour
- UTHealth Houston, McGovern Medical School, Department of Orthopedic Surgery, Houston, Texas, USA
| | - Stephanie Mayer
- Children's Hospital of Colorado, Department of Orthopaedic Surgery, Denver, Colorado, USA
| | - Scott McKay
- Texas Children's Hospital, Department of Orthopedic Surgery, Houston, Texas, USA
| | - Matt Milewski
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Emily Niu
- Children's National Medical Center, Department of Orthopedic Surgery and Sports Medicine, Washington, DC, USA
| | - Donna Pacicca
- Children's Mercy, Department of Orthopedics-Sports Medicine, Kansas City, Missouri, USA
| | - Shital Parikh
- Cincinnati Children's Hospital Medical Center, Division of Orthopaedic Surgery, Cincinnati, Ohio, USA
| | - Jason Rhodes
- Children's Hospital Colorado, Department of Orthopedics, Aurora, Colorado, USA
| | - Michael Saper
- Seattle Children's Hospital, Department of Orthopedics and Sports Medicine, Seattle, Washington, USA
| | - Greg Schmale
- Seattle Children's Hospital, Department of Orthopedics and Sports Medicine, Seattle, Washington, USA
| | - Matthew Schmitz
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Kevin Shea
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Stephen Storer
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Philip L Wilson
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA.,Investigation performed at Scottish Rite for Children, University of Texas Southwestern, Dallas, Texas, USA
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Shi B, Stinson Z, Nault ML, Brey J, Beck J. Meniscus Repair in Pediatric Athletes. Clin Sports Med 2022; 41:749-767. [DOI: 10.1016/j.csm.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mercurio AM, Coene RP, Cook DL, Feldman L, Milewski MD. Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction. Am J Sports Med 2022; 50:2909-2916. [PMID: 35916744 DOI: 10.1177/03635465221109607] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment. HYPOTHESIS Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction. STUDY DESIGN Descriptive epidemiology study. METHODS The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations. RESULTS A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all P < .05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all P < .05). There were no associations detected between income bracket and the outcomes in this study. CONCLUSION This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair.
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Affiliation(s)
| | - Ryan P Coene
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Lanna Feldman
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
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10
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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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11
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Deroche E, Batailler C, Swan J, Lustig S, Servien E. Significant risk of arthrolysis after simultaneous anterior cruciate ligament reconstruction and treatment of dislocated bucket-handle meniscal tear. Orthop Traumatol Surg Res 2022; 108:103252. [PMID: 35183759 DOI: 10.1016/j.otsr.2022.103252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 11/15/2021] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Postoperative stiffness is a feared complication after anterior cruciate ligament (ACL) reconstruction. In case of associated dislocated bucket-handle meniscal tear (BHMT), reduction is urgent, with ligament reconstruction in the same surgical step. HYPOTHESIS Treatment of associated dislocated BHMT in ACL reconstruction incurs increased risk of arthrolysis for stiffness in flexion and/or extension. MATERIAL AND METHODS A retrospective exposure/non-exposure study included 208 patients undergoing ACL reconstruction between January 2009 and December 2018. Those showing dislocated medial or lateral BHMT at surgery (group A) were compared versus those free of meniscal lesions (group B). The main objective was to assess the risk of surgical revision for arthrolysis within 12 months. Group A included 69 patients: 40 male (58%), 29 female (42%); mean age, 29.0±11.2 years. Group B included 139 patients: 68 male (49%), 71 female (51%); mean age, 30.0±10.4 years. Patients were classified according to age of ACL tear, as acute (<6 weeks), subacute (6 weeks to 6 months), or chronic (>6 months). RESULTS Risk of revision surgery for arthrolysis was greater in Group A than in Group B, with 7 (10.1%) and 4 (2.9%) cases respectively (p=0.044), with 12-month arthrolysis-free survival of 89.7% (95% CI, 82.7-97.2) and 97.1% (95% CI, 94.3-99.9) respectively (p=0.023). Stiffness in flexion and extension was more frequent in Group A at 6 weeks and at 6 months (p>0.05). Risk of arthrolysis did not significantly differ according to accident-to-surgery time in the overall series (p=0.421) or specifically in Group A (p=0.887). The BHMT was sutured in 39 cases (56.5%), including 3 failures (7.7%) at 12 months' follow-up. Arthrolysis was required in 6 patients treated by meniscal suture (15.4%) and just 1 patient treated by meniscectomy (3.3%) (p=0.128). CONCLUSION The present study confirmed increased risk of surgical revision for arthrolysis after ACL reconstruction in case of dislocated BHMT treated in the same surgical step. Age of ACL tear and type of BHMT treatment (suture or meniscectomy) showed no impact on postoperative stiffness. LEVEL OF EVIDENCE IV, retrospective exposure/non-exposure cohort study.
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Affiliation(s)
- Etienne Deroche
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
| | - Cécile Batailler
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - John Swan
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; LIBM-EA 7424, Laboratoire Interuniversitaire de la Biologie du Mouvement, Université Claude Bernard Lyon 1, Lyon, France
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12
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Costa GG, Grassi A, Zocco G, Graceffa A, Lauria M, Fanzone G, Zaffagnini S, Russo A. What Is the Failure Rate After Arthroscopic Repair of Bucket-Handle Meniscal Tears? A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:1742-1752. [PMID: 34161741 DOI: 10.1177/03635465211015425] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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 has become the treatment of choice for meniscal tears, especially in the subset of bucket-handle meniscal tears (BHMTs). However, a comprehensive estimate of the corresponding failure rate is not available, thus maintaining doubts about the healing potential of these tears. Furthermore, a wide range of factors to predict high failure rates have been reported but with conflicting evidence. PURPOSE To determine the failure rate after arthroscopic repair of BHMTs as reported in the literature, compare this with the failure rate of simple meniscal tears extracted from the same studies, and analyze the influence of factors previously reported to be predictive of meniscal repair failure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic search was conducted by 2 independent reviewers using principal bibliographic databases (PubMed, Scopus, Cochrane Library, and EMBASE). After a stepwise exclusion process, 38 articles met the inclusion criteria. Failure rate data were analyzed with a random-effects proportional meta-analysis (weighted for individual study size), and forest plots were constructed to determine any statistically significant differences between BHMTs versus simple tears (longitudinal, radial, or horizontal), medial versus lateral BHMTs, isolated procedures versus repairs with concomitant anterior cruciate ligament reconstruction, and tears in red-red versus red-white zones. Moreover, a meta-regression analysis was conducted to evaluate the effect of patient age and sex, suture technique (in-out or all-inside), time from injury to surgery, mean number of stitches, and length of follow-up on failure rates. RESULTS The pooled failure rate was 14.8% (95% CI, 11.3%-18.3%; I2 = 77.2%). A total of 17 studies provided failure rates of both BHMT repairs (46/311 repairs) and simple tear repairs (54/546 repairs), demonstrating a significantly higher failure rate for BHMT repairs (risk ratio [RR] = 1.50; 95% CI, 1.05-2.15; I2 = 0%; P = .03). Medial BHMT repairs (RR = 1.94; 95% CI, 1.25-3.01; I2 = 0%; P = .003) and isolated repairs (RR = 1.77; 95% CI, 1.15-2.72; I2 = 0%; P = .009) had statistically higher risk of failure, but no statistically significant difference was found between tears in red-red versus red-white zones. Among the other factors evaluated with meta-regression, only the mean number of stitches showed a statistically significant effect on failure rates. CONCLUSION Based on the currently available literature, this systematic review provides a reasonably comprehensive analysis of failure rate after arthroscopic BHMT repair; failure is estimated to occur in 14.8% of cases. Medial tears and isolated repairs were the 2 major predictors of failure.
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Affiliation(s)
- Giuseppe Gianluca Costa
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Alberto Grassi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Zocco
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Angelo Graceffa
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Michele Lauria
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Giuseppe Fanzone
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Arcangelo Russo
- Orthopaedic and Traumatologic Unit, Umberto I Hospital, Azienda Sanitaria Provinciale di Enna, Enna, Italy
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13
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Sebastianelli WJ, Hanna T, Smith NP. Treatment, Return to Play, and Performance Following Meniscus Surgery. Curr Rev Musculoskelet Med 2022; 15:157-169. [PMID: 35467166 DOI: 10.1007/s12178-022-09754-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The standard of care in meniscal tear management is constantly evolving, especially for athletes and high-demand patients. Meniscus repairs, meniscus transplants, and partial meniscectomies are commonly performed, and rehabilitation methods following these operations are becoming more sophisticated. The ultimate goal of these procedures is returning patients to full activity with minimal risks. Return to play should be systematic, pathology dependent, and individualized to an athlete's needs, expectations, and level of play. This article provides a review of the current treatment modalities of meniscus tears, the rehabilitation protocols following each modality, and the return to play criteria that must be met before releasing the player to competition. In addition, it overviews articles that describe performance outcomes of patients that have undergone meniscus surgery. RECENT FINDINGS Current research shows high return to play rates for athletes that undergo meniscus surgery and describes effective rehabilitation protocols to facilitate recovery. There is an increased emphasis on meniscus preservation in recent literature. In addition, meniscus allograft transplantation has demonstrated its efficacy as a salvage procedure and has become a stronger consideration in the athlete with meniscus pathology. No standardized return to play protocol can be applied uniformly to all kinds of meniscal surgeries, and two athletes with the same pathology cannot be expected to follow identical paths towards full recovery. A multidisciplinary approach to care should be provided to the patients, and in the case of patients with high levels of athleticism, the road to recovery starts even before the injury itself.
