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Betsch K, Martinez VG, Lyons LP, Weinberg JB, Wittstein JR, McNulty AL. Shedding light on the effects of blood on meniscus tissue: the role of mononuclear leukocytes in mediating meniscus catabolism. Osteoarthritis Cartilage 2024; 32:938-949. [PMID: 38782253 PMCID: PMC11254574 DOI: 10.1016/j.joca.2024.04.022] [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: 10/17/2023] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Traumatic meniscal injuries can cause acute pain, hemarthrosis (bleeding into the joint), joint immobility, and post-traumatic osteoarthritis (PTOA). However, the exact mechanism(s) by which PTOA develops following meniscal injuries is unknown. Since meniscus tears commonly coincide with hemarthrosis, investigating the direct effects of blood and its constituents on meniscus tissue is warranted. The goal of this study was to determine the direct effects of blood and blood components on meniscus tissue catabolism. METHODS Porcine meniscus explants or primary meniscus cells were exposed to whole blood or various fractions of blood for 3 days to simulate blood exposure following injury. Explants were then washed and cultured for an additional 3 days prior to collection for biochemical analyses. RESULTS Whole blood increased matrix metalloproteinase (MMP) activity. Fractionation experiments revealed blood-derived red blood cells did not affect meniscus catabolism. Conversely, viable mononuclear leukocytes induced MMP activity, nitric oxide (NO) production, and loss of tissue sulfated glycosaminoglycan (sGAG) content, suggesting that these cells are mediating meniscus catabolism. CONCLUSIONS These findings highlight the potential challenges of meniscus healing in the presence of hemarthrosis and the need for further research to elucidate the in vivo effects of blood and blood-derived mononuclear leukocytes due to both hemarthrosis and blood-derived therapeutics.
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Affiliation(s)
- Kevin Betsch
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Vianna G Martinez
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
| | - Lucas P Lyons
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - J Brice Weinberg
- Department of Medicine, VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Pathology, Duke University School of Medicine, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA.
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2
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Feroe AG, Clark SC, Hevesi M, Okoroha KR, Saris DBF, Krych AJ, Tagliero AJ. Management of Meniscus Pathology with Concomitant Anterior Cruciate Ligament Injury. Curr Rev Musculoskelet Med 2024; 17:321-334. [PMID: 38822979 PMCID: PMC11219633 DOI: 10.1007/s12178-024-09906-x] [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] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies. RECENT FINDINGS Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.
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Affiliation(s)
- Aliya G Feroe
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sean C Clark
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Daniel B F Saris
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Adam J Tagliero
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Vicens MH, Pujol O, Portas-Torres I, Aguilar M, Joshi N, Minguell J, Castellet E, Casaccia M. Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06241-1. [PMID: 38942964 DOI: 10.1007/s00264-024-06241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/15/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE Meniscal wrapping is a fully arthroscopic technique that involves enhanced meniscal repair with a tissue-engineered collagen matrix wrapping. This study aims to investigate the feasibility of using the meniscal wrapping technique for the treatment of chronic or complex meniscal tears. The primary objective is to assess its failure rate. The secondary objectives are to analyse complication rate, functional outcomes and overall patient satisfaction. METHODS This retrospective case series study included patients who sustained chronic and complex tears undergoing meniscal wrapping with autologous liquid bone marrow injection. Failure rate was considered if the patient underwent partial or complete meniscectomy or knee replacement during the follow-up, while other unexpected knee reoperations were considered as complications. Clinical outcomes were evaluated through the IKDC score, Tegner Activity Score and Short Assessment of Patient Satisfaction. RESULTS Twenty-one patients were included (15 non-acute bucket-handle tears, three non-acute horizontal tears and three non-acute complex injuries). The failure rate was 9.5% at 33 months. The rate of other unplanned reoperations was 14.3%, but none of these complications were apparently directly related to the wrapping technique. The average postoperative IKDC was 73.3/100. No statistically significant difference was encountered between preinjury and postoperative Tegner Activity Score. The mean overall patient satisfaction was 88.3/100. CONCLUSIONS Meniscal wrapping can be safely used as an adjunctive technique to meniscal repair in such difficult-to-treat cases to preserve the meniscus. The technique achieves a low failure rate and promising results of knee function, and patient satisfaction.
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Affiliation(s)
- Marga H Vicens
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Pujol
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Irene Portas-Torres
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marc Aguilar
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Nayana Joshi
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Minguell
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Enric Castellet
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marcelo Casaccia
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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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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Dadoo S, Keeling LE, Engler ID, Chang AY, Runer A, Kaarre J, Irrgang JJ, Hughes JD, Musahl V. Higher odds of meniscectomy compared with meniscus repair in a young patient population with increased neighbourhood disadvantage. Br J Sports Med 2024; 58:649-654. [PMID: 38760154 DOI: 10.1136/bjsports-2023-107409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To investigate the impact of demographic and socioeconomic factors on the management of isolated meniscus tears in young patients and to identify trends in surgical management of meniscus tears based on surgeon volume. METHODS Data from a large healthcare system on patients aged 14-44 years who underwent isolated meniscus surgery between 2016 and 2022 were analysed. Patient demographics, socioeconomic factors and surgeon volume were recorded. Patient age was categorised as 14-29 years and 30-44 years old. Area Deprivation Index (ADI), a measure of neighbourhood disadvantage with increased ADI corresponding to more disadvantage, was grouped as <25th, 25-75th and >75th percentile. Multivariate comparisons were made between procedure groups while univariate comparisons were made between surgeon groups. RESULTS The study included 1552 patients treated by 84 orthopaedic surgeons. Older age and higher ADI were associated with higher odds of undergoing meniscectomy. Patients of older age and with non-private insurance were more likely to undergo treatment by a lower-volume knee surgeon. Apart from the year 2022, higher-volume knee surgeons performed significantly higher rates of meniscus repair compared with lower-volume knee surgeons. When controlling for surgeon volume, higher ADI remained a significant predictor of undergoing meniscectomy over meniscus repair. CONCLUSION Significant associations exist between patient factors and surgical choices for isolated meniscus tears in younger patients. Patients of older age and with increased neighbourhood disadvantage were more likely to undergo meniscectomy versus meniscus repair. While higher-volume knee surgeons favoured meniscus repair, a growing trend of meniscus repair rates was observed among lower-volume knee surgeons. LEVEL OF EVIDENCE Retrospective cohort study, level III.
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Affiliation(s)
- Sahil Dadoo
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura E Keeling
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ian D Engler
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Central Maine Medical Center, Lewiston, Maine, USA
| | - Audrey Y Chang
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Armin Runer
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Sports Orthopaedics, Technical University of Munich, Munchen, Germany
| | - Janina Kaarre
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopaedics, Sahlgrenska Academy, Goteborg, Sweden
| | - James J Irrgang
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Volker Musahl
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopaedics, Sahlgrenska Academy, Goteborg, Sweden
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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6
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Demir IH, Karslı B. The Impact of Bone Marrow Venting Augmentation on Knee Functions in the Repair of Vertical/Longitudinal Meniscus Tears: A Triple Comparison. Indian J Orthop 2024; 58:527-534. [PMID: 38694689 PMCID: PMC11058150 DOI: 10.1007/s43465-024-01135-1] [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] [Received: 12/06/2023] [Accepted: 03/10/2024] [Indexed: 05/04/2024]
Abstract
Objective Preserving and restoring meniscus function is crucial for maintaining knee biomechanics and overall functionality. To enhance the healing process after meniscus repair, various biological techniques have been introduced. In this study, three treatment approaches examined were bone marrow venting with stem cells (BMVP), anterior cruciate ligament reconstruction (ACLR) with meniscus repair, and isolated meniscus repair. Materials and Methods From 2015 to 2019, we retrospectively analyzed data from 83 patients who presented with complaints of knee pain or pain in addition to instability, were diagnosed with vertical/longitudinal meniscus tears, and underwent arthroscopic repair (30 with isolated repair, 28 with ACLR repair, and 25 with BMVP) at our University Hospital. Among the 28 patients with anterior cruciate ligament rupture, pain and instability were the predominant complaints, whereas 55 patients with meniscus tear primarily complained pain. Clinical and functional conditions were assessed using Lysholm, WOMAC, IKDC, and VAS scores before and 18 months after surgery. Surgical success was evaluated based on Barrett's criteria. Causes of failure were analyzed considering demographic data, smoking status, injury time, tear location, shape, zone, and suture type and number. Results Of the participants, 58 were male, 25 were female, 61 had medial meniscus lesions, and 22 had lateral meniscus lesions. The tear types included 51 simple longitudinal tears, 18 bucket handle tears, and 14 complex tears. A significant improvement was observed in the postoperative 18 month Lysholm, WOMAC, and IKDC values in all three groups (p: 0.001). At the 18 month mark, clinical and functional outcomes were comparable between BMVP and ACLR repair groups (Lysholm p: 0.951, WOMAC p: 0.241, IKDC p: 0.984). Both of these procedures yielded better results compared to isolated meniscus repair (Lysholm p: 0.001, WOMAC p: 0.027, IKDC p: 0.001). Conclusion The superior clinical and functional outcomes observed after meniscus repair with BMVP and ACLR, compared to isolated meniscus repair, indicate positive effects of bone marrow stem cells, blood components, and tissue healing factors on meniscus repair and knee function.
