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Ibañez M, Hoffmann F, Mouton C, Seil R. Horizontal Cleavage Meniscus Tear: "The Quad Tendon Augmentation Technique". Arthrosc Tech 2024; 13:102977. [PMID: 39036403 PMCID: PMC11258872 DOI: 10.1016/j.eats.2024.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 07/23/2024] Open
Abstract
The management of medial meniscus horizontal cleavage tears can be challenging. Currently, several treatment options, including nonoperative and surgical options, have been proposed in the literature. Different repair techniques aiming to promote the healing process have been reported and have shown good outcomes. However, recurrent parameniscal cysts and decreased meniscal volume have also been reported. In this Technical Note, a novel surgical technique to repair a horizontal cleavage tear of the posterior horn of the medial meniscus is reported in young patients. The technique uses a strip of autologous quadriceps tendon to fill the void between the upper and lower meniscal leaflets followed by an all-inside compression suture. Both of these technical features aim to overcome the limitations of current repair techniques.
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Affiliation(s)
- Maximiliano Ibañez
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Institut Català de Traumatologia i Medicina de l'Esport, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Hoffmann
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg–Clinique d’Eich, Luxembourg, Luxembourg
- Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg
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Patil HG, Pimprikar MV, Patil CK. Fish Mouth Closure of Horizontal Cleavage Tear of the Meniscus using Self-locking Modified Racking Hitch Knot (HitPat knot). - A Technical Note. J Orthop Case Rep 2024; 14:194-197. [PMID: 38681933 PMCID: PMC11043996 DOI: 10.13107/jocr.2024.v14.i04.4408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 02/13/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Horizontal cleavage tears (HCT) of the meniscus are treated with fish-mouth closure with sutures using different methods. Using a no. 0 fiber wire and taking bites through both the flaps using a suture passing device and tying multiple knots is a cost-effective technique. A racking hitch knot is an option for all inside repairs of HCT. It needs multiple half hitches for locking the knot. Surgical Technique We used a modification of the racking hitch knot (HP knot), making it a self-locking knot, so it does not need half hitches. Loop of no. 0 fiber wire is passed across both the flaps of the meniscus and a modified racking hitch knot tied in one goes closing the fish mouth. Conclusion This modification (HP knot) saves operative time, it is cost-effective and has the distinct advantage of a reduction in the size of the final knot construct.
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Rublev GA, Natchkebia L, Gaprindashvili V, Mohamed MA, Tamazishvili T, Kartozia I, Zimlitski M. Arthroscopic Saucerization of Discoid Lateral Meniscus, With Meniscus Repair as Indicated, Results in Excellent Outcomes in Pediatric Patients Younger Than 12 Years of Age. Arthrosc Sports Med Rehabil 2024; 6:100915. [PMID: 38532769 PMCID: PMC10963204 DOI: 10.1016/j.asmr.2024.100915] [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: 08/18/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Purpose To evaluate the experiences and outcomes of arthroscopic partial meniscectomy in symptomatic non-Wrisberg discoid lateral meniscus in children younger than 12 years old at a single center. Methods We retrospectively reviewed the medical records of all pediatric patients who were treated for non-Wrisberg discoid meniscus at our institute between 2013 and 2021. Patients were separated into 2 groups: Patients who underwent partial resection with saucerization (group A) or patients who underwent saucerization, tear repair, and fixation (group B). Clinical outcomes were compared between the 2 groups. Results A total of 20 patients (22 knees) were treated for non-Wrisberg discoid meniscus and included in this study. Nine patients underwent partial resection with saucerization (group A) whereas 11 patients underwent saucerization, tear repair, and fixation (group B). The average follow-up was 3 years (range 2-10 years). The results showed that 17 of the 20 patients had excellent outcomes whereas the other 3 had good outcomes after a minimum follow-up of 2 years. The average Knee Injury and Osteoarthritis Outcome Score for Children score was 93. Conclusions Arthroscopic saucerization of symptomatic non-Wrisberg discoid lateral meniscus, with additional repair as indicated results in excellent or good outcomes in children younger than 12 years of age. Level of Evidence Level III, case-control study.
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Affiliation(s)
- George A. Rublev
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
- AIETI David Tvildiani Medical University, Tbilisi, Georgia
| | - Levan Natchkebia
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | - Vazha Gaprindashvili
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | | | - Tamaz Tamazishvili
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | - Irakli Kartozia
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
| | - Mikheil Zimlitski
- Center for Arthrology, Sports Medicine, and Regenerative PRP at MediClub, Tbilisi, Georgia
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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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Schwach M, Dergham R, Klasan A, Putnis S, Farizon F, Philippot R, Rambaud A, Neri T. Return-to-sport criteria after isolated meniscus suture: Scoping review of the literature. Orthop Traumatol Surg Res 2023; 109:103604. [PMID: 36940904 DOI: 10.1016/j.otsr.2023.103604] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 03/22/2023]
Abstract
BACKGROUND Follow-up care including rehabilitation therapy after isolated meniscal repair remains to be standardized. Thus, no standard criteria are available for the return-to-running (RTR) or return-to-sport (RTS). The objective of this study was to identify criteria for RTR and RTS after isolated meniscal repair, based on a review of the literature. HYPOTHESIS Return-to-sport criteria after isolated meniscal repair have been published. METHODS We performed a scoping review of the literature using the methodology developed by Arksey and O'Malley. The terms "menisc*" and "repair" and "return-to-sport" or "return to play" or "return to run" or "rehabilitation" were used to search the PubMed database on 1st March 2021. All relevant studies were included. All RTR and RTS criteria were identified, analyzed, and classified. RESULTS We included 20 studies. Mean RTR and RTS times were 12.9 and 20 weeks, respectively. Clinical, strength, and performance criteria were identified. The clinical criteria included full range-of-motion recovery with no pain, quadriceps wasting, or joint effusion. Strength criteria were a quadriceps and hamstring deficit, no greater than 30% and 15% for RTR and RTS, respectively, compared to the normal side. Performance criteria were successful completion of proprioception, balance, and neuromuscular tests. RTS rates ranged from 80.4% to 100%. CONCLUSION Patients must meet clinical, strength, and performance criteria before resuming running and sports. The level of evidence is low, due to the heterogeneity and generally arbitrary choice of criteria. Further large-scale studies are therefore needed to validate and standardize RTR and RTS criteria. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maxime Schwach
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France.