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Affiliation(s)
- Wayne J Sebastianelli
- Penn State Department of Orthopedics and Rehabilitation, Penn State Sports Medicine, 1850 East Park Avenue, Suite 112, University Park, State College, PA, 16803, USA.
| | - Tammam Hanna
- Penn State Department of Orthopedics and Rehabilitation, Penn State Sports Medicine, 1850 East Park Avenue, Suite 112, University Park, State College, PA, 16803, USA
| | - Nathan P Smith
- Penn State College of Medicine, Department of Orthopedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
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14
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Kawashima I, Kawai R, Tsukahara T, Hiraiwa H, Ishizuka S, Kusaka Y, Imagama S. Outcomes of pediatric anterior cruciate ligament reconstructions in patients with and without bucket handle meniscus repairs. J Pediatr Orthop B 2022; 31:e185-e189. [PMID: 33720076 DOI: 10.1097/bpb.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to report the outcomes of concomitant bucket handle meniscal tear (BHMT) repair and anterior cruciate ligament (ACL) reconstruction and to compare the outcomes with those after isolated ACL reconstruction in patients aged ≤16 years. Patients in our database from 2013 to 2017 were retrospectively analyzed. Patients were assigned to one of two treatment groups based on the presence of BHMTs: no meniscal tear group (group A) and BHMT group (group B). All BHMTs were repaired using the combined inside-out with all-inside technique. This study included 64 knees divided into two groups: 47 knees in group A and 17 knees in group B. There was a significant difference in the interval between ACL injury and surgery between groups A and B (69 vs. 150 days, respectively; P < 0.001). Mean postoperative International Knee Documentation Committee and Lysholm scores in group A were slightly, although significantly, improved compared to those in group B (96.5 vs. 92.6, respectively; P < 0.05, and 98 vs. 95, respectively; P < 0.05). There were no significant differences in postoperative anteroposterior laxity and graft failure rate between the groups. In group B, four patients (23.5%) required surgery for incomplete meniscal healing. Postoperative International Knee Documentation Committee and Lysholm scores of patients with BHMTs were significantly lower than those of patients without any meniscal tear, although with significant improvement in the amount of instability. Level of evidence was Level III.
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Affiliation(s)
- Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Asahi
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Ryosuke Kawai
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Takashi Tsukahara
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Hideki Hiraiwa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Asahi
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Asahi
| | - Yoshiaki Kusaka
- Department of Orthopaedic Surgery, Asahi University Hospital, Gifu, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Asahi
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15
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Duethman NC, Wilbur RR, Song BM, Stuart MJ, Levy BA, Camp CL, Krych AJ. Lateral Meniscal Tears in Young Patients: A Comparison of Meniscectomy and Surgical Repair. Orthop J Sports Med 2021; 9:23259671211046057. [PMID: 34660830 PMCID: PMC8511929 DOI: 10.1177/23259671211046057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Meniscal tears are common in active patients, but treatment trends and
surgical outcomes in young patients with lateral meniscal tears are
lacking. Purpose: To evaluate treatment trends, outcomes, and failure rates in young patients
with lateral meniscal tears. Study Design: Cohort study; Level of evidence, 3. Methods: Patients aged ≤25 years treated surgically for isolated lateral meniscal
tears from 2001 to 2017 were identified. Treatment trends were compared over
time. International Knee Documentation Committee (IKDC) scores and failure
rates were compared by treatment modality (meniscectomy vs meniscal repair).
Failure was defined as reoperation, symptomatic osteoarthritis, or a
severely abnormal IKDC score. Univariate regression analyses were performed
to predict failure and IKDC scores based on treatment, type and location of
tear, or extent of meniscectomy. Results: Included were 217 patients (226 knees) with a mean age of 17.4 years (range,
7-25 years); of these patients, 144 knees (64%) were treated with
meniscectomy and 82 knees (36%) with meniscal repair. Treatment with repair
increased over time compared with meniscectomy (P <
.001). At a minimum 2-year follow-up (mean, 6.1 ± 3.9 years), 107 patients
(110 knees) had IKDC scores, and analysis indicated that although scores in
both groups improved from pre- to postoperatively (repair: from 69.5 ± 13.3
to 97.4 ± 4.3; meniscectomy: from 75.7 ± 9.0 to 97.3 ± 3.9;
P < .001 for both), improvement in IKDC score was
greater after repair (27.9 ± 13.9) versus meniscectomy (21.6 ± 9.4)
(P = .005). Included in the failure analysis were 184
patients (192 knees) at a mean follow-up of 8.4 ± 4.4 years. The rates of
reoperation, symptomatic osteoarthritis, and failure were not significantly
different between the meniscectomy and repair groups. Conclusion: An increase was seen in the rate of isolated lateral meniscal tear repair in
young patients. IKDC score improvement was greater after repair than
meniscectomy, although postoperative IKDC scores were similar. Symptomatic
arthritis, reoperation, and failure rates were similar between groups;
however, there was a trend for increased arthritis symptoms in patients
treated with meniscectomy, especially total meniscectomy. Treatment
modality, type and location of tear, and amount of meniscus removed were not
predictive of final IKDC scores or failure.
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Affiliation(s)
- Nicholas C Duethman
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan R Wilbur
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M Song
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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16
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Klarmann GJ, Gaston J, Ho VB. A review of strategies for development of tissue engineered meniscal implants. BIOMATERIALS AND BIOSYSTEMS 2021; 4:100026. [PMID: 36824574 PMCID: PMC9934480 DOI: 10.1016/j.bbiosy.2021.100026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 12/09/2022] Open
Abstract
The meniscus is a key stabilizing tissue of the knee that facilitates proper tracking and movement of the knee joint and absorbs stresses related to physical activity. This review article describes the biology, structure, and functions of the human knee meniscus, common tears and repair approaches, and current research and development approaches using modern methods to fabricate a scaffold or tissue engineered meniscal replacement. Meniscal tears are quite common, often resulting from sports or physical training, though injury can result without specific contact during normal physical activity such as bending or squatting. Meniscal injuries often require surgical intervention to repair, restore basic functionality and relieve pain, and severe damage may warrant reconstruction using allograft transplants or commercial implant devices. Ongoing research is attempting to develop alternative scaffold and tissue engineered devices using modern fabrication techniques including three-dimensional (3D) printing which can fabricate a patient-specific meniscus replacement. An ideal meniscal substitute should have mechanical properties that are close to that of natural human meniscus, and also be easily adapted for surgical procedures and fixation. A better understanding of the organization and structure of the meniscus as well as its potential points of failure will lead to improved design approaches to generate a suitable and functional replacement.
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Affiliation(s)
- George J. Klarmann
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA,Corresponding author at: USU-4D Bio³ Center, 9410 Key West Ave., Rockville, MD 20850, USA.
| | - Joel Gaston
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA,The Geneva Foundation, 917 Pacific Ave., Tacoma, WA 98402, USA
| | - Vincent B. Ho
- 4D Bio³ Center, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA
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17
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Abstract
Meniscal tears may be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention. Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time. Surgical advances in operative techniques, modern instrumentation and biological enhancements collectively improve healing rates of meniscal repair. However, failed repair is not without consequences and can negative impact patient outcomes. Therefore, it is imperative for surgeons to have a thorough understanding of the vascular zones and biomechanical classifications of meniscal tears in order to best determine the most appropriate treatment.
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18
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Meniscus Repair Techniques. Sports Med Arthrosc Rev 2021; 29:e34-e43. [PMID: 34398120 DOI: 10.1097/jsa.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The menisci play a vital role in maintaining knee function and protecting the chondral surfaces. Acute and chronic tears are common injuries among both young athletes and older patients with early degenerative changes. The progression of physiological derangement and chondral injury after meniscus injury and meniscectomy have prompted interest in expanding meniscus repair techniques. Recent literature encourages an attempt at repair in tear patterns previously declared irreparable if the tissue quality allows. The orthopedic surgeon should understand the multitude of techniques available to them and be prepared to combine techniques to optimize the quality of their repair construct. While biological augmentation may show some promising early results, the quality of the current data precludes strong recommendations in their favor.