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Affiliation(s)
- Ibrahim Halil Demir
- Department of Orthopaedics and Traumatology, T.C. Ministry of Health Gaziantep City Hospital, 27470 Gaziantep, Turkey
| | - Burcin Karslı
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, 27310 Gaziantep, Turkey
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Skinner M, Sullivan B, Conley C, Johnson D, Ireland ML, Landy D, Stone A, Jacobs C. Incidence of Osteoarthritis Diagnosis Within 5 Years of Surgery Was Greater Following Partial Meniscectomy Than Meniscus Repair and/or Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2024; 6:100903. [PMID: 38426126 PMCID: PMC10901843 DOI: 10.1016/j.asmr.2024.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 01/13/2024] [Indexed: 03/02/2024] Open
Abstract
Purpose To compare knee osteoarthritis (OA) incidence within 5 years of surgery between 5 common sports medicine procedures: isolated anterior cruciate ligament (ACL) reconstruction, isolated meniscus repair (MR), isolated arthroscopic partial meniscectomy (APM), ACL reconstruction with MR (ACL + MR), and ACL reconstruction with APM (ACL + APM). Methods The PearlDiver Mariner M157Ortho database was searched. Five cohorts were identified using Current Procedural Terminology (CPT) codes and included those 16 to 60 years old who underwent isolated ACL reconstruction, isolated MR, ACL + MR, isolated APM, or ACL + APM repair. Groups were matched by age, sex, and presence of diagnosis codes for obesity. The incidence of knee OA diagnosis within 5 years of the index procedure was determined for each group, and odds ratios (ORs) were calculated and compared against isolated ACL reconstruction. Results Each group consisted of 7,672 patients (3,450 females, 4,222 males). A significantly greater proportion of the APM group was diagnosed with knee OA within 5 years of surgery compared to isolated ACL reconstruction (APM = 1,032/7,672 [13.5%] vs ACL = 745/7,672 [9.7%]; P ≤ .001; OR, 1.45; 95% confidence interval [CI], 1.31-1.60). Similarly, a greater proportion of the MR group was diagnosed with OA compared to isolated ACL reconstruction (MR = 826/7,672 [10.7%]; P = .030; OR, 1.12; 95% CI, 1.01-1.25). No differences in OA incidence were noted between the ACL + APM group when compared to isolated ACL reconstruction (P = .81). Patients undergoing ACL + MR demonstrated the lowest OA incidence with reduced odds when compared to isolated ACL reconstruction (ACL + MR = 575/7,672 [7.5%]; P < .001; OR, 0.75; 95% CI, 0.67-0.84). Conclusions In this analysis using CPT codes, APM was associated with the highest knee OA incidence, and ACL + MR was associated with the lowest OA incidence within 5 years of surgery. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Matthew Skinner
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Breanna Sullivan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Caitlin Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Darren Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Mary Lloyd Ireland
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - David Landy
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Austin Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Cale Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
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Schweizer C, Hanreich C, Tscholl PM, Blatter S, Windhager R, Waldstein W. Meniscal Repair Outcome in 3829 Patients With a Minimum Follow-up From 2 Years Up to 5 Years: A Meta-analysis on the Overall Failure Rate and Factors Influencing Failure. Am J Sports Med 2024; 52:822-831. [PMID: 37022676 DOI: 10.1177/03635465231158385] [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] [Indexed: 04/07/2023]
Abstract
BACKGROUND The importance of meniscal repair is widely accepted because of the association of loss of meniscal tissue with the development of early-onset knee arthritis. Many factors influencing the results of meniscal repair have been reported, but results remain controversial. PURPOSE This meta-analysis determines the pooled meniscal repair failure rate of studies with a minimum follow-up of 2 years up to 5 years, with a mean follow-up of 43 months. Moreover, selected failure-influencing factors are analyzed. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed and Scopus were searched for studies published between January 2000 and November 2021 reporting on meniscal repair outcome with a minimum follow-up of 24 months. The overall pooled failure rate and pooled failure rates for possible predictors were calculated. Random-effect models were used to pool failure rates, and effect estimates in the form of odds ratios with 95% CIs were established. RESULTS The initial literature search identified 6519 studies. A total of 51 studies met the inclusion criteria. In total, 3931 menisci were included with an overall failure rate of 14.8%. Subgroup analysis revealed a significantly lower failure rate for meniscal repair with concomitant anterior cruciate ligament (ACL) reconstruction compared with knees without any reported injury to the ACL (8.5% vs 14%; P = .043). The pooled failure rate for lateral meniscal repair was significantly lower than that for medial meniscal repair (6.1% vs 10.8%; P = .031). Pooled failure rates of all-inside and inside-out repair were not significantly different (11.9% vs 10.6%; P > .05). CONCLUSION This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. Meniscal repair remains a procedure with a high failure rate, especially within the first 2 postoperative years. This review and meta-analysis also identified clinically relevant factors associated with favorable outcomes such as concomitant ACL reconstruction or repair of the lateral meniscus. All-inside meniscal repair with the latest-generation devices yields failure rates of <10%. The failure mechanism and the time of failure is poorly documented; further studies are needed for a better understanding of the retear mechanism.
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Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Carola Hanreich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philippe M Tscholl
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; ReFORM (Reseau Francophone Olympique de la Recherche en Médecine du Sport), IOC Research Centre for Prevention of Injury and Protection of Athlete Health
| | - Samuel Blatter
- Division of Orthopedics and Trauma Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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9
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Kahan JB, Burroughs P, Petit L, Schneble CA, Joo P, Moran J, Modrak M, Mclaughlin W, Nasreddine A, Grauer JN, Medvecky MJ. Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction. PLoS One 2023; 18:e0294964. [PMID: 38015977 PMCID: PMC10684064 DOI: 10.1371/journal.pone.0294964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES The purpose of this study was to compare the rates of secondary knee surgery for patients undergoing meniscus repair with or without concurrent anterior cruciate ligament reconstruction (ACLr). METHODS Utilizing a large national database, patients with meniscal repair with or without concurrent arthroscopic ACLr were identified. The two cohorts were then queried for secondary surgical procedures of the knee within the following 2 years. Frequency, age distribution, rates of secondary surgery, and type of secondary procedures performed were compared. RESULTS In total, 1,585 patients were identified: meniscus repair with ACLr was performed for 1,006 (63.5%) and isolated meniscal repair was performed for 579 (36.5%). Minimum of two year follow up was present for 487 (30.7% of the overall study population). Secondary surgery rates were not significantly different between meniscus repair with concurrent ACLr and isolated meniscus repairs with an overall mean follow up of 13 years (1.5-24 years) (10.6% vs. 13.6%, p = 0.126). For the 2 year follow up cohort, secondary surgery rates were not significantly different (19.3% vs. 25.6%, p = 0.1098). There were no differences in survivorship patterns between the two procedures, both in the larger cohort (p = 0.2016), and the cohort with minimum 2-year follow-up (p = 0.0586). CONCLUSION The current study assessed secondary surgery rates in patients undergoing meniscus repair with or without concurrent ACLr in a large patient database. Based on this data, no significant difference in rates of secondary knee surgery was identified.
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Affiliation(s)
- Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | | | - Logan Petit
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Peter Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Maxwell Modrak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - William Mclaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Adam Nasreddine
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
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10
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Oeding JF, Berlinberg EJ, Lu Y, Marigi EM, Okoroha KR, Camp CL, Barlow JD, Krych AJ. Platelet-Rich Plasma and Marrow Venting May Serve as Cost-Effective Augmentation Techniques for Isolated Meniscal Repair: A Decision-Analytical Markov Model-Based Analysis. Arthroscopy 2023; 39:2058-2068. [PMID: 36868533 DOI: 10.1016/j.arthro.2023.02.018] [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] [Received: 09/01/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To evaluate the cost-effectiveness of 3 isolated meniscal repair (IMR) treatment strategies: platelet-rich plasma (PRP)-augmented IMR, IMR with a marrow venting procedure (MVP), and IMR without biological augmentation. METHODS A Markov model was developed to evaluate the baseline case: a young adult patient meeting the indications for IMR. Health utility values, failure rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing IMR at an outpatient surgery center. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). RESULTS Total costs of IMR with an MVP were $8,250; PRP-augmented IMR, $12,031; and IMR without PRP or an MVP, $13,326. PRP-augmented IMR resulted in an additional 2.16 QALYs, whereas IMR with an MVP produced slightly fewer QALYs, at 2.13. Non-augmented repair produced a modeled gain of 2.02 QALYs. The ICER comparing PRP-augmented IMR versus MVP-augmented IMR was $161,742/QALY, which fell well above the $50,000 willingness-to-pay threshold. CONCLUSIONS IMR with biological augmentation (MVP or PRP) resulted in a higher number of QALYs and lower costs than non-augmented IMR, suggesting that biological augmentation is cost-effective. Total costs of IMR with an MVP were significantly lower than those of PRP-augmented IMR, whereas the number of additional QALYs produced by PRP-augmented IMR was only slightly higher than that produced by IMR with an MVP. As a result, neither treatment dominated over the other. However, because the ICER of PRP-augmented IMR fell well above the $50,000 willingness-to-pay threshold, IMR with an MVP was determined to be the overall cost-effective treatment strategy in the setting of young adult patients with isolated meniscal tears. LEVEL OF EVIDENCE Level III, economic and decision analysis.
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Affiliation(s)
- Jacob F Oeding
- School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, U.S.A; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.
| | - Elyse J Berlinberg
- School of Medicine, NYU Grossman School of Medicine, New York, New York, U.S.A
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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11
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Nakagawa Y, Tsuji K, Nakamura T, Katagiri H, Ozeki N, Shioda M, An JS, Yoshida R, Sekiya I, Koga H. Association of Infrapatellar Fat Pad Fibrosis at 3 Months After ACL Reconstruction With Short-term Clinical Outcomes and Inflammatory Cytokine Levels in the Synovial Fluid. Orthop J Sports Med 2023; 11:23259671231164122. [PMID: 37123994 PMCID: PMC10134128 DOI: 10.1177/23259671231164122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/17/2023] [Indexed: 05/02/2023] Open
Abstract
Background Infrapatellar fat pad (IFP) fibrosis is reportedly associated with anterior knee pain and the progression of patellofemoral osteoarthritis after anterior cruciate ligament reconstruction (ACLR). However, causes of IFP fibrosis after ACLR have not been sufficiently investigated. Purpose To compare the descriptive characteristics, clinical outcomes, and inflammatory cytokine levels in the synovial fluid between patients who underwent ACLR with versus without severe IFP fibrosis. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent primary ACLR using autologous hamstring tendon were divided into 2 groups based on magnetic resonance imaging IFP fibrosis scoring (grades 0-5) at 3 months after surgery: the severe fibrosis group (grades 4 and 5) and mild fibrosis group (grades 0-3). Synovial fluid was aspirated on postoperative day 3 or 4 to measure inflammatory cytokine levels. Patient characteristics, clinical outcomes at 3 and 12 months after surgery, and inflammatory cytokine (interleukin [IL]-1β, IL-2, IL-6, IL-8, IL-10, tumor necrosis factor-α, and interferon-γ) levels were compared between the groups. Results Of the 36 patients included, 7 were allocated to the severe fibrosis group and 29 were allocated to the mild fibrosis group. The severe fibrosis group had a significantly longer operation time (153.0 vs 116.5 minutes for mild fibrosis; P = .007). Compared with the mild fibrosis group, the severe fibrosis group had greater pain during stair climbing (2.0 vs 0.7; P = .01) and a lower extension muscle strength ratio (operated/healthy side, 52.9% vs 76.1%; P < .001) at 3 months, and the severe fibrosis group had a lower Lysholm score (93.7 vs 97.3; P = .026) and greater knee extension (0.3° vs 1.9°; P = .043) and flexion angle restriction (142.9° vs 149.0°; P = .013) at 12 months. The severe fibrosis group demonstrated higher IL-1β (2.6 vs 1.4 pg/mL; P = .022), IL-6 (2.0 vs 1.1 ng/mL; P = .029), and interferon-γ levels (11.3 vs 4.0 pg/mL; P = .044). Conclusion Severe IFP fibrosis was associated with a longer operation time, higher inflammatory cytokine level in the synovial fluid, and worse clinical outcomes at 3 and 12 months after ACLR.