| | - Rayan Dergham
- EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
| | - Antonio Klasan
- Kepler University Hospital, Linz, Austria; Johanne-Kepler University, Linz, Austria
| | - Sven Putnis
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Frédéric Farizon
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France
| | - Rémi Philippot
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France; EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
| | - Alexandre Rambaud
- EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, Saint-Étienne, France; EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon - University Jean-Monnet Saint-Étienne, Saint-Étienne, France
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Migliorini F, Asparago G, Oliva F, Bell A, Hildebrand F, Maffulli N. Greater rate of return to play and re-injury following all-inside meniscal repair compared to the inside-out technique: a systematic review. Arch Orthop Trauma Surg 2023; 143:6273-6282. [PMID: 37284879 PMCID: PMC10491517 DOI: 10.1007/s00402-023-04933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Inside-out and all-inside arthroscopic meniscal repairs are widely performed. However, it remains unclear which method promotes greater clinical outcomes. This study compared inside-out versus all-inside arthroscopic meniscal repair in terms of patient-reported outcome measures (PROMs), failures, return to play, and symptoms. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. Two authors independently performed the literature search by accessing the following databases: PubMed, Google Scholar, and Scopus in February 2023. All clinical studies which investigated the outcomes of all-inside and/or inside-out meniscal repair were considered. RESULTS Data from 39 studies (1848 patients) were retrieved. The mean follow-up was 36.8 (9 to 120) months. The mean age of the patients was 25.8 ± 7.9 years. 28% (521 of 1848 patients) were women. No difference was found in PROMs: Tegner Activity Scale (P = 0.4), Lysholm score (P = 0.2), and International Knee Document Committee score (P = 0.4) among patients undergoing meniscal repair with all inside or inside-out techniques. All-inside repairs showed a greater rate of re-injury (P = 0.009) but also a greater rate of return to play at the pre-injury level (P = 0.0001). No difference was found in failures (P = 0.7), chronic pain (P = 0.05), reoperation (P = 0.1) between the two techniques. No difference was found in the rate of return to play (P = 0.5) and to daily activities (P = 0.1) between the two techniques. CONCLUSION Arthroscopic all-inside meniscal repair may be of special interest in patients with a particular interest in a fast return to sport, while, for less demanding patients, the inside-out suture technique may be recommended. High-quality comparative trials are required to validate these results in a clinical setting. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany.
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB, Stoke On Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England
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Guo Z, Wang X, Liu G, Lu Y, Bai Y, Lv J, Liu F. Localizing the position of the Segond fracture bed under CT measurements to determine the functional tibial insertion of an anterolateral ligament. Front Surg 2023; 10:1235750. [PMID: 37638122 PMCID: PMC10457158 DOI: 10.3389/fsurg.2023.1235750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Many studies have confirmed the existence of ligament structures in the anterolateral region of the knee that maintain rotational stability of the knee joint, namely, the anterolateral ligament (ALL). Most scholars believe that knee joint reconstruction should be considered during revision surgery and a high level of pivot displacement test (stage 2 or 3). During ALL reconstruction, the choice of ligament reconstruction sites affects the success rate and prognosis of the operation. Therefore, the choice of ligament reconstruction sites is particularly important. There is little research on the lateral ALL tibia insertion point, and most clinicians use the midpoint Gerdy's tubercle and fibular head as insertion points. However, the reconstruction effect is not ideal. Objective This study aims to measure the position of the Segond fracture bed on CT images to determine the ALL position of the tibia. Method To determine the position of the Segond fracture bone bed, the CT AM Volume Share 2 system was used to manually measure the position of bone fragments in 23 Segond fracture patients. Using the highest point of Gerdy's tubercle in the CT axial slices and the outermost point of the fibular head in the CT axial slices as reference points, the direction and angle of the CT slices were adjusted to ensure that the highest point of the Gerdy tubercle, the outermost point of the fibular head, and the center of Segond fracture bed were in the same sagittal slice. A CT sagittal slice measures the vertical distance from the center of the Segond fracture bed to the Gerdy-fibular line segment (G-F line segment), which is the line connecting the highest point of the segment to the outermost point of the fibula. The distance from the vertical point at the center of the Segond fracture bed of the G-F line to the highest point of the Gerdy tubercle was measured. All measurements were performed using the same measurement standard and were expressed as a percentage of the length of the G-F line. The measured results were statistically analyzed using SPSS 25.0 descriptive statistical research methods. Results The average length of the G-F segment measured on CT images was 39.6 ± 2.0 mm, and the average vertical length from the center of the Segond fracture bed to the G-F segment was 13.1 ± 1.1 mm, accounting for 33.2% ± 2.1% of the length of the G-F segment. The length from the vertical point of the fracture bed on the G-F line segment to the highest point of the Gerdy tubercle was 14.7 ± 1.3 mm, accounting for 37.1% ± 2.9% of the length of the G-F segment. Conclusion Through the study of the CT measurement of the Segond fracture location, we obtained the location of the functional tibial insertion of ALL, which is different from the anatomical insertion of ALL and is more inclined to the Gerdy tubercle and above, which has reference value for the treatment of recovering the function of anterolateral ligament after reconstruction.