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19
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Cerkez D, Fernandez FF. Der kindliche Meniskus. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Imada AO, O'Hara JJ, Proumen IL, Molinari PS, Wascher DC, Richter DL, Schenck RC. Bucket handle meniscus tears in low-resource settings can be successfully treated with a cost-effective technique. INTERNATIONAL ORTHOPAEDICS 2021; 46:43-49. [PMID: 34050384 DOI: 10.1007/s00264-021-05090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In regions of the world where resources can limit medical care (limited-resource settings, LRS), most meniscal tears are often treated with meniscectomy. A simple, low-cost option for meniscal repair has been developed. We sought to evaluate patient reported outcomes (PROMs) and clinical failure rates of bucket handle meniscus tears (BHTs) treated with meniscal repair in a LRS. METHODS We prospectively enrolled patients over 18 who were treated for BHT with meniscal repair in a LRS. Meniscal repair was primarily accomplished using an outside-in technique. Pre-injury and final follow-up PROMs were recorded. Clinical failure was defined as the need for re-operation or symptoms that prevented the patient from returning to recreational activities or work responsibilities. RESULTS Nineteen patients with a mean age of 25.4 years were eligible. Two patients sustained a clinical failure (10.5%). At mean follow-up of 40.6 months, there was significant improvement in all PROMs from baseline. Subgroup analysis revealed no significant difference in the failure group compared to the success group in number of knots used, pre-injury Tegner score, number of devices used, suture type, or technique. CONCLUSION Bucket-handle meniscal tears can be repaired using a low-cost technique resulting in satisfactory healing rates and excellent outcomes.
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Affiliation(s)
- Allicia Ostoposides Imada
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA.
| | - James J O'Hara
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
| | - Ignacio L Proumen
- Department of Orthopedic Surgery, Instituto Medico De Alta Complejidad (IMAC), Salta, Argentina
| | - Pablo S Molinari
- Department of Orthopedic Surgery, Instituto Medico De Alta Complejidad (IMAC), Salta, Argentina
| | - Daniel C Wascher
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
| | - Dustin L Richter
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
| | - Robert C Schenck
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
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Tomihara T, Hashimoto Y, Takahashi S, Taniuchi M, Takigami J, Okazaki S, Shimada N. Risk Factors Related to the Presence of Meniscal Injury and Irreparable Meniscal Tear at Primary Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:2325967121989036. [PMID: 33748307 PMCID: PMC7940744 DOI: 10.1177/2325967121989036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Few studies have attempted to identify risk factors associated with irreparable meniscal tears at anterior cruciate ligament reconstruction (ACLR) and to describe follow-up data, such as the failure rate, after meniscal repair. Purpose: To investigate the associations of age, sex, body mass index (BMI), time to surgery (TTS), and preinjury Tegner score with the presence of meniscal injuries and irreparable meniscal tears at primary ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was performed on 784 patients who underwent primary ACLR by a single surgeon between 2005 and 2017 (406 men and 378 women; mean age, 25.8 years; mean BMI, 23.1; median TTS, 3 months; median preinjury Tegner score, 7). All patients had a minimum follow-up of 12 months (mean postoperative follow-up, 33.0 months). Multivariate logistic regression analysis was conducted to determine the association of patient variables with the presence of meniscal injuries and irreparable meniscal tears during primary ACLR. Results: The risk factor for medial meniscal injuries was TTS ≥3 months (odds ratio [OR], 4.213; 95% CI, 3.104-5.719; P < .001). The presence of irreparable medial meniscal tears increased with older age (OR, 1.053; 95% CI, 1.024-1.084; P < .001), higher BMI (OR, 1.077; 95% CI, 1.003-1.156; P = .042), and TTS ≥3 months (OR, 1.794; 95% CI, 1.046-3.078; P = .034). On multivariate analysis, none of the variables were significantly associated with lateral meniscal injuries and irreparable meniscal tears. The failure rate, defined as patients who needed additional medial meniscal surgery after medial meniscal repair, was 4.6%. Conclusion: Time from ACL injury to reconstruction of ≥3 months was strongly associated with medial meniscal injuries and irreparable medial meniscal tears at primary ACLR. Older age and increased BMI were also risk factors for the presence of irreparable medial meniscal tears at ACLR.
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Affiliation(s)
- Tomohiro Tomihara
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Junsei Takigami
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Shiro Okazaki
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
| | - Nagakazu Shimada
- Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan
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22
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Geffroy L. Meniscal pathology in children and adolescents. Orthop Traumatol Surg Res 2021; 107:102775. [PMID: 33321242 DOI: 10.1016/j.otsr.2020.102775] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
The menisci play a key role in knee biomechanics and long-term cartilage protection. Preserving the meniscus is thus a major functional consideration in children and adolescents. In normal menisci, lesions are traumatic in origin. They are often vertical, in the posterior segment, associated with anterior cruciate ligament tear. In abnormal menisci, lesions are much more specific to children, occurring atraumatically, mainly in discoid menisci. Clinical signs of traumatic meniscal lesion are minimal, and associated ligament involvement should be systematically screened for. In contrast, clinical findings are rich and specific in discoid malformative pathology, sometimes showing the typical "clunk" sign highly suggestive of a detachment. The complementary examination of choice is MRI. In children more than in adults, lesions need screening for in apparently normal menisci. This particularly concerns ramp lesions of the medial meniscus. It is important also to be aware of false signs, and notably linear hypersignal of vascular origin in the posterior segment of the medial meniscus. MRI is essential in determining type of tear and guiding surgery in discoid meniscal pathology. Indications for meniscal repair in children are maximal, even in lesions extending into the white zone, and the risk of failure needs to be assumed. All meniscal suture techniques - all-inside, in-out and out-in - need to be acquired. Meniscectomy, even partial, should be exceptional. Treatment of symptomatic discoid meniscus usually involves minimal central meniscoplasty and suture of the discovered lesion. Results of meniscal repair in children are generally very satisfactory, whatever the type or site of lesion. Vertical suture is to be preferred; suture failure is often only partial. In all, optimal treatment of meniscal pathology in children and adolescents requires perfect knowledge of pediatric specificities and above all mastery of repair techniques to restore meniscal tissue as fully as possible so as to conserve future knee function.
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Affiliation(s)
- Loïc Geffroy
- Chirurgie orthopédique et traumatologique, polyclinique Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
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23
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Fedje-Johnston W, Tóth F, Albersheim M, Carlson CS, Shea KG, Rendahl A, Tompkins M. Changes in Matrix Components in the Developing Human Meniscus. Am J Sports Med 2021; 49:207-214. [PMID: 33237814 DOI: 10.1177/0363546520972418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of meniscal tears is necessary to maintain the long-term health of the knee joint. Morphological elements, particularly vascularity, that play an important role in meniscal healing are known to change during skeletal development. PURPOSE To quantitatively evaluate meniscal vascularity, cellularity, collagen, and proteoglycan content by age and location during skeletal development. STUDY DESIGN Descriptive laboratory study. METHODS Medial and lateral menisci from 14 male and 7 female cadavers aged 1 month to 11 years were collected and evaluated. For each meniscus, histologic and immunohistologic techniques were used to establish the ratio of the area of proteoglycan (safranin O) positivity to the total area (proteoglycan ratio), collagen type I and type II immunostaining positivity, number of blood vessels, and cell density. These features were evaluated over the entire meniscus and also separately in 5 circumferential segments: anterior root, anterior horn, body, posterior horn, and posterior root. Additionally, cell density and number of blood vessels were examined in 3 radial regions: inner, middle, and periphery. RESULTS Age was associated with a decrease in meniscal vessel count and cell density, while the proteoglycan ratio increased with skeletal maturity. Differences in vessel counts, cellular density, and proteoglycan ratio in different anatomic segments as well as in the inner, middle, and peripheral regions of the developing menisci were also observed. Collagen immunostaining results were inconsistent and not analyzed. CONCLUSION The cellularity and vascularity of the developing meniscus decrease with age and the proteoglycan content increases with age. All of these parameters are influenced by location within the meniscus. CLINICAL RELEVANCE Age and location differences in meniscal morphology, particularly in the number of blood vessels, are expected to influence meniscal healing.