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Affiliation(s)
- Yusuke Nakagawa
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
- Department of Cartilage Regeneration,
Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University,
Tokyo, Japan
| | - Kunikazu Tsuji
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
- Department of Cartilage Regeneration,
Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University,
Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
- Department of Joint Surgery and Sports
Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University, Tokyo, Japan
| | - Hiroki Katagiri
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Nobutake Ozeki
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Mikio Shioda
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Jae-Sung An
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
- Department of Joint Surgery and Sports
Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University, Tokyo, Japan
| | - Ryu Yoshida
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
- Department of Joint Surgery and Sports
Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery,
Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
- Department of Joint Surgery and Sports
Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University, Tokyo, Japan
- Hideyuki Koga, MD, PhD,
Department of Joint Surgery and Sports Medicine, Graduate School of Medical and
Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku,
Tokyo 113-8519, Japan ()
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12
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Wei W, Li R, Ni J, Shi Z. Regarding "Repair Augmentation of Unstable, Complete Vertical Meniscal Tears With Bone Marrow Venting Procedure: A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study". Arthroscopy 2022; 38:2593-2594. [PMID: 36064270 DOI: 10.1016/j.arthro.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Wang Wei
- First Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Ruiying Li
- First Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Jianlong Ni
- First Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Zhibin Shi
- First Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
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13
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Abstract
Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. “Masterly neglect” is a valuable option in selected cases.
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14
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Axelrod D, Ziegler T, Pincus D, Widdifield J, Marks P, Paterson M, Wasserstein D. Basketball vs. Hockey-The Changing Face of Sport-Related Injuries in Canada. Clin J Sport Med 2022; 32:e281-e287. [PMID: 33797478 DOI: 10.1097/jsm.0000000000000908] [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] [Received: 05/05/2020] [Accepted: 09/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize and compare the incidence of basketball-related, soccer-related, and hockey-related injuries over a 10-year period. DESIGN Cohort analysis of sport-related injuries using multiple Ontario healthcare databases. SETTING Emergency department visits in Ontario, Canada. PATIENTS Any patient who sustained musculoskeletal injuries sustained while playing basketball, soccer, or hockey between 2006 and 2017 were identified. ASSESSMENT OF RISK FACTORS Sport of injury, age, sex, rurality index, marginalization status, and comorbidity score. MAIN OUTCOME MEASURES Annual Incidence Density Rates of injury were calculated for each sport, and significance of trends was analyzed by assessing overlap of 95% confidence intervals. RESULTS One lakhs eighty five thousand eighty hundred sixty-eight patients (median age: 16 years, interquartile range 13-26) received treatment for sport-related injuries (basketball = 55 468; soccer = 67 021; and hockey = 63 379). The incidence of basketball-related and soccer-related injuries increased from 3.4 (3.3-3.5) to 5.6 (5.5-5.7) and 4.4 (4.3-4.5) to 4.9 (4.8-5) per 10 000 person years, respectively, whereas the incidence of hockey-related injuries decreased from 4.7 (4.6-4.8) to 3.7 (3.6-3.8). Patients with basketball injuries were more marginalized (3.01 ± 0.74) compared with patients with soccer and hockey injuries (2.90 ± 0.75 and 2.72 ± 0.69, respectively). CONCLUSIONS Accurate regional epidemiologic information regarding sports injuries can be used to guide policy development for municipal planning and sport program development. The trends and demographic patterns described highlight general and sport-specific injury patterns in Ontario. Populations with the highest incidence of injury, most notably adolescents and men older than 50, may represent an appropriate population for injury risk prevention.
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Affiliation(s)
- Daniel Axelrod
- Department of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Teresa Ziegler
- University of Toronto, Faculty of MedicineToronto, ON, Canada
- Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, ON, Canada; and
| | - Daniel Pincus
- University of Toronto, Faculty of MedicineToronto, ON, Canada
- Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, ON, Canada; and
| | - Jessica Widdifield
- Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, ON, Canada; and
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Paul Marks
- University of Toronto, Faculty of MedicineToronto, ON, Canada
- Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, ON, Canada; and
| | - Michael Paterson
- Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, ON, Canada; and
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - David Wasserstein
- University of Toronto, Faculty of MedicineToronto, ON, Canada
- Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, ON, Canada; and
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15
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Martin RK, Persson A, Moatshe G, Fenstad AM, Engebretsen L, Drogset JO, Visnes H. Low annual hospital volume of anterior cruciate ligament reconstruction is not associated with higher revision rates. Knee Surg Sports Traumatol Arthrosc 2022; 30:1575-1583. [PMID: 34236479 DOI: 10.1007/s00167-021-06655-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Surgery performed in low-volume centres has been associated with longer operating time, longer hospital stays, lower functional outcomes, and higher rates of revision surgery, complications and mortality. This has been reported consistently in the arthroplasty literature, but there is a paucity of data regarding the relationship between surgical volume and outcome following anterior cruciate ligament (ACL) reconstruction. The purpose was to compare ACL reconstruction failure rates between hospitals performing different annual surgical volumes. METHODS All patients from the Norwegian Knee Ligament Register having primary autograft ACL reconstruction between 2004 and 2016 were included. Hospital volume was divided into quintiles based on the number of ACL reconstructions performed annually, defined arbitrarily as: 1-12 (V1), 13-24 (V2), 25-49 (V3), 50-99 (V4) and ≥ 100 (V5) annual procedures. Kaplan-Meier estimated survival curves and survival percentages were calculated with revision ACL reconstruction as the end point. Secondary outcome measures included (1) mean change in Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) and Sport subsections from pre-operative to 5-year follow-up and (2) subjective failure defined as KOOS QoL < 44. RESULTS Twenty thousand eight hundred and fifty patients met the inclusion criteria and 1195 (5.7%) underwent subsequent revision ACL reconstruction over the study period. Revision rates were lower in the lower volume hospitals compared with the higher volume hospitals (p < 0.001). There was no clinically significant difference in improvement between pre-operative and 5-year follow-up KOOS scores between hospital volume categories, but a higher proportion of patients having surgery at lower volume hospitals reported a subjective failure. Patients in the lower volume categories (V1-3) were more often male and older compared to the higher volume hospitals (V4-5). Concomitant meniscal injuries and participation in pivoting sports were most common in V5 compared with V1 (p < 0.001). Median operative time decreased as hospital volume increased, ranging from 90 min at V1 hospitals to 56 min at V5 hospitals (p < 0.001). CONCLUSION Patients having ACL reconstruction at lower volume hospitals had a lower rate of subsequent revision surgery relative to higher volume hospitals. However, complications occurred more frequently, operative duration was longer, and the number of patients reporting a subjective failure of ACL reconstruction was highest at these lower volume hospitals. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- R Kyle Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
- Department of Orthopaedic Surgery, University of Minnesota, 1900 CentraCare Circle, Saint Cloud, MN, 56303, USA.
| | - Andreas Persson
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Orthopedic Surgery, Martina Hansens Hospital, Baerum, Norway
- Norwegian National Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
| | - Gilbert Moatshe
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Anne Marie Fenstad
- Norwegian National Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jon Olav Drogset
- Norwegian National Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
- Department of Orthopaedic Surgery, Trondheim University Hospital, Trondheim, Norway
| | - Håvard Visnes
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
- Norwegian National Knee Ligament Register, Haukeland University Hospital, Bergen, Norway
- Department of Orthopaedics, Sorlandet Hospital Kristiansand, Kristiansand, Norway
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16
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Degenerative Meniscus in Knee Osteoarthritis: From Pathology to Treatment. Life (Basel) 2022; 12:life12040603. [PMID: 35455094 PMCID: PMC9032096 DOI: 10.3390/life12040603] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
Knee osteoarthritis is a common degenerative joint disease characterized by chronic knee pain and disability in daily living. The lesion can involve the cartilage as well as the synovium, bone, ligaments, and meniscus, indicating a complicated pathology for knee osteoarthritis. The association with the meniscus has recently attracted much attention. Meniscal tears can initiate and progress knee osteoarthritis, with deleterious effects on the important roles of the meniscus in load distribution, shock absorption, and stability of the knee joint. Degenerative meniscus lesions are commonly observed in elderly people, but they have less impact on the prognosis of osteoarthritis. However, they are often accompanied by meniscal extrusion, which substantially decreases the hoop function of the meniscus and increases the risk of knee osteoarthritis. When surgical treatment is necessary, meniscal tears should be repaired to the greatest extent possible to preserve meniscus function. Long-term studies show better clinical outcomes and less degenerative osteoarthritis changes following meniscal repair than following partial meniscectomy. For meniscal extrusion repair, centralization techniques have been proposed that involve suturing the meniscus-capsule complex to the edge of the tibial plateau. Advancements in orthobiologics, such as platelet-rich plasma or stem cell therapy, have the potential to prevent the initiation or progression of osteoarthritis.