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Affiliation(s)
- Ziteng Guo
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
- School of Graduate, Hebei Medical University, Shijiazhuang, China
| | - Xuyang Wang
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Guoshuai Liu
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yang Lu
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Yuxi Bai
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Jian Lv
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Fei Liu
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
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Mallory N, Qin C, Gibbs D, Milliron E, Cavendish P, Magnussen RA, Flanigan DC. Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00006. [PMID: 37561839 DOI: 10.2106/jbjs.rvw.23.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.
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Affiliation(s)
- Noah Mallory
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles Qin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Gibbs
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Eric Milliron
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Parker Cavendish
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Dong C, Zhao C, Wang F. Clinical benefit of high tibial osteotomy combined with the intervention of platelet-rich plasma for severe knee osteoarthritis. J Orthop Surg Res 2022; 17:405. [PMID: 36064432 PMCID: PMC9446579 DOI: 10.1186/s13018-022-03304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The objective of present study was to investigate the therapeutic effects of high tibial osteotomy (HTO) combined with platelet-rich plasma (PRP) for severe knee osteoarthritis (KOA). METHODS This was a double-blinded, randomized, placebo-controlled trial. The participants were randomly divided by computerderived random charts into 3 groups: 24 participants in group A (24 knees) received a treatment option of HTO combined with PRP, 25 participants in group B (25 knees) received a treatment program of HTO combined with hyaluronic acid, and 25 participants in group C (25 knees) received a treatment method of HTO combined with normal saline (NS) (physiological control/placebo). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) were measured preoperatively and at the final follow-up. Status of articular cartilage was assessed according to the International Cartilage Repair Society grade and the presence of newly formed cartilaginous tissue by arthroscopy. MRI was completed of knee joint to measure the cartilaginous thickness. RESULTS Compared to Group B and C, the final follow-up results of knee function in Group A were significantly different (P < 0.001), such as the total WOMAC score 18.54 (SD 4.17), the VAS score 1.72 (SD 0.53). Cartilage regeneration of femur and tibia in Group A was observed in all patients. The cartilaginous thickness in Group A were significantly different (P < 0.001), such as the anterior patella femoral region 3.52 (SD 0.47), the anterior meniscal region 1.16 (SD 0.24), the posterior meniscal region 1.24 (SD 0.26) and the posterior condyle region 2.25 (SD 0.31). CONCLUSIONS The addition of combined PRP to HTO may be a more reasonable choice to relieve knee pain and decelerate the progression of the medial KOA.
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Affiliation(s)
- Conglei Dong
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Ziqiang Road 139, Shijiazhuang, 050051 Hebei China
| | - Chao Zhao
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Ziqiang Road 139, Shijiazhuang, 050051 Hebei China
| | - Fei Wang
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Ziqiang Road 139, Shijiazhuang, 050051 Hebei China
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Tao T, Yang W, Tao X, Li Y, Zhang K, Jiang Y, Gui J. Arthroscopic Direct Anterior-to-Posterior Suture Suspension Fixation for the Treatment of Posterior Cruciate Ligament Tibial Avulsion Fracture. Orthop Surg 2022; 14:2031-2041. [PMID: 35894145 PMCID: PMC9483072 DOI: 10.1111/os.13401] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives A posterior cruciate ligament (PCL) avulsion fracture of the tibial attachment site is a specific type of PCL injury that is difficult and unpleasant to manage. The objective of this study is to report the preliminary results of a newly developed technique: arthroscopic endobutton‐suture fixation using a single tibial tunnel. Methods From January 2016 to January 2018, 120 patients with PCL avulsion fracture who met our criteria were recruited. Sixty cases were treated by arthroscopic direct anterior‐to‐posterior suture suspension fixation (endobutton‐suture group), and 60 cases were treated by arthroscopic screw‐suture fixation (screw‐suture group). All radiographic studies were recorded. The curative effect was evaluated by the range of motion (ROM), KT‐2000, International Knee Documentation Committee (IKDC) scores, Tegner activity scale, and Lysholm scoring system. For statistical analysis the Student t‐test was used. Results The average follow‐up duration was 24 months. Findings and difficulties in surgery are the following. The lax anterior cruciate ligament is one of the diagnostic criteria. The anatomic location of PCL avulsion fractures is deep and surrounded by nerves and vessels; thus, operating through this region is difficult. After each tunnel drilling, the debris at the edge of opening needs to be cleaned to avoid obscuring the operator's vision or wearing the sutures. In endobutton‐suture group, ROM improved from 0° preoperatively to 140.0° ± 5.6° at the last follow‐up (P < 0.001). The postoperative KT‐2000 arthrometric data at 90 N were available for all patients. The IKDC score was 23.6 ± 2.6 and 91.4 ± 4.1 pre‐ and postoperatively, respectively. The Tegner score improved from 1.2 ± 0.6 to 7.3 ± 2.3 (p < 0.001). The median Lysholm knee score increased from 40.4 ± 5.2 preoperatively to 90.1 ± 10.1 postoperatively (p < 0.001). The operative time was shorter in the endobutton‐suture group (p < 0.001). The Lysholm knee score in the endobutton‐suture group was lower than that in the endobutton‐suture group (3.1 ± 1.2 vs. 4.2 ± 1.8, p < 0.01). No significant complications were noted in the study. Conclusions The arthroscopic direct anterior‐to‐posterior suture suspension fixation is a simple and reliable method that not only provides better clinical outcomes, but also fixes avulsion fragments of any size.