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Affiliation(s)
- William Fedje-Johnston
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota, USA
| | - Ferenc Tóth
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota, USA
| | - Melissa Albersheim
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cathy S Carlson
- Department of Veterinary Clinical Sciences, University of Minnesota, St Paul, Minnesota, USA
| | - Kevin G Shea
- Department of Orthopedic Surgery, Stanford University, Redwood City, California, USA
| | - Aaron Rendahl
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St Paul, Minnesota, USA
| | - Marc Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,Tria Orthopedic Center, Bloomington, Minnesota, USA
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Fried JW, Manjunath AK, Hurley ET, Jazrawi LM, Strauss EJ, Campbell KA. Return-to-Play and Rehabilitation Protocols Following Isolated Meniscal Repair-A Systematic Review. Arthrosc Sports Med Rehabil 2020; 3:e241-e247. [PMID: 33615271 PMCID: PMC7879171 DOI: 10.1016/j.asmr.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/29/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To systematically review the literature and assess the reported rehabilitation protocols, return-to-play guidelines, and reported rates of return-to-play after meniscal repair. Methods MEDLINE, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies on meniscal repair. Studies were included if return-to-play data and/or rehabilitation protocols were reported. The rate and timing of return-to-play was assessed. The rehabilitation protocols were documented, in addition to when to start range of motion (ROM), full ROM, partial weight-bearing (WB), and full WB. Results Overall, 88 studies met our inclusion criteria. Thirteen studies, including 507 patients, cited a range of 71.2% to 100% of return-to-play, with 53.9% to 92.6% returning to the same/greater level, ranging between 3.3 and 10 months. There was considerable variability in the reported rehabilitation protocols, but the most frequently reported time to begin ROM exercises was within the first week (78.9%) and full ROM at 6 weeks (33.3%). Partial WB was typically begun during the first week (61.0%), and full WB between the fourth and sixth week (65.6%) postoperatively. Following surgery, time elapsed was the most commonly cited criteria for return-to-play (97.0%), with 6 months being the most common time point applied (46.9%). No study advised against returning to competitive or contact sports after meniscal repair. Conclusions In conclusion, there was a high rate of return-to-play following meniscal repair, with 60% of patients returning to the same level of play. However, there was considerable diversity in the reported rehabilitation protocols and insufficient reporting on return-to-play criteria in the literature. This demonstrates the need for further research and formulation of an evidence-based consensus statement for this patient population. Level of Evidence Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Jordan W Fried
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Amit K Manjunath
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
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25
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Blanchard ER, Hadley CJ, Wicks ED, Emper W, Cohen SB. Return to Play After Isolated Meniscal Repairs in Athletes: A Systematic Review. Orthop J Sports Med 2020; 8:2325967120962093. [PMID: 33283001 PMCID: PMC7686632 DOI: 10.1177/2325967120962093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Meniscal tears are a common knee injury. Isolated meniscal tears are less
common; however, unaddressed tears can be troublesome, particularly for
athletes. There is currently a lack of data in the literature on athletes
returning to play after isolated meniscal repair. Purpose: To evaluate the return to play rate and time to return to play for athletes
with isolated meniscal injuries. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, EMBASE, and Cochrane electronic databases was
conducted to identify studies that reported the time and the rate of return
to play in athletes after repair of isolated meniscal tears. Studies were
excluded if there was a concomitant anterior cruciate ligament
reconstruction, if there was a meniscectomy instead of a meniscal repair, or
if the study was a systematic review. Quality assessment and data extraction
were performed by 2 examiners. Results: Overall, 21 studies were included in this review. There were 355 athletes
(358 knees) with a mean age of 22.5 years (range, 9-68 years). A sex
breakdown was noted in 16 of the 21 (76.2%) studies with 224 men and 71
women. The specific repair technique was described in 259 (72.3%) knees. Of
the total knees, 109 (30.4%) had an open repair, 128 (35.8%) had an
inside-out arthroscopic technique repair, and 22 (6.1%) had an all-inside
arthroscopic technique repair. Complications were addressed in 11 studies,
with 13 out of 155 (8.4%) patients across the 11 articles having a
postoperative complication. Of the total 355 patients, 295 (83.1%) returned
to play, and 17 of these 21 (81.0%) articles reported the time it took for
athletes to return to play, with a mean return of 8.7 months. Conclusion: The study results indicate that return to play rates after isolated meniscal
repair are high, with an overall return to play rate of 83.1% and a mean
return to play time of 8.7 months. However, the limited number of studies,
particularly ones with larger patient numbers, highlights the need for
further investigation regarding isolated meniscal repair in athletes.
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Affiliation(s)
- Erica R Blanchard
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Christopher J Hadley
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Eric D Wicks
- Lakeland Regional Health, Lakeland, Florida, USA
| | - William Emper
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Steven B Cohen
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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26
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Meniscus repairs in the adolescent population-safe and reliable outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:3587-3596. [PMID: 32979079 PMCID: PMC7654713 DOI: 10.1007/s00167-020-06287-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and functional results, and (3) activity-related outcomes including return to sport. METHODS Two authors independently searched MEDLINE, Cochrane Central Register of Controlled Trials & Cochrane Library, and CINHAL databases for literature related to meniscus repair in an adolescent population according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No meta-analysis was performed in this qualitative systematic review. RESULTS Thirteen studies, including no Level I, one Level II, one Level III, and eleven Level IV studies yielded 466 patients with 503 meniscus repairs. All defined meniscal re-tear as a primary endpoint, with a reported failure rate ranging from 0 to 42% at a follow-up ranging from 22 to 211 months. There were a total of 93 failed repairs. IKDC scores were reported in four studies with a mean improvement ranging from 24 to 42 (P < 0.001). Mean post-operative Lysholm scores were reported in seven studies, ranging from 85 to 96. Additionally, four of those studies provided mean pre-operative Lysholm scores, ranging from 56 to 79, with statistically significant mean score improvements ranging from 17 to 31. Mean post-operative Tegner Activity scores were reported in nine studies, with mean values ranging from 6.2 to 8. CONCLUSION This systematic review demonstrates that both subjective and clinical outcomes, including failure rate, Lysholm, IKDC, and Tegner activity scale scores, are good to excellent following meniscal repair in the adolescent population. Further investigations should aim to isolate tear type, location, surgical technique, concomitant procedures, and rehabilitation protocols to overall rate of failure and clinical and functional outcomes. LEVEL OF EVIDENCE IV.
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27
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Hinckel BB, Baumann CA, Ejnisman L, Cavinatto LM, Martusiewicz A, Tanaka MJ, Tompkins M, Sherman SL, Chahla JA, Frank R, Yamamoto GL, Bicos J, Arendt L, Fithian D, Farr J. Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00083. [PMID: 33986224 PMCID: PMC7537824 DOI: 10.5435/jaaosglobal-d-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
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Affiliation(s)
- Betina B Hinckel
- From the Oakland University, Rochester (Dr. Hinckel, and Dr. Cavinatto); Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak (Dr. Hinckel, Dr. Cavinatto), MI; the University of Missouri-School of Medicine, Columbia, MO (Mr. Baumann); the Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR (Dr. Ejnisman); the Shoulder and Elbow Surgery, Beaumont Orthopaedic Associates, Beaumont Health (Dr. Martusiewicz); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Tanaka); the Department of Orthopedic Surgery, TRIA Orthopedic Center, University of Minnesota, Gillette Children's Specialty Healthcare, MN (Dr. Tompkins); the Department of Orthopedic Surgery, Stanford University, CA (Dr. Sherman); the Rush University Medical Center, Chicago, IL (Dr. Chahla); the Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, Aurora, CO (Dr. Frank); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Yamamoto); CEGH-CEL, Instituto de Biociências, Universidade de São Paulo (Dr. Yamamoto); DASA Laboratories, Sao Paulo, Brazil (Dr. Yamamoto); the Michigan Orthopedic Surgeons, Fellowship Director William Beaumont Sports Medicine Fellowship, Assistant Professor Oakland University William Beaumont School of Medicine, MI (Dr. Bicos); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Arendt); the Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, CA (Dr. Fithian); and the Knee Preservation, Cartilage Regeneration and OrthoBiologics, Department of Orthopedic Surgery, Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, IN (Dr. Farr)
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Abstract
Meniscal injuries are common in the population, representing the major cause of functional impairment in the knee. Vertical longitudinal injuries of the meniscus can be stable or unstable. When extensive, they are commonly unstable and can lead to clinical signs of significant functional disability. Vertical longitudinal injuries have the best prognosis for repair, especially when occurring in the meniscal periphery, called the red-red zone. A recently developed type of meniscal suture device called Meniscus 4 A-II enables the surgeon to perform a meniscal suture from the inside-out continuously, reducing surgical time. Because it allows the surgeon to use a single and inexpensive device to repair the entire injury, costs are significantly reduced. Here, an approach to carry out continuous meniscal repair with vertical sutures is described. This technique warrants excellent stability to the meniscal repair, increasing the chances of a successful outcome. We believe that the popularization of the repair technique from the inside out using the Meniscus 4-All device will help many surgeons around the world save menisci that otherwise would have a great chance of being excised, since it is a cheap, reproducible, and easy-to-handle device.