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17
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Schweizer C, Hanreich C, Tscholl PM, Ristl R, Apprich S, Windhager R, Waldstein W. Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta-analysis with a minimum follow-up of 5 years. Knee Surg Sports Traumatol Arthrosc 2022; 30:2267-2276. [PMID: 34671817 PMCID: PMC9206598 DOI: 10.1007/s00167-021-06770-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many reports of meniscus repair outcome in short-term studies, data on the long-term outcome of meniscus repair are still scarce. The purpose of this meta-analysis was to evaluate the overall failure rate of meniscus repair with a minimum follow-up of 5 years. Additionally, possible factors influencing meniscus repair outcome were assessed. METHODS PubMed and Scopus were searched for studies of the last 20 years reporting on meniscus repair outcome with a minimum follow-up of 5 years. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search terms used for this study were ([meniscus OR meniscal] AND repair). Titles and abstracts were evaluated by two authors independently. Using meta package of R (version 3.6.2), random-effect models were performed to pool failure rates. Subgroup analyses were performed and effect estimates in form of an odds ratio with 95% CIs were established. RESULTS In total, 12 studies with 864 patients were included. Degenerative tears were excluded in two studies and one study only included traumatic meniscus tears. Other studies did not state whether the cause of meniscus tear was degenerative or traumatic. Studies reporting meniscus repair outcome on root repairs, revision anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. Revision surgery was used as failure definition in all included studies. The overall failure rate of meniscal repair at a mean follow-up of 86 months was 19.1%. There was no significant difference in meniscus repair outcome when performed in combination with anterior cruciate ligament reconstruction compared to isolated meniscus repair (18.7% vs. 28%; n.s.) or when performed on the lateral meniscus compared to the medial meniscus (19.5% vs. 24.4%; n.s.). There was no significant difference of meniscus repair outcome between vertical/longitudinal tears and bucket-handle tears (n.s.). Thirty-six percent of meniscus repair failures occur after the second postoperative year. The only significant finding was that inside-out repair results in a lower failure rate compared to all-inside repair (5.6% vs. 22.3%; p = 0.009) at 5 years. CONCLUSION The overall meniscus repair failure rate remains nineteen percent in long-term studies. The cause of failure is poorly documented, and it remains unclear whether failure of the meniscus repair itself or additional adjacent tears lead to revision surgery. Despite the given technical advantages of all-inside repair devices, this meta-analysis cannot demonstrate superior outcomes compared to inside-out or outside-in repair at 5 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Carola Hanreich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philippe M. Tscholl
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, ReFORM (Reseau Francophone Olympique de la Recherche en Médecine du Sport), IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Geneva, Switzerland
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
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18
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Stelzeneder B, Trabauer BM, Aldrian S, Stelzeneder D, Juras V, Albrecht C, Hajdu S, Platzer P, Trattnig S. Evaluation of Meniscal Tissue after Meniscal Repair Using Ultrahigh Field MRI. J Knee Surg 2021; 34:1337-1348. [PMID: 32268408 DOI: 10.1055/s-0040-1709135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The study evaluates the meniscal tissue after primary meniscal suturing using 7-Tesla (T) magnetic resonance imaging with T2* mapping at 6 and 12 months after surgery to investigate the differences between repaired meniscal tissue and healthy meniscal tissue in the medial and lateral compartment. This prospective study included 11 patients (9m/2f) with a mean age of 30.6 years (standard deviation 9.0). Patients with a meniscal tear that was treated arthroscopically with meniscus suturing, using an all-inside technique, were included. All patients and seven healthy volunteers were imaged on a 7-T whole-body system. T2* mapping of the meniscus was applied on sagittal slices. Regions-of-interest were defined manually in the red and white zone of each medial and lateral meniscus to measure T2*-values. In the medial posterior and medial anterior horn similar T2*-values were measured in the red and white zone at 6- and 12-month follow-up. Compared with the control group higher T2*-values were found in the repaired medial meniscus. After 12-months T2*-values decreased to normal values in the anterior horn and remained elevated in the posterior horn. In the red zone of the lateral posterior horn a significant decrease in the T2*-values (from 8.2 milliseconds to 5.9 milliseconds) (p = 0.04), indicates successful repair; a tendency toward a decrease in the white zone between the 6 and 12 months follow-up was observed. In the red zone of the lateral anterior horn the T2*-values decreased significantly during follow-up and in the white zone of the lateral anterior horn T2*-values were comparable. In comparison to the control group higher T2*-values were measured at 6-months; however, the T2*-values showed comparable values in the repaired lateral meniscus after 12 months. The T2* mapping results of the current study indicated a better healing response of the red zone of the lateral posterior horn compared with the medial posterior horn.
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Affiliation(s)
- Beate Stelzeneder
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Michael Trabauer
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.,Landeskliniken Holding Korneuburg-Stockerau, Stockerau, Austria
| | - Silke Aldrian
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - David Stelzeneder
- Department of Orthopaedics and Trauma Surgery, Hanusch-Krankenhaus, Vienna, Austria.,Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Vladimir Juras
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Imaging Methods, Institute of Measurement Science, Bratislava, Slovakia
| | - Christian Albrecht
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.,I. Orthopaedic Department, Orthopaedic Hospital Speising GmbH, Vienna, Austria
| | - Stefan Hajdu
- Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Patrick Platzer
- Department of Trauma Surgery and Sports Traumatology, University Hospital St. Poelten, St. Poelten, Austria
| | - Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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19
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Lucidi GA, Dunn R, Wagala NN, Musahl V. Editorial Commentary: The Importance of Bony Morphology in the Anterior Cruciate Ligament-Injured Patient. Arthroscopy 2021; 37:3166-3169. [PMID: 34602156 DOI: 10.1016/j.arthro.2021.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
The outcome of anterior cruciate ligament (ACL) surgery depends on many factors. Successful ACL surgery includes evaluating patients' characteristics and addressing all the underlying knee pathologies, including the meniscus tears and ramp lesions. In recent years, there has been a growing interest in ramp lesions as well as the role that bony morphology plays in predisposing patients to ACL injury and failed ACL surgery. Not only pathologic but also physiologic variations in bony morphology like tibial slope and lateral femoral condyle ratio have been correlated with clinical outcomes, failure rates, rotatory instability, and even lesions to the contralateral knee. Evaluating each patient's specific anatomy is recommended when customizing ACL surgery. With further research and increased awareness of relevant bony parameters, we will be able to improve our ability to prevent injury, increase the diagnostic accuracy of associated lesions, and tailor surgery to improve the outcomes and reduce failure rates.
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20
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Bailey L, Weldon M, Kleihege J, Lauck K, Syed M, Mascarenhas R, Lowe WR. Platelet-Rich Plasma Augmentation of Meniscal Repair in the Setting of Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:3287-3292. [PMID: 34477016 DOI: 10.1177/03635465211036471] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increasing incidence of anterior cruciate ligament (ACL) and meniscal injuries has led to strong interest in discovering new methods to enhance the biological healing response of these tissues. Platelet-rich plasma (PRP) contains various growth factors associated with a positive healing response, but few existing clinical studies are available to determine the risks and benefits of these therapies. PURPOSE To determine the effects of intraoperative PRP on postoperative knee function and complications at 2 years after ACL reconstruction with meniscal repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective matched case-control study was conducted between 2013 and 2017 using a single surgeon database of 1014 patients undergoing primary ACL reconstruction with concomitant meniscal repair, resulting in 324 patients (162 PRP patients and 162 control patients) who met the study criteria. Patients were matched by age, sex, graft type, and meniscal injury. The Single Assessment Numeric Evaluation (SANE) was administered at 2 years, and injury surveillance was conducted. Secondary outcomes included the time to return to activity (months), self-reported knee function (International Knee Documentation Committee [IKDC] score), functional performance testing (knee range of motion, single-leg balance, single-leg hopping, agility testing), and postoperative complications (graft failure, infection, loss of motion [requiring repeat arthroscopy for lysis of adhesions], venous thrombosis, etc). Univariate models were used for between-group comparisons, and alpha was set at .05 for all analyses. RESULTS No differences were found in SANE knee function scores between the PRP and matched-control groups at 2 years (91.6 ± 11.2 vs 92.4 ± 10.6, respectively; P = .599). Additionally, no differences were reported between groups for self-reported function (IKDC score, 87.6 ± 13.3 vs 88.1 ± 12.6; P = .952), functional performance testing (P > .05), and timing of return to activity (7.8 ± 1.9 vs 8.0 ± 1.9 months; P = .765). The PRP group demonstrated a higher rate of postoperative knee motion loss compared with the control group (13.6% vs 4.6%; P < .001). No other differences were observed in postoperative complications (P > .05). CONCLUSION The added use of intraoperative PRP did not improve self-reported knee function, functional performance, and timing of return to activity for patients undergoing ACL reconstruction with meniscal repair. Furthermore, the use of PRP may have negative consequences for regaining knee range of motion after surgery. On the basis of these data, surgeons should cautiously consider the application of PRP when planning surgery for intra-articular injuries of the knee. REGISTRATION NCT03704376 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Lane Bailey
- Department of Sports Medicine & Rehabilitation, Memorial Hermann Ironman Sports Medicine Institute, Houston, Texas, USA
| | - Matthew Weldon
- Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
| | - Jacquelyn Kleihege
- Department of Sports Medicine & Rehabilitation, Memorial Hermann Ironman Sports Medicine Institute, Houston, Texas, USA
| | - Kyle Lauck
- Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
| | - Mohammad Syed
- Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
| | - Randy Mascarenhas
- Department of Orthopaedic Surgery, The Winnipeg Clinic, Winnipeg, Manitoba, Canada
| | - Walter R Lowe
- Department of Sports Medicine & Rehabilitation, Memorial Hermann Ironman Sports Medicine Institute, Houston, Texas, USA.,Department of Orthopedic Surgery, University of Texas Health Sciences Center, McGovern Medical School, Houston, Texas, USA
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21
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Engler ID, Moradian JR, Pockros BM, Schirmeister CM, Richmond JC, Salzler MJ. Patient-reported outcomes of meniscal repair and meniscectomy in patients 40 years of age and older show similar good results. Knee Surg Sports Traumatol Arthrosc 2021; 29:2911-2917. [PMID: 33025055 DOI: 10.1007/s00167-020-06299-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to evaluate patient-reported outcome measures (PROMs) in patients aged 40 years and older who underwent meniscal repair or meniscectomy. All patients aged 40 and older who underwent a meniscal repair at a single institution from 2006 to 2017 were included. Meniscal repair cases were matched with a meniscectomy control group in a 1:3 ratio, selected for an equal proportion of concomitant ACL reconstruction in each group. PROMs, collected at a minimum follow-up of 24 months, included International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), Marx activity scale, and a patient satisfaction scale. The primary outcome was IKDC score, which was compared between groups using a Mann-Whitney U test. Rate of failure, defined as repeat ipsilateral knee surgery or surgeon report of failure, was reported. Thirty-five meniscal repair patients and 131 meniscectomy patients were identified; 28 (80.0%) and 67 (51.1%) completed all PROMs with mean follow-up of 4.9 and 5.2 years, respectively. The mean age was 48.5 ± 7.0 years in the meniscal repair cohort and 52.8 ± 7.1 years in the meniscectomy cohort (p = 0.009). Concomitant ACL reconstruction was present in 46.4% and 49.3% of the meniscal repair and meniscectomy cohorts, respectively (n.s.). The median IKDC score was 78 (IQR 66, 87) in the repair cohort and 77 (IQR 56, 86) in the meniscectomy cohort (n.s.). The median Marx activity scale was 3.5 (IQR 0, 8) in the repair cohort and 3.0 (IQR 0, 9) in the meniscectomy cohort (n.s.). Over 85% of both groups were satisfied or very satisfied with no between-group differences (n.s.). In patients aged 40 years and older, patient-reported outcomes at an average of 5 years postoperatively were satisfactory and similar in patients undergoing meniscal repair and meniscectomy, indicating that age alone should not be a contraindication to meniscal repair.Level of evidence: Level III.