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Affiliation(s)
- Tianqi Tao
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wengbo Yang
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xing Tao
- Department of Physical Education, Sanjiang University, Nanjing, China
| | - Yang Li
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Kaibin Zhang
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yiqiu Jiang
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianchao Gui
- Department of Orthopedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Li H, Li Z, Li Q, Mei L, Pierre BS, Abdullenur A, Huang T, Wang W, Mao X, Zhu W. Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three-Year MRI Follow-Up. Orthop Surg 2022; 14:1743-1750. [PMID: 35818343 PMCID: PMC9363751 DOI: 10.1111/os.13374] [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: 08/09/2020] [Revised: 04/20/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations. Methods A total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing. Results Preoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus. Conclusions Arthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.
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Affiliation(s)
- Hongxing Li
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Orthopaedic, The Central Hospital of Shaoyang, Shaoyang, China
| | - Zhiling Li
- Center of Health Management, The Central Hospital of Shaoyang, Shaoyang, China
| | - Quanchao Li
- Department of Orthopaedic, The First People's Hospital of Changde city, Changde, China
| | - Lin Mei
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bigiriman Simon Pierre
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ayub Abdullenur
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianlong Huang
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wanchun Wang
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xinzhan Mao
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Zhu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
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12
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Yin X, Li X, Zhao P. Comparison of adductor canal block and femoral nerve block for pain management in anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e29295. [PMID: 35758360 PMCID: PMC9276137 DOI: 10.1097/md.0000000000029295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To compare the efficacy of adductor canal block and femoral nerve block for pain management in patients with anterior cruciate ligament reconstruction. METHODS A computerized search was performed in the database of PubMed, Embase, Web of Science and Cochrane Library for randomized controlled trials. The outcome measures included visual analog scale, morphine consumption, quadriceps strength, length of hospitalization and postoperative adverse events. The risk of bias of randomized controlled trials was assessed according to the Cochrane Risk of Bias Tool. All quantitative syntheses were completed using STATA version 14. RESULTS Seven randomized controlled trials involving a total of 643 patients were included in our meta-analysis. The present meta-analysis indicated that there were no significant differences between the 2 groups in terms of postoperative pain score, opioid consumption, length of hospitalization or adverse effects after anterior cruciate ligament reconstruction. However, adductor canal block showed superior quadriceps strength and range of motion in the early postoperative period. CONCLUSION Adductor canal block shows similar and adequate analgesia compared to the femoral nerve block in anterior cruciate ligament reconstruction and adductor canal block can preserve a higher quadriceps strength and better range of motion.
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13
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Novaretti JV, Astur DC, Cavalcante ELB, Kaleka CC, Amaro JT, Cohen M. Preoperative Meniscal Extrusion Predicts Unsatisfactory Clinical Outcomes and Progression of Osteoarthritis after Isolated Partial Medial Meniscectomy: A 5-Year Follow-Up Study. J Knee Surg 2022; 35:393-400. [PMID: 32838459 DOI: 10.1055/s-0040-1715109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outcomes and progression of osteoarthritis and to determine the extent of meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis. Ninety-five patients who underwent partial medial meniscectomy with a minimum follow-up of 5 years were retrospectively reviewed. Preoperative meniscal extrusion was evaluated with magnetic resonance imaging. Patients were assessed preoperatively and postoperatively with Lysholm and International Knee Documentation Committee (IKDC) subjective scores for clinical outcomes and with IKDC radiographic scale for osteoarthritis. An ANOVA (Analysis of Variance) was used to analyze the variations in meniscal extrusion and the clinical and radiological outcomes. A regression analysis was performed to identify factors that affect preoperative medial meniscus extrusion and that influence results after partial meniscectomy. An optimal cutoff value for meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis was established. Significance was set at p < 0.05. The mean ± SD preoperative and postoperative Lysholm scores were 59.6 ± 15.5 versus 83.8 ± 13.1 (p < 0.001) and the mean preoperative and postoperative IKDC subjective scores were 59.4 ± 16.8 versus 82.0 ± 15.8 (p < 0.001). Meniscal extrusion greater than 2.2 mm (sensitivity, 84%; specificity, 81%) and 2.8 mm (sensitivity, 73%; specificity, 85%) was associated with unsatisfactory (poor/fair) Lysholm and IKDC subjective scores, respectively. The progression of osteoarthritis, characterized as a change of at least one category on the IKDC radiographic scale, occurred when meniscal extrusion was greater than 2.2 mm (sensitivity, 63%; specificity, 75%). Patients with higher body mass index (BMI) had significantly greater meniscal extrusion that patients with normal BMI (p < 0.001). The medial meniscus was more extruded in patients with horizontal and root tears. In conclusion, patients with preoperative meniscal extrusion of 2.2 mm or greater had unsatisfactory clinical outcomes and progression of osteoarthritis after partial medial meniscectomy at a minimum of 5 years follow-up. Higher BMI and horizontal and root tears were associated with greater preoperative meniscal extrusion.