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Risk of Subsequent Knee Arthroplasty After Sports Medicine Procedures. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00125. [PMID: 32852917 PMCID: PMC7430232 DOI: 10.5435/jaaosglobal-d-20-00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Approximately 10% of men and 13% of women older than the age of 60 are affected by symptomatic osteoarthritis of the knee. Anatomic repair or reconstruction after knee injury has been a central tenet of surgical treatment to reduce the risk of osteoarthritis. The purpose of this study was to examine common sports medicine procedures of the knee and determine the proportion of patients who subsequently undergo total knee arthroplasty (TKA). METHODS The MarketScan database was queried from the period of January 2007 through December 2016. Patients were identified, who underwent a procedure of the knee, as defined by Current Procedural Terminology codes relating to nonarthroplasty procedures of the knee. Patients in whom laterality could not be confirmed or underwent another ipsilateral knee procedure before TKA were excluded from this study. The primary outcome of this study was the overall rate of TKA after index knee surgery. Time from index procedure to TKA was a secondary outcome. A multivariate regression analysis was used to control for covariates such as age, sex, and comorbidity status. RESULTS A total of 843,749 patients underwent one of the 13 common sports medicine procedures of the knee. The procedure with the highest unadjusted rate of subsequent TKA was arthroscopic osteochondral allograft (5.81%), whereas anterior cruciate ligament (ACL) reconstruction with meniscus repair demonstrated the lowest rate of subsequent TKA (0.01%). When adjusting for confounding factors, the regression analysis identified meniscal transplantation (odds ratio [OR] = 3.06, P < 0.0001) as having the highest risk of subsequent TKA, followed by osteochondral autograft (OR = 1.74, P = 0.0424) and arthroscopic osteochondral allograft (OR = 1.49, P < 0.0001). ACL reconstruction with meniscus repair (OR = 0.02, P < 0.0001), ACL reconstruction alone (OR = 0.17, P < 0.0001), ACL with meniscectomy (OR = 0.20, P < 0.0001), and meniscal repair (OR = 0.65, P < 0.0001) had the lowest rate of subsequent TKA. ACL reconstruction with meniscus repair had the longest period from index procedure to TKA at 2827 days. CONCLUSION ACL reconstruction and meniscus preservation demonstrated an extremely low rate of conversion to TKA when compared with patients who needed salvage interventions such as meniscus and cartilage transplantation. None of the salvage interventions delayed the need for a TKA. Meniscal transplantation had the highest risk of all procedures of going on to a TKA.
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30
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Morris JH, Magnussen RA, DiBartola AC, Aldabbeh S, Duerr RA, Kaeding CC, Flanigan DC. Patient Outcomes After Horizontal Cleavage Tear Repair: A Systematic Review. Arthroscopy 2020; 36:2316-2331. [PMID: 32360266 DOI: 10.1016/j.arthro.2020.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the clinical outcomes and survivorship of meniscal horizontal cleavage tear (HCT) repairs with hopes of guiding future treatment decisions. METHODS Standard systematic review methodology was used. A comprehensive search of PubMed was conducted on June 1, 2019. The inclusion criteria were articles that were published in English, involved human subjects, and reported on at least 1 outcome after repair of HCTs. The exclusion criteria included technique guides and reviews, studies without full text available, and studies with HCT outcomes not separated from other repair groups. Effect heterogeneity was determined using the I2 measure. Forest plots were created in addition to a random-effects model to show the results. RESULTS The systematic review yielded 19 studies evaluating 289 knees in a total of 273 patients. At most recent follow-up, there was a high probability of return to sport (93.1% [67 of 72]). Overall, 74% of patients (67 of 90) were symptom free at last follow-up, and 80% expressed satisfaction with their overall result (80 of 100). The most frequently reported subjective outcome was the Lysholm score, which improved from a preoperative study range of 48 to 79 (I2 = 20.7%, P = .283) to a postoperative study range of 56 to 99 (I2 = 49%, P = .081). The next most commonly reported was the International Knee Documentation Committee subjective score, which improved from a preoperative study range of 16 to 49 (I2 = 47.7%, P = .125) to a postoperative study range of 72 to 95 (I2 = 0%, P = .660). An overall 11.7% reported risk of reoperation was found, with most cases involving revision meniscectomy. Rates of complications beyond fixation failure were overall very low, with infrequent reports of septic arthritis and transitory dysesthesia. CONCLUSIONS The short- to intermediate-term results of repair of HCTs are comparable to prior studies. Survivorship is comparable to repairs of other types of meniscal tears with high rates of return to sport and low complication rates. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Jesse H Morris
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Robert A Magnussen
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Alex C DiBartola
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Summer Aldabbeh
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Robert A Duerr
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Christopher C Kaeding
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - David C Flanigan
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Cartilage Restoration Program, Columbus, Ohio, U.S.A..
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31
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Rocha de Faria JL, Pavão DM, Villardi AM, de Sousa EB, Guimarães JM, Carmo JMDM, Mozella ADP. Continuous Meniscal Suture Technique of the Knee. Arthrosc Tech 2020; 9:e791-e796. [PMID: 32577353 PMCID: PMC7301274 DOI: 10.1016/j.eats.2020.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/12/2020] [Indexed: 02/03/2023] Open
Abstract
The menisci are fibroelastic structures interposed between the articular surfaces of the femur and tibia. They absorb impact and transmit load. Meniscal injury may compromise function and cause rapid joint degeneration, leading to the development of secondary osteoarthritis. Surgical treatment of meniscal injury is usually performed by arthroscopy, and meniscectomy or meniscal suture may be associated with such treatment. Meniscal suture should be considered when the injury compromises the proper functioning of the meniscus to recover its anatomy and function. Different meniscal suture techniques exist; the most widely used are the inside-out, outside-in, and all-inside techniques. The gold-standard repair technique is the inside-out technique. A drawback of this technique is the need to alternate between intra- and extra-articular structures for every stitch, which makes it even more laborious. We describe the continuous meniscal suture technique, also called "meniscal stitching," for a medial meniscal bucket-handle injury. This technique is performed from the inside out and allows the surgeon to perform multiple stitches with the same thread quickly and effectively. This surgical technique is performed using a single meniscal suture device that was developed by our group, called the "Meniscus 4 A-II" device.
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Affiliation(s)
- José Leonardo Rocha de Faria
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil,Address correspondence to José Leonardo Rocha de Faria, M.D., Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Av Brasil, 500, Rio de Janeiro, Brazil, CEP 20940-070.
| | - Douglas Mello Pavão
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - Alfredo Marques Villardi
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - Eduardo Branco de Sousa
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - João Matheus Guimarães
- Research and Teaching Division, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | | | - Alan de Paula Mozella
- Knee Surgery Center, National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil,Orthopedics Discipline, Medical Science Faculty, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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The repair of horizontal cleavage tears yields higher complication rates compared to meniscectomy: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:915-925. [PMID: 31187178 DOI: 10.1007/s00167-019-05557-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Horizontal cleavage tears of the meniscus (HCTs) are primarily degenerative in nature, and, however, can be the result of trauma. Such tears account for 12-35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. The purpose of this review was to systematically assess the outcomes and complications for patients undergoing the surgical treatment of HCTs. METHODS This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses. The electronic databases PubMed, MEDLINE, and EMBASE were searched from data inception to December 30, 2018 for articles addressing the surgical treatment of HCTs. The Methodological Index for Non-randomized Studies was used to assess study quality. Data are presented descriptively. RESULTS Overall, 23 studies were identified, comprising of 702 patients (708 knees) with a mean age of 36.6 ± 9.9 years and a mean follow-up of 33.6 ± 19.6 months. The majority of patients were treated with a partial meniscectomy (59.0%), followed by repair (32.8%) and total meniscectomy (8.2%). Both meniscectomy and repair patients had improvements which surpassed minimal clinically important differences with regard to clinical (e.g. pain, function, daily living) and radiographic outcomes. The overall complication rate was 5.1%, primarily involving patients undergoing meniscal repair (12.9% of all knees undergoing a repair). CONCLUSION Although meniscal repair theoretically may provide improvement in biomechanical loading, patients undergoing repair had higher complication rates than those undergoing partial meniscectomy. Clinicians should consider the available implants in determining which tear patterns to repair and future studies with long-term follow-up are needed to investigate complications (e.g. secondary meniscal procedures) as well as the potential for delay in the development of osteoarthritis. LEVEL OF EVIDENCE Level IV.