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Affiliation(s)
- Ian D Engler
- Department of Orthopaedics, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
| | - Julia R Moradian
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Benjamin M Pockros
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | | | - John C Richmond
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA, 02120, USA.,Boston Sports and Shoulder Center, 40 Allied Drive, Suite 102, Dedham, MA, 02026, USA
| | - Matthew J Salzler
- Department of Orthopaedics, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
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22
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Risk of Total Hip Arthroplasty After Acetabular Fracture Fixation: The Importance of Age. J Arthroplasty 2021; 36:3194-3199.e1. [PMID: 34074543 DOI: 10.1016/j.arth.2021.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/27/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Geriatric patients are the most rapidly growing cohort of patients sustaining acetabular fractures (AFs). The purpose of this study was to examine the risk of a secondary total hip arthroplasty (THA) in older patients (>60 year old) with a prior AF open reduction internal fixation (ORIF) compared with younger patients (<60 year old) with an AF ORIF on a large population level. METHODS Using administrative health care data from 1996 to 2010 inclusive of all 202 hospitals in Ontario, Canada, all adult patients with an AF ORIF and a minimum of two year follow-up were identified and included. The risk of THA was examined using a Cox proportional hazards model adjusting for patient risk factors. Secondary outcomes included surgical complications and all-cause mortality. RESULTS A total of 1725 patients had an AF ORIF; 1452 (84.2%, mean age of 38.3 ± 12.1 years) aged <60 years ("younger") and 273 (15.8%, mean age of 69.9 ± 7.8 years) > 60 years ("older"). The mean (SD) follow-up time for all patients was 6.9 (4.2) years. In older patients, 19.4% (53 of 273) went on to receive a secondary THA with a median time to event of 3.9 years, compared with 12.9% (187 of 1452) in the younger patient cohort with a median time of 6.9 years (HR 1.7, 95% CI: 1.2-2.3). As expected, older patients had a higher 90-day mortality rate compared with younger patients (7.7% vs. 0.7%, respectively; HR 9.2, 95% CI: 4.3-19.9; P < .001). CONCLUSION Older patients with an AF ORIF are at a significantly higher risk for a secondary THA than younger patients with an AF ORIF.
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23
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Özcafer R, Dırvar F, Mısır A, Dinçel YM, Büyükkuşçu MÖ, Aykut ÜS. Mid-term evaluation of clinical and functional outcomes after arthroscopic medial longitudinal and bucket-handle meniscus repair. Jt Dis Relat Surg 2021; 32:363-370. [PMID: 34145812 PMCID: PMC8343863 DOI: 10.52312/jdrs.2021.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/21/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate clinical and functional outcomes following the arthroscopic medial meniscal repair. PATIENTS AND METHODS A total of 50 patients (42 males, 8 females; mean age: 32.9±7.6 years; range, 17 to 48 years) who underwent arthroscopic repair for longitudinal and bucket-handle medial meniscal tears between March 2005 and October 2011 were retrospectively evaluated. The patients were divided into two groups as those having a longitudinal tear (patient group, n=31) and having a bucket-handle tear (control group, n=19). Preoperative and final follow-up functional outcomes were evaluated using the Lysholm Knee Score (LKS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale (TAS) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS The mean follow-up was 61.7±22.8 (range, 36 to 110) months. The mean preoperative LKS, IKDC score, TAS, and KOOS scores were significantly improved at the final postoperative follow-up (p<0.05). There was no significant difference in functional outcome scores between longitudinal and bucket-handle repairs (p>0.05), and isolated repairs and concomitant meniscal repair and anterior cruciate ligament reconstruction (p>0.05). CONCLUSION Arthroscopic meniscal repair provides similar mid-term functional and clinical outcomes for longitudinal and bucket-handle medial meniscal tears. Concomitant meniscal repair does not seem to affect meniscal healing.
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Affiliation(s)
- Raşit Özcafer
- Vital Hastanesi Ortopedi ve Travmatoloji Bölümü, 34180 Bahçelievler, İstanbul, Türkiye.
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24
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Wagala NN, Tisherman RT, Lucidi GA, Eads R, Musahl V. Meniscal problems in the ACL deficient knee: What every ACL surgeon must be able to do! OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150832] [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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25
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Lyons LP, Weinberg JB, Wittstein JR, McNulty AL. Blood in the joint: effects of hemarthrosis on meniscus health and repair techniques. Osteoarthritis Cartilage 2021; 29:471-479. [PMID: 33307179 PMCID: PMC8051641 DOI: 10.1016/j.joca.2020.11.008] [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] [Received: 08/21/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 02/02/2023]
Abstract
Injury to the meniscus is common and frequently leads to the development of post-traumatic osteoarthritis (PTOA). Many times meniscus injuries occur coincident with anterior cruciate ligament (ACL) injuries and lead to a bloody joint effusion. Hemarthrosis, or bleeding into the joint, has been implicated in degeneration of joint tissues. The goal of this review paper is to understand the pathophysiology of blood-induced joint damage, the possible effects of blood on meniscus tissue, and the implications for current meniscus repair techniques that involve the introduction of blood-derived products into the joint. In this review, we illustrate the similarities in the pathophysiology of joint damage due to hemophilic arthropathy (HA) and osteoarthritis (OA). Although numerous studies have revealed the harmful effects of blood on cartilage and synovium, there is currently a gap in knowledge regarding the effects of hemarthrosis on meniscus tissue homeostasis, healing, and the development of PTOA following meniscus injury. Given that many meniscus repair techniques utilize blood-derived and marrow-derived products, it is essential to understand the effects of these factors on meniscus tissue and the whole joint organ to develop improved strategies to promote meniscus tissue repair and prevent PTOA development.
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Affiliation(s)
- Lucas P. Lyons
- Department of Orthopaedic Surgery, Duke University School
of Medicine, Durham, NC
| | - J. Brice Weinberg
- Department of Medicine, VA Medical Center, Durham, NC,Department of Medicine, Duke University School of Medicine,
Durham, NC
| | - Jocelyn R. Wittstein
- Department of Orthopaedic Surgery, Duke University School
of Medicine, Durham, NC
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School
of Medicine, Durham, NC,Department of Pathology, Duke University School of
Medicine, Durham, NC
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26
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Zaffagnini S, Poggi A, Reale D, Andriolo L, Flanigan DC, Filardo G. Biologic Augmentation Reduces the Failure Rate of Meniscal Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:2325967120981627. [PMID: 33709004 PMCID: PMC7907660 DOI: 10.1177/2325967120981627] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 01/13/2023] Open
Abstract
Background Clinical results after isolated meniscal repair are not always satisfactory, with an overall failure rate of around 25%. To improve the success rate of meniscal repair, different biologic augmentation techniques have been introduced in clinical practice, but their real efficacy is still controversial. Purpose/Hypothesis To evaluate the safety, clinical results, and failure rate of biologic augmentation techniques for meniscal repair. The hypothesis was that biologic augmentation would improve the results of meniscal repair. Study Design Systematic review and meta-analysis of comparative studies. Methods A systematic review of the literature was performed in March 2020 of 3 electronic databases (PubMed, Scopus, and the Cochrane Library) regarding meniscal repair combined with biologic augmentation techniques. Articles combining biologic augmentation with other surgical procedures besides meniscal suture were excluded. The quality of the included studies was assessed using a modified Coleman Methodology Score, and the risk of bias was evaluated using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) and the RoB 2.0 (Revised Tool for Risk of Bias in Randomized Trials) for nonrandomized and randomized controlled trials, respectively. Results A total of 11 studies were included in the qualitative analysis: platelet-rich plasma (PRP) augmentation in 6 comparatives studies, fibrin clot augmentation in 2 case series, and mesenchymal stem cells augmentation in 2 case series and 1 case report. One severe adverse event of septic arthritis was reported for PRP 1 month after surgery. The quality of evidence evaluated with the modified Coleman Methodology Score was low overall. Five studies reporting on 286 patients (111 PRP augmentation, 175 control) were included in the quantitative synthesis. A significantly lower risk of failure was documented in the PRP augmentation group as compared with the control group: 9.9% (4.5%-19.1%) versus 25.7% (12.7%-38.7%) (P < .0005). Conclusion The literature on biologic meniscal augmentation is recent and scarce. Only a few comparative trials are available, all focusing on the potential of PRP. The meta-analysis documented that PRP is safe and useful in improving the survival rate, with a 9.9% rate of failure versus 25.7% for the control group. Further high-level studies are needed to confirm these findings and identify the most effective biologic augmentation strategy to improve the outcome of meniscal repair.
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Affiliation(s)
- Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Poggi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Reale
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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27
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Zhuo H, Pan L, Xu Y, Li J. Functional, Magnetic Resonance Imaging, and Second-Look Arthroscopic Outcomes After Pullout Repair for Avulsion Tears of the Posterior Lateral Meniscus Root. Am J Sports Med 2021; 49:450-458. [PMID: 33382344 DOI: 10.1177/0363546520976635] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little data exist in the literature regarding second-look arthroscopic outcomes after pullout repair for avulsion tears of the posterior lateral meniscus root. PURPOSE To (1) assess the functional, magnetic resonance imaging (MRI), and second-look arthroscopic outcomes after pullout repair for avulsion tears of the posterior lateral meniscus root; (2) determine which demographic and clinical factors influenced healing of the repaired posterior lateral meniscus root; and (3) compare outcomes between different meniscal healing status groups. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 31 patients underwent pullout repair for avulsion tears of the posterior lateral meniscus root and had a minimum 2-year follow-up. Functional outcomes were assessed using patient-reported scores (Lysholm, Tegner, and International Knee Documentation Committee [IKDC] scores). Lateral meniscal extrusion, cartilage degeneration of the lateral compartment, and healing of the repaired posterior lateral meniscus root were assessed via MRI. The healing status was also assessed using second-look arthroscopic surgery, and the patients were divided into different healing status groups. RESULTS The postoperative patient-reported scores improved significantly compared with the preoperative values (P = .001). Lateral meniscal extrusion was reduced significantly from 3.37 ± 0.82 mm preoperatively to 0.63 ± 0.80 mm at final follow-up (P = .001). The grade of cartilage degeneration of the lateral compartment progressed from 0.69 ± 0.67 preoperatively to 0.95 ± 0.83 at final follow-up (P = .213). MRI scans showed complete healing in 28 patients (90.3%) and partial healing in 3 patients (9.7%). Second-look arthroscopic surgery showed stable healing in 18 of 23 patients (78.3%) and lax healing in 5 of 23 patients (21.7%). Patients with stable healing had significantly higher Lysholm and IKDC scores, more reduction of meniscal extrusion, and less progression of cartilage degeneration than did patients with lax healing (P < .05). Concomitant anterior cruciate ligament reconstruction was found to significantly positively influence healing of the repaired posterior lateral meniscus root (P = .047). CONCLUSION Pullout repair for avulsion tears of the posterior lateral meniscus root yielded significantly improved patient-reported scores, reduced meniscal extrusion, and a satisfactory healing rate at final follow-up. Patients with stable healing had significantly better functional and MRI outcomes than did patients with lax healing.