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Affiliation(s)
- João V Novaretti
- Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center (CETE), Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
| | - Diego C Astur
- Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center (CETE), Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | - Moisés Cohen
- Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center (CETE), Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
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14
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Totlis T, Haunschild ED, Otountzidis N, Stamou K, Condron NB, Tsikopoulos K, Cole BJ. Return-to-Sport Rate and Activity Level Are High Following Arthroscopic All-Inside Meniscal Repair With and Without Concomitant Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2021; 37:2351-2360. [PMID: 33753131 DOI: 10.1016/j.arthro.2021.02.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/13/2020] [Accepted: 02/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the literature of return-to-sport outcomes following all-inside meniscus repair and evaluate whether concomitant anterior cruciate ligament reconstruction (ACLR) influenced these outcomes. METHODS A systematic review of the MEDLINE, PubMed, Embase, and Cochrane Registry of Systematic Reviews databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers examined all literature pertaining to sport outcomes following all-inside meniscal repair. Studies were included if they had a 12-month minimum follow-up and reported return to sport rate, Tegner, or Knee injury and Osteoarthritis Outcome Score (KOOS) Sport outcomes. Studies with meniscal repair techniques other than the all-inside technique were excluded. Studies were not excluded if they contained patients receiving concomitant ACLR. Study quality was evaluated with the Methodological Index for Nonrandomized Studies. RESULTS Nineteen studies comprising 872 patients were included in this investigation. The weighted average patient age was 28.7 (range 14.1-42.1) years, and the weighted average follow-up was 56.0 (range 18.0-155.0) months. The mean Methodological Index for Nonrandomized Studies score was 14.4 ± 3.7. Ten investigations reported both preoperative (range 2.3-3.5) and postoperative (range 4.0-7.3) Tegner outcomes, with scores at final follow-up greater in each of the 10 reporting investigations. KOOS Sport outcomes were examined in 5 investigations, with scores at follow-up ranging from 63.6 to 91. Three studies reported a return to sport rate ranging from 89.6 to 90% at follow-up. Four investigations compared sport-related outcomes between isolated meniscal repair and meniscal repair with concomitant ACLR. Two such studies reported no difference between the 2 cohorts, 1 favored the isolated cohort, and 1 favored the combined cohort. CONCLUSIONS This systematic review found a 90% return-to-sport rate and high postoperative activity level following all-inside meniscal repair, as assessed by KOOS Sport and Tegner activity scales. Further, concurrent ACLR did not significantly affect these outcomes. LEVEL OF EVIDENCE IV, systematic review of level I-IV studies.
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Affiliation(s)
- Trifon Totlis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Thessaloniki Minimally Invasive (The-MIS) Orthopaedic Center, St. Luke's Hospital, Thessaloniki, Greece
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Nikolaos Otountzidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Stamou
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nolan B Condron
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
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15
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Shi L, Zhu H, Ma J, Shi LL, Gao F, Sun W. Intra-articular magnesium to alleviate postoperative pain after arthroscopic knee surgery: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16:111. [PMID: 33546717 PMCID: PMC7863353 DOI: 10.1186/s13018-021-02264-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/25/2021] [Indexed: 12/16/2022] Open
Abstract
Objective We aimed to evaluate the safety and efficacy of intra-articular (IA) magnesium (Mg) for postoperative pain relief after arthroscopic knee surgery. Methods We searched PubMed, Embase, Medline, Cochrane library, and Web of Science to identify randomized controlled trials that compared postoperative pain outcomes with or without IA Mg after knee arthroscopy. The primary outcomes were pain intensity at rest and with movement at different postoperative time points and cumulative opioid consumption within 24 h after surgery. Secondary outcomes included the time to first analgesic request and side effects. Results In total, 11 studies involving 677 participants met the eligibility criteria. Pain scores at rest and with movement 2, 4, 12, and 24 h after surgery were significantly lower, doses of supplementary opioid consumption were smaller, and the time to first analgesic requirement was longer in the IA Mg group compared with the control group. No significant difference was detected regarding adverse reactions between the groups. Conclusions Intra-articular magnesium is an effective and safe coadjuvant treatment for relieving postoperative pain intensity after arthroscopic knee surgery. Protocol registration at PROSPERO: CRD42020156403.
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Affiliation(s)
- Lijun Shi
- Department of Orthopedic, Surgery Graduate School of Peking Union Medical College, China-Japan Friendship institute of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, 100029, Beijing, China
| | - Haiyun Zhu
- Department of Intensive Care Unit, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, 354 North Road, Hongqiao District, Tianjin, 300120, China
| | - Jinhui Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Li-Li Shi
- Department of Gastroenterology, Henan Provincial People's Hospital, Weiwu road No 7, Jinshui district, Zhengzhou City, 450003, Henan province, China
| | - Fuqiang Gao
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wei Sun
- Department of Orthopedic, Surgery Graduate School of Peking Union Medical College, China-Japan Friendship institute of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, 100029, Beijing, China. .,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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16
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Wang CL, Chen JB, Li T. Outcome and experience of arthroscopic lateral retinacular release combined with lateral patelloplasty in the management of excessive lateral pressure syndrome. J Orthop Surg Res 2021; 16:80. [PMID: 33482854 PMCID: PMC7821727 DOI: 10.1186/s13018-021-02229-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/11/2021] [Indexed: 02/01/2023] Open
Abstract
Background Only a few studies have described the effect of full arthroscopic surgery in treatment of excessive lateral pressure syndrome (ELPS). Therefore, the purpose of this study was to assess the clinical efficacy and experience of total arthroscopic lateral retinacular (LR) release and lateral patelloplasty for the treatment of ELPS. Methods A total of 73 patients (88 knees) with ELPS underwent arthroscopic LR release and lateral patelloplasty. The visual analogue scale (VAS), Kujala score, Lysholm scores, patella medial pushing distance, patellar tilt angle (PTA), and lateral patellofemoral angle (LPFA) were measured and evaluated before and after surgery. Results Follow-up ranged from 12 to 36 months with an average of 24 ± 5.8 months. The VAS was significantly lower at the last follow-up than before surgery (P < 0.01). The patella medial pushing distance, Kujala score, Lysholm score, PTA, and LPFA were significantly higher at the last follow-up than before surgery (P < 0.01, respectively). Years and lateral patella Outerbridge classification at the last follow-up have negative correlation with Kujala score, Lysholm score, Patella medial pushing distance, PTA, and LPFA (P < 0.01, respectively) and have positive correlation with VAS (P < 0.01, respectively). Related complications were not reported. Conclusions Full arthroscopic LR release combined with lateral patelloplasty in the treatment of ELPS is an effective minimally invasive method, which can effectively correct anomalies of force line and skeleton of patella, relieve pain, and restore knee joint motor function with less complications.