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Mine T, Ueda T, Ihara K, Kawamura H, Kuriyama R, Tominaga Y. Possibility of Meniscal Repair for Degenerative and Horizontal Tears. Open Orthop J 2019. [DOI: 10.2174/1874325001913010260] [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] [Indexed: 02/22/2023] Open
Abstract
Background:Poor long-term clinical results have been reported following partial and total menisectomy. To preserve the meniscus, many surgeons perform meniscal repairs when possible. However, meniscal repair for degenerative tears and white-white tears is challenging.Methods:15 patients underwent meniscal repair for degenerative and horizontal tears. Follow-up evaluation included clinical assessment and Magnetic Resonance Imaging examination. The mean follow-up time was 11.9 months (from 8 months to 13 months).Result:The healing rate on clinical assessment was 86.6% 12 months after surgery. MRI showed partial healing in 12 patients, complete healing in 1 and no healing in 2 after 12 months.Conclusion:The findings suggest that it may be possible to repair degenerative and horizontal meniscal tears.
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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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Schlechter JA, Nguyen SV, Fletcher KL. Meniscal Repairs in the Adolescent Knee: Can the Number of Fixation Sites Improve Outcomes? Orthop J Sports Med 2019; 7:2325967119881963. [PMID: 31803787 PMCID: PMC6878606 DOI: 10.1177/2325967119881963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Meniscal pathology in children and adolescents is now a common occurrence because of their ever-increasing participation in youth sports. Purpose: To investigate the outcomes of arthroscopic meniscal repair in an adolescent cohort and analyze the variables that may affect outcomes, specifically the number of fixation sites utilized during repair. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all children and adolescents younger than 18 years who underwent arthroscopic meniscal repair at a single institution was performed. Patient characteristics, operative details (eg, tear pattern, tear location, method of repair, and number of fixation sites [determined based on the number of sutures used for repair]), and concomitant procedures were recorded. Results: A total of 175 primary meniscal repairs met inclusion criteria and were analyzed. Of this cohort, 115 were able to be contacted and were included in the final study cohort. The mean follow-up was 41 months. The mean age of the children was 14.9 years, and 91 (79%) had concomitant anterior cruciate ligament reconstructions with their meniscal repair. The mean Pediatric International Knee Documentation Committee functional outcome score was 91 (range, 43-100), and the mean Lysholm functional outcome score was 91 (range, 47-100). Of the 115 meniscal repairs, there were a total of 19 reoperations (17%); 15 (13%) were because of meniscal repair failures. The only variable that statistically increased the risk of meniscal repair failure was low number of fixation sites, with the failure group having a mean of 1.79 sutures and the nonfailure group having a mean of 2.97 sutures (P = .03). Conclusion: Successful meniscal repairs and a lower failure rate may be achieved with a greater number of fixation sites with promising results at a minimum 2-year follow-up. Validated functional outcome scores were good, with a 13% failure rate. Larger cohort, longer term, multicenter multisurgeon data are still needed to further elucidate the number of fixation sites needed when performing a meniscal repair in the pediatric and adolescent knee.
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Affiliation(s)
- John A Schlechter
- Children's Hospital of Orange County, Orange, California, USA.,Riverside University of Health Sciences, Moreno Valley, California, USA
| | - Shawn V Nguyen
- Riverside University of Health Sciences, Moreno Valley, California, USA
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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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Cruz AI, Gao B, Ganley TJ, Pennock AT, Shea KG, Beck JJ, Ellis HB. Trends in Concomitant Meniscal Surgery Among Pediatric Patients Undergoing ACL Reconstruction: An Analysis of ABOS Part II Candidates From 2000 to 2016. Orthop J Sports Med 2019; 7:2325967119869848. [PMID: 31579682 PMCID: PMC6759752 DOI: 10.1177/2325967119869848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Rates of anterior cruciate ligament (ACL) reconstruction among pediatric and adolescent patients are increasing. Limited knowledge exists about population-level rates of concomitant meniscal surgery in this age group. Purpose/Hypothesis This study sought to examine trends in concomitant meniscal procedures and describe short-term complications in pediatric and adolescent patients undergoing ACL reconstruction. We hypothesized that overall meniscal surgery rates are increasing and that the likelihood of performing meniscal repair or meniscectomy is associated with patient- and surgeon-specific factors. Study Design Cross-sectional study. Methods We queried ACL procedures in patients younger than 19 years reported by American Board of Orthopaedic Surgery (ABOS) part II examination candidates from 2000 to 2016. Regression models examined associations between patient and surgeon characteristics, year of surgery, follow-up time, meniscal procedure type, and number and type of complications. Results A total of 9766 cases were identified. Females represented 46% (n = 4468) of included cases. Mean patient age was 16.1 years (SD, 1.62 years; range, 0-18 years). The rate of concomitant ACL-meniscal procedures increased from the years 2000 to 2016 (49%-60%; P = .005). Surgeons with sports medicine (+7.0%) or pediatric orthopaedic fellowship (+6.6%) training had a higher likelihood of reporting a concomitant ACL-meniscal procedure (P = .003 and .006, respectively). Sports medicine-trained surgeons were more likely to perform meniscal repair compared with meniscectomy (+3.0%; P = .016). Younger patient age was associated with increased likelihood of undergoing meniscal repair compared with meniscectomy. Overall reported complication rate was 12.8%. Notable reported complications included infection (1.61%), arthrofibrosis (1.14%), and deep venous thrombosis or pulmonary embolism (0.11%). Sports medicine and pediatric orthopaedic fellowship training was associated with higher rates of reporting postoperative stiffness and/or arthrofibrosis. Conclusion Among ABOS part II candidates, concomitant ACL-meniscal surgery has become more common than isolated ACL procedures. Procedures involving sports medicine fellowship-trained surgeons and younger patients were associated with increased rates of meniscal repair compared with meniscectomy. Pediatric orthopaedic and sports medicine training was associated with a greater likelihood of being involved in a concomitant ACL-meniscal procedure of any kind, and surgeons with such training also reported a higher incidence of postoperative stiffness and/or arthrofibrosis in patients.
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Affiliation(s)
- Aristides I Cruz
- Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Burke Gao
- Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Theodore J Ganley
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew T Pennock
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Jennifer J Beck
- Orthopaedic Institute for Children, University of California, Los Angeles, Los Angeles, California, USA
| | - Henry B Ellis
- Department of Orthopaedic Surgery, University of Texas Southwestern, Texas Scottish Rite Hospital for Children and Children's Medical Center, Dallas, Texas, USA
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Hagmeijer MH, Hevesi M, Desai VS, Sanders TL, Camp CL, Hewett TE, Stuart MJ, Saris DBF, Krych AJ. Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up. Am J Sports Med 2019; 47:1583-1590. [PMID: 31145668 DOI: 10.1177/0363546519844481] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. PURPOSE To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. RESULTS Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). CONCLUSION Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.
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Affiliation(s)
- Michella H Hagmeijer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vishal S Desai
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas L Sanders
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy E Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,MIRA Institute for Biotechnology and Technical Medicine, University Twente, Enschede, the Netherlands
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
PURPOSE OF REVIEW The purpose of this study was to review the clinical and functional outcomes of meniscus repair in children and adolescents. RECENT FINDINGS The sequel of meniscal tears and the outcome of meniscus repair have been well studied in adults. However, these topics have received less attention in the pediatric population despite the high prevalence and potentially critical effect on long-term knee function in children. Meniscus repair has a healing rate ranging from 33 to 100% with less than 40% reoperation rate. Several factors have been suggested to play a role in healing, such as concomitant ACL reconstruction and complexity of the tear. There is a lack of standardization among the utilization of functional outcome and activity level questionnaires across studies; however, most report improved function postoperatively. Other important considerations include bucket handle tears, the discoid meniscus, rehabilitation and return to sports, and alternatives after failed meniscus repair. Based on the favorable outcomes reported, meniscus repair should be attempted in most meniscus tears in children.
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Affiliation(s)
- Brian W Yang
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth S Liotta
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikolaos Paschos
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Liechti DJ, Constantinescu DS, Ridley TJ, Chahla J, Mitchell JJ, Vap AR. Meniscal Repair in Pediatric Populations: A Systematic Review of Outcomes. Orthop J Sports Med 2019; 7:2325967119843355. [PMID: 31205961 PMCID: PMC6537073 DOI: 10.1177/2325967119843355] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Loss of meniscal tissue in the pediatric population can have long-term consequences on joint health, highlighting the importance of meniscal preservation in this group. Purpose: To systematically review reported knee outcome measures and complication rates after repair of meniscal tears in children and adolescents. Study Design: Systematic review; Level of evidence, 4. Methods: A review of the literature regarding the existing evidence for pediatric meniscal tear outcomes was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). Included were articles in English that reported the outcomes of meniscal tears in the pediatric population (<18 years old) with a follow-up of more than 12 months. Clinical outcome scores were reviewed. Results: A total of 1003 total studies were initially retrieved, with 8 meeting the inclusion criteria. The review included 287 patients (165 male, 122 female), mean age 15.1 years (range, 4-18 years), with 301 meniscal tears (reported: 134 medial, 127 lateral, and 32 both medial and lateral, 8 location unspecified). Concomitant anterior cruciate ligament reconstruction was performed in 52% (158/301) of meniscal repairs. The average reported postoperative Lysholm scores ranged from 85.4 to 96.3, and the average reported postoperative Tegner activity scores ranged from 6.2 to 8. Conclusion: Arthroscopic repair of a meniscal tear in the pediatric and adolescent population is an effective treatment option that has a low failure rate, enhances postoperative clinical outcomes, and preserves meniscal tissues.