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Affiliation(s)
- Hongwu Zhuo
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ling Pan
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yangkai Xu
- Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jian Li
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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28
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Turcotte JJ, Maley AD, Levermore SB, Petre BM, Redziniak DE. Risk factors for all-inside meniscal repair failure in isolation and in conjunction with anterior cruciate ligament reconstruction. Knee 2021; 28:9-16. [PMID: 33278740 DOI: 10.1016/j.knee.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 10/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study examines the relationship between meniscus tear presentations and failure rates following all-inside repair in isolation and in conjunction with an anterior cruciate ligament (ACL) reconstruction. METHODS Eighty seven consecutive patients undergoing all-inside meniscal repair at a single institution from July 2016 to June 2018 were retrospectively reviewed. Details of patient presentation, tear type and location, the presence or absence of simultaneous ACL reconstruction, and surgical repair details were recorded to evaluate the relationship between patient characteristics and the primary endpoint of repair failure. RESULTS Patients were followed for an average of 2.7 ± 0.8 years. Three patients (3.4%) experienced 30-day complications including 1 deep vein thrombosis and 2 joint aspirations. Within the study time frame, 15 repairs (17.2%) failed, with 10 (11.5%) failing within one year of the initial procedure; the average time to failure was 12.3 ± 9.0 months. Patients undergoing concurrent ACL reconstruction were less likely to experience repair failure (9.7% vs. 36.0%, p = .009), while bucket-handle repairs were more likely to fail during the study period (45.0% vs. 9.0%, p = .001). These trends remained after controlling for tear location, body mass index, and number of sutures (ACL reconstruction Odds Ratio [OR]: 0.229, p = .029; Bucket-handle OR: 9.400, p = .003). CONCLUSION Our findings suggest concurrent ACL reconstruction at the time of meniscal repair is associated with increased repair survival. The all-inside technique may be successfully used across a variety of tear types and locations, although further study of its efficacy in repairing bucket-handle tears is warranted.
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Affiliation(s)
- Justin J Turcotte
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States.
| | - Alyssa D Maley
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Sandra B Levermore
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Benjamin M Petre
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Daniel E Redziniak
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
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29
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Mine T, Ihara K, Kawamura H, Shinohara M, Kuriyama R, Tominaga Y. Migration of a Meniscal Repair Implant Mimicking Meniscal Injury. Open Orthop J 2020. [DOI: 10.2174/1874325002014010117] [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
Complications after arthroscopic meniscal suture repair have been reported. Migration of a meniscal repair implant mimicking meniscal injury is rare. A 28-year-old female had undergone Anterior Cruciate Ligament (ACL) reconstruction at another hospital 12 years ago . The remaining instability after ACL reconstruction resulted in medial meniscal damage, wear and narrowing in the posterior third. The H-fix that was used in the meniscal repair became detached, exposing the inside of the knee joint. Meniscal repair is a successful procedure in conjunction with ACL reconstruction. However, when knee instability after ACL reconstruction remains, the choice of meniscal repair implants may lead to potential complications even after long-term clinical follow-up.
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30
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Wright RW, Huston LJ, Haas AK, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Pennings JS, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Steven J Svoboda L, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort. Am J Sports Med 2020; 48:2978-2985. [PMID: 32822238 PMCID: PMC8171059 DOI: 10.1177/0363546520948850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. PURPOSE To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. RESULTS In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. CONCLUSION Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.
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Ozeki N, Seil R, Krych AJ, Koga H. Surgical treatment of complex meniscus tear and disease: state of the art. J ISAKOS 2020; 6:35-45. [PMID: 33833044 DOI: 10.1136/jisakos-2019-000380] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/25/2020] [Accepted: 08/03/2020] [Indexed: 01/09/2023]
Abstract
The meniscus is important for load distribution, shock absorption and stability of the knee joint. Meniscus injury or meniscectomy results in decreased function of the meniscus and increased risk of knee osteoarthritis. To preserve the meniscal functions, meniscal repair should be considered as the first option for meniscus injury. Although reoperation rates are higher after meniscal repair compared with arthroscopic partial meniscectomy, long-term follow-up of meniscal repair demonstrated better clinical outcomes and less severe degenerative changes of osteoarthritis compared with partial meniscectomy. In the past, the indication of a meniscal repair was limited both because of technical reasons and due to the localised vascularity of the meniscus. Meanwhile, it spreads today as the development of the concept to preserve the meniscus and the improvement of meniscal repair techniques. Longitudinal vertical tears in the peripheral third are considered the 'gold standard' indication in terms of meniscus healing. Techniques for meniscal repair include 'inside-out', 'outside-in' and 'all-inside' strategies. Surgical decision-making depends on the type, size and location of the meniscus injury. Meniscal root tears substantially affect meniscal hoop function and accelerate cartilage degeneration; therefore, meniscus root repair is necessary to prevent the progression of osteoarthritis change. For symptomatic meniscus defects after meniscectomy, transplantation of allograft or collagen meniscus implant may be indicated, and acceptable clinical results have been obtained. Recently, meniscus extrusion has attracted attention due to increased interest in early osteoarthritis. The centralisation techniques have been proposed to reduce the meniscus extrusion by suturing the meniscus-capsule complex to the edge of the tibial plateau. Long-term clinical outcomes of this procedure may change the strategy of treating meniscus extrusion. When malalignment of the lower leg is accompanied with meniscus pathologies, knee osteotomies are a reasonable option to protect the repaired meniscus by unloading the pathological compartment. Advancements in biological augmentation such as bone marrow stimulation, fibrin clot, platelet-rich plasma, stem cell therapy and scaffolds have also expanded the indications for meniscus surgery. In summary, improved repair techniques and biological augmentation have made meniscus repair more appealing to treat that had previously been considered irreparable. However, further research would be necessary to validate the efficacy of these specialised technique.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Romain Seil
- Department of Orthopaedic Surgery, Hopital Municipal et Clinique d'Eich, Luxembourg City, Luxembourg.,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Aaron J Krych
- Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
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Van Genechten W, Verdonk P, Krych AJ, Saris DB. Biologic Adjuvants in Meniscus Repair: A Review of Current Translational and Clinical Evidence. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodríguez-Roiz JM, Sastre-Solsona S, Popescu D, Montañana-Burillo J, Combalia-Aleu A. The relationship between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate-2- to 12-year follow-up. J Orthop Surg Res 2020; 15:361. [PMID: 32854749 PMCID: PMC7450795 DOI: 10.1186/s13018-020-01878-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023] Open
Abstract
Background Few studies have approached in a long-term follow-up of meniscal repair at an amateur level, specially studying variables as a quality of life and failure rate. The purpose of this review is to study medium to long-term clinical results in patients at amateur sports patients, that have required meniscal sutures at our center, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as patients’ return to sports activities, quality of life, and the rate of failed repair and study of the possible reasons. Methods This was an observational retrospective study. Ninety-two patients who regularly perform amateur sports activities (Tegner 4 to 7) were assessed, with a minimum follow-up period of 2 years, divided into 2 groups: group 1, isolated meniscal suture (43 cases) and group 2, associated to ACL reconstruction (49 cases). Each patient made this test in 2019: Lysholm and Tegner (validated for Spanish) before a knee injury and after surgery, motivation to return to sports activity (Likert scale with 3 items: low, regular, or high), and quality of life through SD-12 test. Results High return to amateur sports rate (92%) was even higher in the isolated meniscal repair group in comparison to the group with associated ACL. We have not found statistically significant differences between sports return and age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%). Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). No statistically significant association was found between the other variables studied. Conclusions Good results with 92% of sports return, low rate of complications, and low retear rate, even lower when is associated with ACL reconstruction and in external meniscus repair, and high values at SF-12 between 2 groups.
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Affiliation(s)
- Juan M Rodríguez-Roiz
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain. .,CLINICA SAGRADA FAMILIA BARCELONA, c/torras i pujalt 1, 08022, Barcelona, Spain.
| | - Sergi Sastre-Solsona
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Dragos Popescu
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Jordi Montañana-Burillo
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Andres Combalia-Aleu
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
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Carlson Strother CR, Saris DBF, Verdonk P, Nakamura N, Krych AJ. Biological augmentation to promote meniscus repair: from basic science to clinic application—state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000426] [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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Pathak S, Bharadwaj A, Patil P, Raut S, Rv S. Functional Outcomes of Arthroscopic Combined Anterior Cruciate Ligament Reconstruction and Meniscal Repair: A Retrospective Analysis. Arthrosc Sports Med Rehabil 2020; 2:e71-e76. [PMID: 32368741 PMCID: PMC7190550 DOI: 10.1016/j.asmr.2019.11.001] [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: 07/15/2019] [Accepted: 11/04/2019] [Indexed: 11/15/2022] Open
Abstract
Purpose To evaluate the outcomes of arthroscopic meniscal repair performed in combination with anterior cruciate ligament (ACL) repair. Methods This study presents a case series of 34 patients who underwent repair of meniscal tears along with ACL reconstruction from 2014 to 2016. Cases of discoid meniscal lesions and combined or ligament injuries other than ACL injuries were excluded. Patients were followed up periodically, at 3, 6, 9, 12, and 24 months. Preoperative and postoperative functional evaluations were performed using visual analog scale, International Knee Documentation Committee, and Lysholm knee scores. Results The mean age of the patients was 29.1 years (range, 17-44 years). The mean follow-up period was 18 ± 7.8 months (range, 6-24 months). Among the 34 individual knees, 1 patient (3%) underwent both medial and lateral meniscal repairs. Medial meniscal repair was performed in 20 knees (59%), whereas the lateral meniscus was repaired in 13 knees (38%). A longitudinal tear was the most common type of tear pattern, followed by radial (6 patients) and complex (3 patients) tear patterns. The radial and complex tears were treated with an additional partial meniscectomy. The mean International Knee Documentation Committee score was 38.46 preoperatively and improved to 80.30 at final postoperative follow-up (statistically significant difference, P < .01). The mean Lysholm score was 50.30 preoperatively and improved to 91.40 at final postoperative follow-up (statistically significant difference, P < .01). According to the Lysholm knee score, 31 patients (89%) had excellent or good results. The mean visual analog scale score decreased from 7.3 preoperatively to 2 postoperatively. The clinical success rate of the repairs was 89%. Of 35 repairs, 4 (11%) had retears. Conclusions Arthroscopic meniscal repair along with ACL reconstruction provided predictable high rates of meniscal healing and yielded favorable functional and clinical results. Patient selection remains one of the most important prognostic factors. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Shirish Pathak
- Sports Injuries Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Abhinav Bharadwaj
- Sports Injuries Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Prateek Patil
- Sports Injuries Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Sudarshan Raut
- Sports Injuries Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Srikanth Rv
- Sports Injuries Department, Deenanath Mangeshkar Hospital and Research Centre, Pune, India
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Inside-Out Repair of the Meniscus in Concomitant Anterior Cruciate Ligament Reconstruction: Absorbable Versus Nonabsorbable Sutures. Arthroscopy 2020; 36:1074-1082. [PMID: 31948720 DOI: 10.1016/j.arthro.2019.08.045] [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: 02/15/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the clinical and magnetic resonance imaging (MRI) outcomes of meniscal repair using absorbable versus nonabsorbable sutures in patients undergoing concomitant anterior cruciate ligament reconstruction. METHODS Data of 142 patients who underwent meniscal repair with concomitant anterior cruciate ligament reconstruction using either absorbable or nonabsorbable sutures for longitudinal meniscal tear were retrospectively reviewed. Inside-out suture technique was used for all meniscal repairs. Weight bearing and flexion (>90°) were allowed after 6 weeks postoperatively. Clinical evaluations were assessed by the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score preoperatively and at 2-year follow-up. MRI outcomes at 1-year follow-up were compared to identify the successful healing (complete or partial healing) rate and incidence of additional meniscal tears. Subgroup analysis was performed to evaluate the results of medial or lateral meniscus. RESULTS Eighty patients underwent meniscal repair using absorbable sutures (mean age, 26.3 ± 11.9 years) and 62 patients with nonabsorbable sutures (mean age, 27.2 ± 10.0 years). There were no differences in zone and length of meniscal tears and stability tests between the groups. At a 2-year follow-up, all clinical scores had improved in both groups but did not differ significantly between the groups. Successful healing rate based on 1-year postoperative MRI was not significantly different between the absorbable and nonabsorbable sutures (93.7% vs 96.8%, P = .469). However, the absorbable sutures showed a lower additional tear incidence than the nonabsorbable sutures (2.5% vs 9.6%, P = .031). Subgroup analysis showed that the successful healing rate was not significantly different between the suture materials in both the medial and lateral menisci. CONCLUSIONS The use of absorbable sutures leads to comparable healing rates to and lower incidence of additional tears than nonabsorbable sutures in patients undergoing meniscal repair with anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Abstract
INTRODUCTION Ruptures of the anterior cruciate ligament (ACL) can be accompanied by meniscal lesions. Generally, the rehabilitation protocols are altered by meniscal repair. Therefore, the aim of this study was to investigate the effect of meniscal repair on the early recovery of thigh muscle strength in ACL reconstruction (ACLR). MATERIALS AND METHODS We performed a matched cohort analysis of n = 122 isolated ACLR (CON) compared to n = 61 ACLR with meniscal repair (ACLR + MR). The subgroups of meniscal repair consisted of 30 patients who had undergone medial meniscus repairs (MM), 19 lateral meniscus repairs (LM) and 12 repairs of medial and lateral meniscus (BM). Isokinetic strength measurement was performed pre-operatively and 6 months post-surgery to perform a cross-sectional and a longitudinal analysis. All injuries were unilateral, and the outcome measures were compared to the non-affected contralateral leg. RESULTS Six months postoperatively overall there is no significant difference between the groups (extension strength MR 82% vs. CON 85% and flexion strength 86% vs. 88%, resp.). Subgroup analysis showed that medial repairs exhibit a comparable leg symmetry while lateral repairs performed worse with leg symmetry being 76% in extension and 81% in flexion strength. Patients undergoing BM repair performed in between lateral and medial repairs (82% extension, 86% flexion). CONCLUSION Generally, meniscal repair in conjunction with ACLR does not significantly alter the recovery of limb symmetry in strength at 6 months postoperatively. Interestingly, medial repairs seem to perform superior to lateral meniscal repair and repair of both menisci. Since the recovery of symmetric strength is a major factor in rehabilitation testing, these results will help to advise surgeons on appropriate rehabilitation protocols and setting realistic goals for the injured athlete. LEVEL OF EVIDENCE III, retrospective cohort study.