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Affiliation(s)
- Cheng-Liang Wang
- Third Ward of Orthopedic Department, CR & WISCO General Hospital, Wuhan University of Science and Technology, Wuhan, 430080, China
| | - Ji-Bin Chen
- Department of Orthopedic Surgery, Wuhan Hanyang Hospital, Wuhan University of Science and Technology, No.53 Moshuihu Road, Hanyang District, Wuhan, Hubei Province, China.
| | - Te Li
- Department of Orthopedic Surgery, General Hospital of Central Theater Command, No.68 Huangpu Road, Jiangan District, Wuhan, Hubei Province, China.
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17
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Fried JW, Manjunath AK, Hurley ET, Jazrawi LM, Strauss EJ, Campbell KA. Return-to-Play and Rehabilitation Protocols Following Isolated Meniscal Repair-A Systematic Review. Arthrosc Sports Med Rehabil 2020; 3:e241-e247. [PMID: 33615271 PMCID: PMC7879171 DOI: 10.1016/j.asmr.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 07/29/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To systematically review the literature and assess the reported rehabilitation protocols, return-to-play guidelines, and reported rates of return-to-play after meniscal repair. Methods MEDLINE, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies on meniscal repair. Studies were included if return-to-play data and/or rehabilitation protocols were reported. The rate and timing of return-to-play was assessed. The rehabilitation protocols were documented, in addition to when to start range of motion (ROM), full ROM, partial weight-bearing (WB), and full WB. Results Overall, 88 studies met our inclusion criteria. Thirteen studies, including 507 patients, cited a range of 71.2% to 100% of return-to-play, with 53.9% to 92.6% returning to the same/greater level, ranging between 3.3 and 10 months. There was considerable variability in the reported rehabilitation protocols, but the most frequently reported time to begin ROM exercises was within the first week (78.9%) and full ROM at 6 weeks (33.3%). Partial WB was typically begun during the first week (61.0%), and full WB between the fourth and sixth week (65.6%) postoperatively. Following surgery, time elapsed was the most commonly cited criteria for return-to-play (97.0%), with 6 months being the most common time point applied (46.9%). No study advised against returning to competitive or contact sports after meniscal repair. Conclusions In conclusion, there was a high rate of return-to-play following meniscal repair, with 60% of patients returning to the same level of play. However, there was considerable diversity in the reported rehabilitation protocols and insufficient reporting on return-to-play criteria in the literature. This demonstrates the need for further research and formulation of an evidence-based consensus statement for this patient population. Level of Evidence Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Jordan W Fried
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Amit K Manjunath
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A
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Ogawa H, Matsumoto K, Sengoku M, Yoshioka H, Akiyama H. Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing. Knee Surg Sports Traumatol Arthrosc 2020; 28:3474-3480. [PMID: 31748918 DOI: 10.1007/s00167-019-05782-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/29/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes and meniscus healing after arthroscopic repair of horizontal-cleavage meniscus tears, compared with vertical-longitudinal meniscus tears. METHODS This was a retrospective review of a consecutive series of 52 meniscal repairs for horizontal-cleavage tears (n = 27) or vertical-longitudinal tears (n = 25); the groups were compared with respect to clinical symptoms and meniscal healing. Arthroscopic meniscal repair was performed using the inside-out technique with a marrow-stimulating technique. Clinical symptoms were evaluated using the Lysholm score and Knee injury and osteoarthritis outcome score (KOOS). Meniscus healing was evaluated by MRI. RESULTS The mean follow-up periods were 35.4 ± 8.9 months in the horizontal-cleavage tear group and 39.8 ± 8.3 months in the vertical-longitudinal tear group. There were no significant differences in Lysholm score and KOOS, including each subscale, between the horizontal-cleavage tear- and vertical-longitudinal tear-groups at the final follow-up. At the final follow-up, MRI meniscus grades 0 and 1 were significantly more frequent in the vertical-longitudinal tear-group than in the horizontal-cleavage tear-group, while grade 3 was significantly more frequent in the horizontal-cleavage tear group than in the vertical-longitudinal tear group (p < 0.0001). CONCLUSIONS Although meniscus healing of horizontal-cleavage tears may be poor, arthroscopic repair should be considered for horizontal-cleavage tears because it does provide good clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Gifu, Japan
- Department of Advanced Joint Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Gifu, Japan.
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Japan
| | - Hiroki Yoshioka
- Department of Orthopaedic Surgery, Yamauchi Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Gifu, Japan
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Atsumi S, Hara K, Arai Y, Kamitani A, Nakagawa S, Inoue H, Kubo T. Outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture technique for horizontal meniscal tears sustained in sports. Medicine (Baltimore) 2020; 99:e22609. [PMID: 33031317 PMCID: PMC7544389 DOI: 10.1097/md.0000000000022609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate the outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture arthroscopic technique for sports-related horizontal meniscal tears.The inter-leaf vertical suture procedure was performed to repair sports-related horizontal tears in the middle and posterior segments of the medial (11 cases) and lateral (2 cases) menisci in 13 patients (mean age: 30 ± 14 years). Pre- and post-operative Barrett criteria, Lysholm scores, and patient ability to resume sports were assessed. Magnetic resonance imaging (MRI) grades and signal intensity changes near the joint capsule were evaluated in the 9 cases among which pre- and post-operative MRI images were available.All Barrett criteria items were negative following surgery; Lysholm scores increased from 70.2 ± 13.1 before surgery to 98.9 ± 2.64 after surgery (P < .01). All patients were able to resume their sport. Preoperative MRI grade of tears was 3 for all patients; postoperative MRI grades were 1 in 3 cases, 2 in 4 cases, and 3 in 2 cases (P < .05). Importantly, MRI signal intensity at the repaired menisci near the joint capsule was reduced in 8 of these 9 cases postoperatively.The inter-leaf vertical suture procedure is associated with good outcomes for horizontal tears in the middle and posterior segments of the medial and lateral menisci. The procedure is useful and convenient.