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Affiliation(s)
- Daniel J Liechti
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - David S Constantinescu
- Virginia Commonwealth University Department of Orthopedic Surgery, Richmond, Virginia, USA
| | - Taylor J Ridley
- University of Minnesota Department of Orthopaedic Surgery, Minneapolis, Minnesota, USA
| | - Jorge Chahla
- Cedars Sinai Kerlan Jobe Institute, Santa Monica, California, USA
| | - Justin J Mitchell
- Gundersen Health System, Division of Sports Medicine, La Crosse, Wisconsin, USA
| | - Alexander R Vap
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Patel NM, Mundluru SN, Beck NA, Ganley TJ. Which Factors Increase the Risk of Reoperation After Meniscal Surgery in Children? Orthop J Sports Med 2019; 7:2325967119842885. [PMID: 31080841 PMCID: PMC6498778 DOI: 10.1177/2325967119842885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Meniscal injuries in children can pose treatment challenges, as the meniscus must maintain its biomechanical function over a long lifetime while withstanding a high activity level. While the adult literature contains a plethora of studies regarding risk factors for failure of meniscal surgery, such reports are scarcer in children. Purpose: To determine the rate at which children undergoing meniscal surgery require subsequent reoperation as well as to define risk factors for reoperation in this population. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective institutional database of 907 first-time meniscal surgical procedures performed between 2000 and 2015 was reviewed. All patients were <18 years old. Demographic and intraoperative information was recorded, as were concurrent injuries or operations and subsequent procedures. Univariate analysis consisted of chi-square and independent-samples t tests. Multivariate logistic regression with purposeful selection was then performed to adjust for confounding factors. Results: The mean ± SD patient age was 13.2 ± 2.1 years, and 567 (63%) were male. The mean postoperative follow-up duration was 20.1 ± 10.1 months. Overall, 83 patients (9%) required repeat surgery at a mean of 23.2 months after the index operation. After adjustment for confounders in a multivariate model, meniscal repair resulted in 3.1-times higher odds of reoperation when compared with meniscectomy (95% CI, 1.2-8.3; P = .02), while white-white zone tears had 2.8-times lower odds of reoperation (95% CI, 1.01-7.7; P = .04) versus red-red and red-white zone tears. Conclusion: Approximately 9% of children undergoing meniscal surgery will require reoperation at a mean 23.2 months after the index operation. Repair carried approximately 3-times higher odds of reoperation than meniscectomy, while white-white zone tears had nearly 3-times lower odds of requiring repeat surgery when compared with tears in other zones.
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Affiliation(s)
- Neeraj M. Patel
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Surya N. Mundluru
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Theodore J. Ganley
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Theodore J. Ganley, MD, Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA ()
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Hagmeijer MH, Kennedy NI, Tagliero AJ, Levy BA, Stuart MJ, Saris DBF, Dahm DL, Krych AJ. Long-term Results After Repair of Isolated Meniscal Tears Among Patients Aged 18 Years and Younger: An 18-Year Follow-up Study. Am J Sports Med 2019; 47:799-806. [PMID: 30802135 DOI: 10.1177/0363546519826088] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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 desirable over resection to prevent postmeniscectomy arthritis, especially among young and active patients. However, long-term data are currently lacking following isolated meniscal repair, particularly in the pediatric population. PURPOSE/HYPOTHESIS To report long-term follow-up of isolated meniscal tears treated by meniscal repair in a pediatric and adolescent population and to compare those results with previous midterm follow-up data reported. The authors hypothesized that these patients would have satisfactory function and reoperation rates at long-term follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS Forty-four patients aged ≤18 years undergoing repair of an isolated meniscal tear (without concomitant anterior cruciate ligament injury) between 1990 and 2005 were included. At the time of final follow-up, recurrent tear, reoperations, and International Knee Documentation Committee (IKDC) and Tegner scores were determined. With logistic regression, the overall failure among tear types was calculated. Wilcoxon rank sum analysis were performed to calculate the differences in clinical outcome for different time points, and Spearman coefficients were calculated for Tegner and IKDC with different variables. RESULTS At a mean follow-up of 17.6 years (range, 13.1-25.9 years), 32 patients with 33 isolated meniscal repairs (29 male, 3 female) with a mean age of 16.1 years (range, 9.9-18.7 years) at surgery were included in this study. At early follow-up, the overall failure rate was 14 of 33 (42%); complex tears (80%) and bucket-handle tears (47%) had higher overall failure rates when compared with simple tears (18.2%), although only complex tears had a significantly higher failure rate. However, no further failures occurred since midterm follow-up with any tear type. At final follow-up, the mean IKDC score was 92.3, which was significantly increased when compared with preoperative (65.3, P < .0001) and midterm (90.2, P = .01) scores. The mean Tegner score (6.5) was significantly lower than both preoperative (8.3, P < .0001) and midterm (8.4, P < .0001) scores. There was no difference in Tegner or IKDC score for patients with successful versus failed repair. CONCLUSION In conclusion, while there was a high early failure rate, this study demonstrated overall good to excellent long-term clinical outcomes after isolated meniscal repair in an adolescent population, even for those requiring reoperation. Early failure and reoperation rates were variable, depending on tear type, with complex multiplanar tears having more failures at short-term follow-up. However, at long-term follow-up, IKDC and Tegner scores were not significantly different for those with complex tears as compared with other tear types.
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Affiliation(s)
- Michella H Hagmeijer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicholas I Kennedy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam J Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,MIRA Institute for Biotechnology and Technical Medicine, University Twente, Enschede, the Netherlands
| | - 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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44
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Kramer DE, Kalish LA, Martin DJ, Yen YM, Kocher MS, Micheli LJ, Heyworth BE. Outcomes After the Operative Treatment of Bucket-Handle Meniscal Tears in Children and Adolescents. Orthop J Sports Med 2019; 7:2325967118820305. [PMID: 30729144 PMCID: PMC6350150 DOI: 10.1177/2325967118820305] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Bucket-handle meniscal tears (BHMTs), which we define as vertical
longitudinal tears of the meniscus with displacement of the torn inner
fragment toward the intercondylar notch region, are a well-recognized tear
pattern. Optimizing the management of BHMTs in younger patients is
important, as preserving meniscal tissue may limit future joint
degeneration. Purpose/Hypothesis: The purpose of this study was to review the patient demographics, clinical
presentation, operative details, outcomes, and risk factors for a
reoperation associated with operatively treated BHMTs in a pediatric
population. We hypothesized that the repair of BHMTs in adolescents would
yield a higher reoperation rate than meniscectomy in our population. Study Design: Case-series; Level of evidence, 4. Methods: A departmental database was queried to identify all patients 19 years or
younger who presented with a BHMT and underwent surgery between October 2002
and February 2013. Clinical, radiological, and surgical data were
retrospectively collected, and risk factors for a reoperation and persistent
pain were assessed in all patients with longer than or equal to 6 months of
follow-up. Results: A total of 280 BHMTs were treated arthroscopically by 1 of 8 sports medicine
fellowship–trained surgeons. The mean age at surgery was 15.5 ± 2.5 years
(range, 2.1-19.2 years), and most patients were male (177/280; 63%). Most
injuries occurred during sports (203/248; 82%) and involved the medial
meniscus (157/280; 56%). Concurrent anterior cruciate ligament (ACL) surgery
was performed in 103 cases (37%). Meniscal repair was performed in 181 cases
(65%) and was more common in younger patients (P = .01) and
for the lateral meniscus (P < .001). Among 185 (66%)
cases with longer than or equal to 6 months of adequate follow-up data
(which included 126 meniscal repairs [68%]), a meniscus-related reoperation
occurred in 45 (24%) cases. A reoperation related to the original BHMT
injury or surgery was more common after meniscal repair than after
meniscectomy (40/126 [32%] vs 5/59 [8%], respectively) (P =
.001) and less common with concurrent ACL surgery (P =
.07), although this was not statistically significant. Among patients
injured during sports and with adequate follow-up, all but 1 patient
(176/177; 99%) returned to sports; a slower rate of return was seen in those
undergoing meniscal repair (P = .002) and concurrent ACL
surgery (P < .001). At final follow-up, 170 of 185
patients (92%) were pain free. For the 15 patients with persistent pain at
final follow-up, no identifiable risk factors for persistent pain were
identified. Conclusion: Most BHMTs in younger patients occurred in males and during sports and
affected the medial meniscus. Concurrent ACL surgery was indicated in
approximately one-third of cases and was associated with a lower reoperation
rate and slower return to sports. Two-thirds of patients underwent meniscal
repair, over two-thirds of whom did not require a reoperation during the
study period, despite the high activity levels in this age group.