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Saltzman BM, Cotter EJ, Wang KC, Rice R, Manning BT, Yanke AB, Forsythe B, Verma NN, Cole BJ. Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases. Cartilage 2020; 11:77-87. [PMID: 29957019 PMCID: PMC6921958 DOI: 10.1177/1947603518783473] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To define patient demographics, preoperative, and intraoperative surgical variables associated with successful or failed repair of bucket-handle meniscal tears. DESIGN All patients who underwent arthroscopic repair of a bucket-handle meniscus tear at a single institution between May 2011 and July 2016 with minimum 6-month follow-up were retrospectively identified. Patient demographic, preoperative (including imaging), and operative variables were collected and evaluated. A Kaplan-Meier curve was generated to demonstrate meniscus repair survivorship. RESULTS In total, 75 patients (78 knees) with an average age of 26.53 ± 10.67 years met inclusion criteria. The average follow-up was 23.41 ± 16.43 months. Fifteen knees (19.2%) suffered re-tear of the repaired meniscus at an average 12.24 ± 9.50 months postoperatively. Survival analysis demonstrated 93.6% survival at 6 months, 84.6% survival at 1 year, 78.4% survival at 2 years, and 69.9% survival at 3 years. There was significant improvement from baseline to time of final follow-up in all patient-reported outcome (P < 0.05) except Marx score (P = 0.933) and SF-12 Mental Subscale (P = 0.807). The absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively was the only variable significantly associated with repair failure (P = 0.024). Concurrent anterior cruciate ligament reconstruction (vs. no concurrent anterior cruciate ligament reconstruction) trended toward significance (P = 0.059) as a factor associated with successful repair. CONCLUSIONS With the exception of the absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively, no other variables were significantly associated with re-tear. The results are relatively durable with 84.6% survival at 1 year. Surgeons should attempt meniscal repair when presented with a bucket-handle tear.
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Affiliation(s)
| | - Eric J. Cotter
- Georgetown University School of
Medicine, Washington, DC, USA
| | - Kevin C. Wang
- Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Richard Rice
- Rush University Medical Center, Chicago,
IL, USA
| | | | | | | | | | - Brian J. Cole
- Rush University Medical Center, Chicago,
IL, USA,Brian J. Cole, Rush University Medical
Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, 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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Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:3441-3452. [PMID: 30719542 DOI: 10.1007/s00167-019-05389-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this review was to compare the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with either meniscal repair or meniscectomy for concomitant meniscal injury. The primary hypothesis was that short-term clinical outcomes (≤ 2-year follow-up) for ACLR concomitant with either meniscal repair or resection would be similar. The secondary hypothesis was that ACLR with meniscal repair would result in better longer term outcomes compared with meniscal resection. METHODS The authors searched two online databases (EMBASE and MEDLINE) from inception until March 2018 for the literature on ACLR and concurrent meniscal surgery. Two reviewers systematically screened studies in duplicate, independently, and based on a priori criteria. Quality assessment was also performed in duplicate. The Knee injury and Osteoarthritis Outcome Score (KOOS) sub-scale scores at 2 years post-operatively were combined in a meta-analysis of proportions using a random-effects model. RESULTS Of 2566 initial studies, 25 studies satisfied full-text inclusion criteria. Mean follow-up was 2.09 years, with a total sample of 37,087 subjects including controls. The meta-analysis demonstrated equivocal results at 2 years, except for KOOS symptom scores which favoured meniscal resection over repair. Mean KT-1000 side-to-side difference (SSD) scores were 1.51 ± 0.60 mm for meniscal repair, 1.96 ± 0.36 mm for meniscal resection, and 1.58 ± 0.20 for control patients (isolated ACLR). Medial meniscal repair showed decreased anterior knee joint laxity compared to medial meniscal resection (P < 0.001). Patients with meniscal repair had higher rates of re-operation (13.3% vs 0.8% for meniscal resection, P < 0.001). CONCLUSION Patients with ACLR combined with meniscal resection demonstrate better symptoms at 2-year follow-up compared to patients with ACLR combined with meniscal repair. ACLR combined with meniscal repair results in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term, but also higher re-operation rates. LEVEL OF EVIDENCE III.
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Kwon H, Brown WE, Lee CA, Wang D, Paschos N, Hu JC, Athanasiou KA. Surgical and tissue engineering strategies for articular cartilage and meniscus repair. Nat Rev Rheumatol 2019; 15:550-570. [PMID: 31296933 PMCID: PMC7192556 DOI: 10.1038/s41584-019-0255-1] [Citation(s) in RCA: 336] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/30/2022]
Abstract
Injuries to articular cartilage and menisci can lead to cartilage degeneration that ultimately results in arthritis. Different forms of arthritis affect ~50 million people in the USA alone, and it is therefore crucial to identify methods that will halt or slow the progression to arthritis, starting with the initiating events of cartilage and meniscus defects. The surgical approaches in current use have a limited capacity for tissue regeneration and yield only short-term relief of symptoms. Tissue engineering approaches are emerging as alternatives to current surgical methods for cartilage and meniscus repair. Several cell-based and tissue-engineered products are currently in clinical trials for cartilage lesions and meniscal tears, opening new avenues for cartilage and meniscus regeneration. This Review provides a summary of surgical techniques, including tissue-engineered products, that are currently in clinical use, as well as a discussion of state-of-the-art tissue engineering strategies and technologies that are being developed for use in articular cartilage and meniscus repair and regeneration. The obstacles to clinical translation of these strategies are also included to inform the development of innovative tissue engineering approaches.
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Affiliation(s)
- Heenam Kwon
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Cassandra A Lee
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - Nikolaos Paschos
- Division of Sports Medicine, Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA.
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Logan CA, Aman ZS, Kemler BR, Storaci HW, Dornan GJ, LaPrade RF. Influence of Medial Meniscus Bucket-Handle Repair in Setting of Anterior Cruciate Ligament Reconstruction on Tibiofemoral Contact Mechanics: A Biomechanical Study. Arthroscopy 2019; 35:2412-2420. [PMID: 31395180 DOI: 10.1016/j.arthro.2019.03.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the impact of an inside-out repair versus meniscectomy of a medial meniscus bucket-handle tear in restoring native contact areas and pressures across the tibial plateaus in the setting of an anterior cruciate ligament (ACL) reconstruction (ACLR). METHODS Ten fresh-frozen cadaveric knees were tested in 6 knee conditions (1: intact; 2: ACL torn and bucket-handle tear of medial meniscus, flipped; 3: bucket-handle tear of medial meniscus, reduced; 4: bucket-handle tear of medial meniscus, repaired via inside-out vertical mattress suture technique; 5: ACLR with bone patella tendon bone autograft and bucket-handle repair; 6: ACLR and medial meniscus bucket-handle tear debridement) at 4 flexion angles (0°, 30°, 45°, and 60°), under a 1,000-N axial load. Contact area and pressure were measured with Tekscan sensors. RESULTS ACLR with a concurrent medial meniscectomy for a medial meniscus bucket-handle tear resulted in significantly decreased contact area (P < .05) and increased mean and peak pressure in both the medial and lateral compartments across all tested flexion angles (P < .05). The ACLR with medial meniscectomy state also demonstrated significantly lower contact area than the bucket-handle repair state between 30° and 60° of flexion (all P < .05). CONCLUSIONS Resection of a bucket-handle medial meniscus tear concurrent with an ACLR resulted in significant increases in mean and peak contact pressures in not only the medial but also the lateral compartment. Preservation of the medial meniscus in the face of a bucket-handle tear is essential to more closely restore native tibiofemoral biomechanics. CLINICAL RELEVANCE The increased mean and peak tibiofemoral contact pressure seen with excision of a bucket-handle medial meniscus tear would over time result in increased cartilaginous degradation and resultant osteoarthritis. Decreasing both of these factors through concomitant ACLR and inside-out bucket-handle meniscal repairs should improve patient outcomes by restoring knee biomechanics and kinematics closer to that of the native state.