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Affiliation(s)
- Satoru Atsumi
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Kunio Hara
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine
| | - Aguri Kamitani
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | | | - Hiroaki Inoue
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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20
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Morris JH, Magnussen RA, DiBartola AC, Aldabbeh S, Duerr RA, Kaeding CC, Flanigan DC. Patient Outcomes After Horizontal Cleavage Tear Repair: A Systematic Review. Arthroscopy 2020; 36:2316-2331. [PMID: 32360266 DOI: 10.1016/j.arthro.2020.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the clinical outcomes and survivorship of meniscal horizontal cleavage tear (HCT) repairs with hopes of guiding future treatment decisions. METHODS Standard systematic review methodology was used. A comprehensive search of PubMed was conducted on June 1, 2019. The inclusion criteria were articles that were published in English, involved human subjects, and reported on at least 1 outcome after repair of HCTs. The exclusion criteria included technique guides and reviews, studies without full text available, and studies with HCT outcomes not separated from other repair groups. Effect heterogeneity was determined using the I2 measure. Forest plots were created in addition to a random-effects model to show the results. RESULTS The systematic review yielded 19 studies evaluating 289 knees in a total of 273 patients. At most recent follow-up, there was a high probability of return to sport (93.1% [67 of 72]). Overall, 74% of patients (67 of 90) were symptom free at last follow-up, and 80% expressed satisfaction with their overall result (80 of 100). The most frequently reported subjective outcome was the Lysholm score, which improved from a preoperative study range of 48 to 79 (I2 = 20.7%, P = .283) to a postoperative study range of 56 to 99 (I2 = 49%, P = .081). The next most commonly reported was the International Knee Documentation Committee subjective score, which improved from a preoperative study range of 16 to 49 (I2 = 47.7%, P = .125) to a postoperative study range of 72 to 95 (I2 = 0%, P = .660). An overall 11.7% reported risk of reoperation was found, with most cases involving revision meniscectomy. Rates of complications beyond fixation failure were overall very low, with infrequent reports of septic arthritis and transitory dysesthesia. CONCLUSIONS The short- to intermediate-term results of repair of HCTs are comparable to prior studies. Survivorship is comparable to repairs of other types of meniscal tears with high rates of return to sport and low complication rates. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Jesse H Morris
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Robert A Magnussen
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Alex C DiBartola
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Summer Aldabbeh
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Robert A Duerr
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Christopher C Kaeding
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - David C Flanigan
- Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Cartilage Restoration Program, Columbus, Ohio, U.S.A..
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Postoperative rehabilitation and outcomes following arthroscopic isolated meniscus repairs: A systematic review. Phys Ther Sport 2020; 45:76-85. [PMID: 32688294 DOI: 10.1016/j.ptsp.2020.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to review the current literature on rehabilitation protocols following arthroscopic meniscus repair. METHODS A systematic literature review was performed of Medline, Scopus, and Web of Science databases to identify relevant articles from January 1990 to April 2019. Search terms were (meniscus OR meniscal repair) AND (repaired OR repair) AND (rehabilitation OR physiotherapy OR physical therapy). Each study was independently scored for methodological research quality level using the Modified Coleman Methodology Score (MCMS). The following variables were extracted from each study: publication year, study type, evidence level, subject demographics, injury mechanism, meniscus tear type, surgical procedure, rehabilitation program [immobilization, weight bearing, ROM progression, therapeutic exercises, length of follow-up, patient-reported outcome measurements, return to sport timing/criteria and failure rate/criteria. RESULTS Eighteen studies met the inclusion criteria. The overall MCMS was moderate 59.5 ± 11.7 (range = 42-90). The average MCMS score for postoperative rehabilitation was 4.7 ± 1.18. Only 1 (5.6%) study was a prospective randomized controlled trial and 14 studies (78%) had retrospective designs. Fourteen (78%) studies suggested that return to sports should occur between 3 and 6 months post-surgery. Early range of motion and immediate weight-bearing had no influence over patient-reported outcomes or failure rates for vertical meniscus tear repairs. CONCLUSION Low MCMS scores, primarily retrospective study designs and poorly described postoperative rehabilitation protocols made it difficult to design an evidence-based therapeutic rehabilitation program for patients following arthroscopic repair of an isolated meniscus tear. An arthroscopic isolated meniscal tear repair rehabilitation protocol is being attempted to present based on a synopsis of existing evidence.