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Affiliation(s)
- Dennis E Kramer
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leslie A Kalish
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Martin
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Division of Sports Medicine, Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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45
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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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46
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Vaquero-Picado A, Rodríguez-Merchán EC. Arthroscopic repair of the meniscus: Surgical management and clinical outcomes. EFORT Open Rev 2018; 3:584-594. [PMID: 30595844 PMCID: PMC6275851 DOI: 10.1302/2058-5241.3.170059] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
From the biomechanical and biological points of view, an arthroscopic meniscal repair (AMR) should always be considered as an option. However, AMR has a higher reoperation rate compared with arthroscopic partial meniscectomy, so it should be carefully indicated. Compared with meniscectomy, AMR outcomes are better and the incidence of osteoarthritis is lower when it is well indicated. Factors influencing healing and satisfactory results must be carefully evaluated before indicating an AMR. Tears in the peripheral third are more likely to heal than those in the inner thirds. Vertical peripheral longitudinal tears are the best scenario in terms of success when facing an AMR. ‘Inside-out’ techniques were considered as the gold standard for large repairs on mid-body and posterior parts of the meniscus. However, recent studies do not demonstrate differences regarding failure rate, functional outcomes and complications, when compared with the ‘all-inside’ techniques. Some biological therapies try to enhance meniscal repair success but their efficacy needs further research. These are: mechanical stimulation, supplemental bone marrow stimulation, platelet rich plasma, stem cell therapy, and scaffolds and membranes. Meniscal root tear/avulsion dramatically compromises meniscal stability, accelerating cartilage degeneration. Several options for reattachment have been proposed, but no differences between them have been established. However, repair of these lesions is actually the reference of the treatment. Meniscal ramp lesions consist of disruption of the peripheral attachment of the meniscus. In contrast, with meniscal root tears, the treatment of reference has not yet been well established.
Cite this article: EFORT Open Rev 2018;3:584-594. DOI: 10.1302/2058-5241.3.170059
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47
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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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48
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Samuelsen BT, Johnson NR, Hevesi M, Levy BA, Dahm DL, Stuart MJ, Krych AJ. Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket-Handle Meniscal Tears: A Propensity-Matched Analysis. Orthop J Sports Med 2018; 6:2325967118779045. [PMID: 29977943 PMCID: PMC6024537 DOI: 10.1177/2325967118779045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: There are limited data comparing the outcomes of all-inside versus inside-out meniscal repair techniques. Purpose: To assess failure rates and clinical outcomes after the surgical repair of bucket-handle meniscal tears utilizing either an all-inside or inside-out technique. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with bucket-handle meniscal tears undergoing all-inside or inside-out repair at a single institution between 2003 and 2013 were analyzed. A total of 28 mensici repaired utilizing second-generation all-inside suturing devices and 42 menisci repaired using an inside-out technique were eligible for inclusion. Rigorous propensity matching was performed on the basis of age, sex, tear laterality, rim width, and concomitant anterior cruciate ligament reconstruction (ACLR), resulting in a total of 40 patients equally distributed between the 2 repair techniques for comparison. Retear-free survival as well as preoperative and postoperative International Knee Documentation Committee (IKDC) and Tegner scores and physical examination findings were subsequently analyzed. Results: Twenty patients who underwent all-inside repair (14 male; mean age, 23.7 ± 6.7 years) were successfully propensity matched to 20 patients who underwent inside-out meniscal repair (15 male; mean age, 22.5 ± 7.6 years), with a mean retear-free follow-up of 4.4 years (range, 2.5-7.4 years). Four (20%) all-inside repairs and 4 (20%) inside-out repairs failed over the course of follow-up (P > .999), with a mean time to failure of 2.7 years (range, 1.3-4.4 years) and 5.0 years (range, 0.8-7.5 years), respectively (P = .25). Increasing patient age trended toward a decreased clinical retear rate, independent of the repair technique (hazard ratio, 0.86; P = .056). There were no significant differences in the Tegner scores, IKDC scores, or range of motion between the groups as a whole or when subcategorizing by age, sex, body mass index, tear complexity, rim width, isolated versus concomitant ACLR, or medial- versus lateral-sided repair. There were no complications in the all-inside group, while there was a 10% rate of minor complications in the inside-out group (P = .49). Conclusion: Overall, satisfactory clinical outcomes are achievable at short-term to midterm follow-up with both inside-out and all-inside repair techniques of bucket-handle meniscal tears in rigorously matched patients with similar meniscal tear patterns.
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Affiliation(s)
- Brian T Samuelsen
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas R Johnson
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
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49
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Mosich GM, Lieu V, Ebramzadeh E, Beck JJ. Operative Treatment of Isolated Meniscus Injuries in Adolescent Patients: A Meta-Analysis and Review. Sports Health 2018; 10:311-316. [PMID: 29648924 PMCID: PMC6044115 DOI: 10.1177/1941738118768201] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Context: With the rise in sports participation and increased athleticism in the
adolescent population, there is an ever-growing need to better understand
adolescent meniscus pathology and treatment. Objective: To better understand the operative management of meniscus tears in the
adolescent population. Data Sources: A systematic review of PubMed (MEDLINE) and Google Scholar was performed for
all archived years. Study Selection: Studies that reported on isolated meniscus tears in adolescent patients (age,
10-19 years) were included. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 4. Data Extraction: Two authors reviewed and extracted data from studies that fulfilled all
inclusion criteria. Results: Nine studies on isolated meniscus tears in adolescent patients were found,
with level of evidence ranging from 3 to 4. These studies evaluated a total
of 373 patients (248 males, 125 females) and 390 knees. Seven studies were
published between 1979 and 2000, all of which discuss meniscectomy as the
primary treatment. Two studies were published after 2000 and report on
meniscus repair surgery. The mean patient age was 14.4 years. A total of 308
meniscectomies and 64 meniscus repairs were performed. Follow-up ranged from
1.8 to 30 years (mean, 10.8 years). A 37% retear rate was reported for
patients undergoing meniscus repair. Different outcome measures were used
for meniscectomy versus meniscus repair. Three studies evaluating
meniscectomy reported Tapper-Hoover scores, showing 54 patients with an
excellent result, 58 with good, 57 with fair, and 23 with poor results. Conclusion: A shift in the management of isolated adolescent meniscal tears is reflected
in the literature, with a recent increase in operative repair. This is
likely secondary to poor outcomes after meniscectomy reflected in long-term
follow-up studies. The current literature highlights the need for improved
description of tear patterns, standardized reporting of outcome measures,
and improved study methodologies to help guide orthopaedic surgeons on
operative treatment of meniscal tears in adolescent patients.
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Affiliation(s)
- Gina M Mosich
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Virginia Lieu
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Jennifer J Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.,Orthopaedic Institute for Children, UCLA, Los Angeles, California
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50
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Ardern CL, Ekås G, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi NG, Reider B, Roe JP, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. 2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis, and Management of Pediatric Anterior Cruciate Ligament Injuries. Orthop J Sports Med 2018; 6:2325967118759953. [PMID: 29594177 PMCID: PMC5865521 DOI: 10.1177/2325967118759953] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In October 2017, the International Olympic Committee hosted an international expert group of physical therapists and orthopaedic surgeons who specialize in treating and researching pediatric anterior cruciate ligament (ACL) injuries. The purpose of this meeting was to provide a comprehensive, evidence-informed summary to support the clinician and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the following societies attended: American Orthopaedic Society for Sports Medicine; European Paediatric Orthopaedic Society; European Society for Sports Traumatology, Knee Surgery, and Arthroscopy; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; Pediatric Orthopaedic Society of North America; and Sociedad Latinoamericana de Artroscopia, Rodilla, y Deporte. Physical therapists and orthopaedic surgeons with clinical and research experience in the field and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of pediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision making with children and the potential long-term ramifications of the injury.
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Affiliation(s)
| | - Clare L. Ardern
- Clare L. Ardern, PT, PhD, Division of Physiotherapy, Linköping University, Linköping, Sweden (ORCID ID: 0000-0001-8102-3631) ()
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