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Affiliation(s)
- Catherine A Logan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Steadman Clinic, Vail, Colorado, U.S.A
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Bryson R Kemler
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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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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Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A. Evaluation of Midterm Clinical and Radiographic Outcomes of Arthroscopically Repaired Vertical Longitudinal and Bucket-Handle Lateral Meniscal Tears. Orthop J Sports Med 2019; 7:2325967119843203. [PMID: 31157282 PMCID: PMC6512156 DOI: 10.1177/2325967119843203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Lateral meniscal tears in the stable knee are rare. There are few comparative
studies evaluating functional and radiological outcomes of vertical
longitudinal and bucket-handle lateral meniscal tears. Purpose: To evaluate the midterm clinical and radiological outcomes of
arthroscopically repaired traumatic vertical longitudinal and bucket-handle
lateral meniscal tears. Study Design: Case series; Level of evidence, 4. Methods: A total of 43 full-thickness lateral meniscal repairs, including 22 (51.2%)
for vertical longitudinal tears and 21 (48.8%) for bucket-handle tears, were
evaluated. A clinical assessment was performed according to the Barrett
criteria, and patient outcomes were measured with the Lysholm knee score,
Tegner activity scale, and overall satisfaction scale. Magnetic resonance
imaging was used as the radiological re-examination method preoperatively
and at final follow-up. A subgroup analysis examining isolated repair versus
repair with concurrent anterior cruciate ligament (ACL) reconstruction was
performed. Results: The mean follow-up period was 63.2 months (range, 24-86 months). Based on
clinical and radiological outcomes, 38 of the 43 repairs (88.3%) were
successful, and the remaining 5 (11.6%) cases were considered to be
failures. Overall, the combined results for both groups demonstrated an
improvement in the Lysholm score, Tegner score, and patient satisfaction.
There was no significant difference in the postoperative Lysholm score (91.4
vs 87.0, respectively; P = .223), Tegner score (5.4 vs 5.5,
respectively; P = .872), or patient satisfaction (7.2 vs
7.4, respectively; P = .624) between bucket-handle repair
and vertical longitudinal repair. The subgroup analysis demonstrated no
difference in outcome scores for isolated repair versus repair with
concurrent ACL reconstruction. Smoking was identified as a risk factor for
repair failure. Conclusion: Comparable clinical and radiological outcomes were obtained after vertical
longitudinal and bucket-handle lateral meniscal repairs using the all-inside
or hybrid suture technique with different suture configurations, regardless
of whether ACL reconstruction was performed. Smoking was identified as a
risk factor for failure.
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Affiliation(s)
- Erdal Uzun
- Department of Orthopaedics and Traumatology, Ordu University School of Medicine, Ordu, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopaedics and Traumatology, Ahi Evran University Training and Research Hospital, Kirsehir, Turkey
| | - Soner Akkurt
- Department of Sports Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopaedics and Traumatology, Erciyes University School of Medicine, Kayseri, Turkey
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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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Kaminski R, Kulinski K, Kozar-Kaminska K, Wasko MK, Langner M, Pomianowski S. Repair Augmentation of Unstable, Complete Vertical Meniscal Tears With Bone Marrow Venting Procedure: A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Arthroscopy 2019; 35:1500-1508.e1. [PMID: 30902532 DOI: 10.1016/j.arthro.2018.11.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the effectiveness and safety of meniscal repair in 2 groups of patients: meniscal repair with biological augmentation using a bone marrow venting procedure (BMVP) of the intercondylar notch versus meniscal repair only. METHODS This single-center, prospective, randomized, double-blind, placebo-controlled, parallel-arm study included 40 patients (21 menisci in control, 23 in BMVP group) with complete vertical meniscus tears. Patients underwent all-inside and outside-in meniscal repair and a concomitant BMVP of the intercondylar notch or meniscal repair alone during an index arthroscopy. The primary endpoint was the rate of meniscus healing in the 2 groups assessed during a second-look arthroscopy (at week 35). The secondary endpoints were changes in the International Knee Documentation Committee score, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and visual analog scale in the 2 groups at 30 months. RESULTS After 36 weeks, the meniscus healing rate was significantly higher in the BMVP-treated group than in the control group (100% vs. 76%, P = .0035). Functional outcomes were significantly better 30 months after treatment than at baseline in both groups. The International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and visual analog scale scores were significantly better in the BMVP-treated group than in the control group. No adverse events were reported during the study period. CONCLUSIONS Our blinded, prospective, randomized, controlled trial on the role of BMVP augmentation in meniscus repair, indicates that BMVP augmentation results in a significant improvement in the rate of meniscus healing (100% vs. 76%, P = .0035). The risk of adverse events related to augmentation with BMVP of the arthroscopic meniscal repair is very low. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Rafal Kaminski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland.
| | - Krzysztof Kulinski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
| | - Katarzyna Kozar-Kaminska
- Department of Medical Biology, The Stefan Cardinal Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Marcin K Wasko
- Departament of Radiology, The Medical Centre of Postgraduate Education in Warsaw, Otwock, Poland
| | - Maciej Langner
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
| | - Stanislaw Pomianowski
- Department of Musculoskeletal Trauma Surgery and Orthopaedics, Postgraduate Center for Medical Education, Professor A. Gruca Teaching Hospital, Otwock, Poland
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Okazaki Y, Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T, Masuda S, Ozaki T. Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. Knee Surg Sports Traumatol Arthrosc 2019; 27:361-368. [PMID: 30251100 DOI: 10.1007/s00167-018-5157-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/17/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the shape and shift of the medial meniscus before and after meniscal repair concurrent with anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI) at 90° of knee flexion. METHODS This study included 18 patients with ACL-deficient knees without meniscus tears (group A), 11 patients with medial meniscus tears alone (group M), and 15 patients with ACL-deficient knees complicated with medial meniscus tears (group AM). The posterior segment shape was evaluated using open MRI at 90° of knee flexion preoperatively and at 3 months postoperatively. The length, height, width, and posterior extrusion of the medial meniscus and posterior tibiofemoral distance were measured. These measurements were compared between the three groups. RESULTS On preoperative MRI, a significant difference was observed in the posterior extrusion of the medial meniscus (group A, 1.2 ± 0.5 mm; group M, 1.7 ± 0.3 mm; group AM, 4.1 ± 1.5 mm, p < 0.001). All parameters did not differ between the three groups on postoperative MRI. In addition, the posterior width and extrusion of the medial meniscus were decreased significantly after meniscal repair concurrent with ACL reconstruction. CONCLUSIONS This study demonstrated that the medial meniscus shifted posteriorly at 90° of knee flexion in ACL-deficient knees complicated with medial meniscus tears. Medial meniscal repair concurrent with ACL reconstruction improved the deformed morphology and posterior extrusion. MRI measurements of the posterior extrusion at the knee-flexed position may be clinically useful to assess the functional improvement of the medial meniscus following meniscal repair combined with ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yoshiki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yuya Kodama
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yusuke Kamatsuki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomohito Hino
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Shin Masuda
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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Kim SJ, Chang WH, Lee SK, Chung JH, Ryu KJ, Kim SG. Posterior Horn Repair Augmented With the Central Portion of Thickened Meniscus for Large Posterolateral Corner Loss Type of Discoid Lateral Meniscus. Arthrosc Tech 2018; 8:e65-e73. [PMID: 30899653 PMCID: PMC6408741 DOI: 10.1016/j.eats.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/08/2018] [Indexed: 02/03/2023] Open
Abstract
Large posterolateral corner loss type of discoid lateral meniscus tear is unsalvageable. Therefore, subtotal meniscectomy has been the only treatment option in this case. However, long-term results of subtotal or total meniscectomy have shown a high prevalence of early degenerative changes. Persistent symptoms, such as increased pain, snapping, giving way, locking, and limited extension, can be attributed to progressive loss of posterior tibial meniscal attachment and meniscal degeneration, especially in the posterior horn. The purpose of this technique-based article is to describe a partial repair, posterior horn repair augmented with the central portion of the discoid lateral meniscus that would have been removed if a subtotal meniscectomy were performed and bone marrow stimulation in the intercondylar notch to improve meniscal healing.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, Gangnam Yonseisarang Hospital, Seoul, Republic of Korea
| | - Woo-Hyuk Chang
- Kim & Chung Orthopaedic Clinic, Gwangmyeong, Republic of Korea,Address correspondence to Woo-Hyuk Chang, M.D., 36, Cheolsan-ro, Kim & Chung Orthopaedic Clinic, Gwangmyeong-si, Gyeonggi-do, Republic of Korea 14237
| | - Su-Keon Lee
- Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Republic of Korea
| | - Ju-Hwan Chung
- Kim & Chung Orthopaedic Clinic, Gwangmyeong, Republic of Korea
| | - Keun-Jung Ryu
- Kim & Chung Orthopaedic Clinic, Gwangmyeong, Republic of Korea
| | - Sul-Gee Kim
- Department of Orthopaedic Surgery, Yonsei Sulgee Hospital, Seoul, Republic of Korea
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50
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Meniscal repair in patients age 40 years and older: A systematic review of 11 studies and 148 patients. Knee 2018; 25:1142-1150. [PMID: 30414793 DOI: 10.1016/j.knee.2018.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/15/2018] [Accepted: 09/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this review is to evaluate published outcomes for reported failure rates following meniscus repair in patients age 40 years or older. METHODS A systematic search was performed, and 225 meniscus repair outcome studies on adults were identified in the English literature. Included studies reported either individual patient data with at least one patient age ≥40 years or summary data with all patients' age ≥40 years. Failure rates were determined based on previously reported risk factors (regardless of age) including concomitant anterior cruciate ligament (ACL) reconstruction (ACLR), tear location, and tear pattern. RESULTS Meniscus repair outcomes for 148 patients from 11 studies were included (125 inside-out repairs and 23 all-inside repairs). The overall failure rate was 10% (15/148) and ranged from 0 to 23% in individual studies with more than one patient age ≥40 years. One comparative study of patients over versus under age 40 years was identified, with no difference in failure rates between groups. Most tears were peripheral tears with avascular extension (nine-percent overall failure rate) or without avascular extension (nine-percent failure rate). Among studies that reported tear pattern, overall failure rates for vertical-longitudinal or bucket handle tears were nine percent and complex and/or horizontal tears were 23%. Repairs with concomitant ACL reconstruction had a five-percent overall failure rate versus 15% in ACL intact patients. CONCLUSION Meniscus repair failure rates in patients age 40 years and older are comparable to rates quoted for younger patients. LEVEL OF EVIDENCE Level IV. Systematic review of Level III and IV studies.
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