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Zhang M, Ma J, Zhang RJ, Xi G, Wang HH, Zhao B. One-Stage Repair of Posterior Oblique Ligament Avulsion Fracture Combined with Medial Collateral Ligament Injury. Orthop Surg 2020; 12:1084-1091. [PMID: 32519475 PMCID: PMC7454208 DOI: 10.1111/os.12697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/14/2020] [Accepted: 04/19/2020] [Indexed: 01/29/2023] Open
Abstract
Objective To evaluate the clinical effect of the one‐stage repair of a posterior oblique ligament avulsion fracture combined with a medial collateral ligament injury. Methods This study was a retrospective trial. From February 2007 to May 2017, five patients with posterior oblique ligament avulsion fracture combined with medial collateral ligament injury were included in this study. The patients were aged 37–58 years old with a mean of 45.2 years. All patients underwent the primary repair of a posterior oblique ligament avulsion fracture and medial collateral ligament injury. The main observational index included Lysholm score, International Knee Documentation Committee (IKDC) score, Visual Analogue Scale (VAS) score, and range of motion (ROM). Results The results showed that the average time of follow‐up was 53.6 months (range, 20–86 months). When compared to preoperative scores, the preoperative Lysholm score was significantly increased (47.8 ± 5.1 vs 95.0 ± 3.7, P < 0.05), the IKDC score was significantly increased (51.2 ± 5.6 vs 88.6 ± 4.2, P < 0.05), the VAS score was significantly decreased (7.0 ± 0.7 vs 0.4 ± 0.5, P < 0.05), and the ROM was significantly increased (91.6° ± 8.4° vs 129.9° ± 4.4°, P < 0.05). Conclusion Our study found that with the combination of the one‐stage repair of a posterior oblique ligament (POL) avulsion fracture and medial collateral ligament injury, the patient's postoperative function recovered well, their pain was relieved, and their knee joint stability was reliable.
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Affiliation(s)
- Min Zhang
- Department of Orthopaedic Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ji Ma
- Department of Orthopaedic Surgery, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Run-Jie Zhang
- Department of Orthopaedic Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Gang Xi
- Department of Orthopaedic Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hao-Hao Wang
- Department of Orthopaedic Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- Department of Orthopaedic Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China
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The repair of horizontal cleavage tears yields higher complication rates compared to meniscectomy: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:915-925. [PMID: 31187178 DOI: 10.1007/s00167-019-05557-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Horizontal cleavage tears of the meniscus (HCTs) are primarily degenerative in nature, and, however, can be the result of trauma. Such tears account for 12-35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. The purpose of this review was to systematically assess the outcomes and complications for patients undergoing the surgical treatment of HCTs. METHODS This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses. The electronic databases PubMed, MEDLINE, and EMBASE were searched from data inception to December 30, 2018 for articles addressing the surgical treatment of HCTs. The Methodological Index for Non-randomized Studies was used to assess study quality. Data are presented descriptively. RESULTS Overall, 23 studies were identified, comprising of 702 patients (708 knees) with a mean age of 36.6 ± 9.9 years and a mean follow-up of 33.6 ± 19.6 months. The majority of patients were treated with a partial meniscectomy (59.0%), followed by repair (32.8%) and total meniscectomy (8.2%). Both meniscectomy and repair patients had improvements which surpassed minimal clinically important differences with regard to clinical (e.g. pain, function, daily living) and radiographic outcomes. The overall complication rate was 5.1%, primarily involving patients undergoing meniscal repair (12.9% of all knees undergoing a repair). CONCLUSION Although meniscal repair theoretically may provide improvement in biomechanical loading, patients undergoing repair had higher complication rates than those undergoing partial meniscectomy. Clinicians should consider the available implants in determining which tear patterns to repair and future studies with long-term follow-up are needed to investigate complications (e.g. secondary meniscal procedures) as well as the potential for delay in the development of osteoarthritis. LEVEL OF EVIDENCE Level IV.
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Meniscal repair associated with a partial meniscectomy for treating complex horizontal cleavage tears in young patients may lead to excellent long-term outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:343-348. [PMID: 30349946 DOI: 10.1007/s00167-018-5219-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION While open repair of horizontal meniscal tears in young active patients has shown good results at mid- and long-term follow-up, complex horizontal tears (cleavage associated with meniscal flaps) are often treated by arthroscopic subtotal meniscectomy. The aim of this study was to evaluate long-term outcomes after arthroscopic removal of meniscal flaps associated with an open meniscal repair for treating complex lesions in young active patients. The hypothesis was that this salvage procedure would be efficient in such rare cases. METHODS Fourteen patients underwent an arthroscopic partial meniscectomy associated with an open meniscal repair to treat a painful complex horizontal meniscal cleavage between 2005 and 2010. There were two females and 12 males with a median age of 28.4 years (range 15-48 years). Patients were assessed by KOOS and IKDC scores, return to sport and the need for a secondary meniscectomy. RESULTS Thirty patients were evaluated at a median follow-up of 8.5 years (range 7-12 years). One patient required revision of a partial meniscectomy and one other a meniscal replacement (15% failure rate). All other patients showed improvement with regard to their symptoms and returned to sports, ten (91%) of them at the same level. The mean IKDC subjective score was 86.1 (± 10.9). The mean KOOS scores were: pain 91.4 (± 7.5), symptoms 91.4 (± 10.2), daily activity 97.1 (± 4), sports 84.4 (± 20.7) and quality of life 84 (± 14.2). For six patients, scores at median follow-up of 2.6 years were available and compared to newly obtained data. IKDC score at 8.6 years follow-up was not significantly different. KOOS scores for daily activity and sports were maintained. CONCLUSIONS Even in the presence of a complex lesion, horizontal cleavage can be repaired in young patients with good subjective and objective outcomes and a low rate of long-term failure as with other meniscal lesions in young active patients. LEVEL OF EVIDENCE IV.
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Ge H, Liu C, Shrestha A, Wu P, Cheng B. Do Nonsteroidal Anti-Inflammatory Drugs Affect Tissue Healing After Arthroscopic Anterior Cruciate Ligament Reconstruction? Med Sci Monit 2018; 24:6038-6043. [PMID: 30160247 PMCID: PMC6128182 DOI: 10.12659/msm.910942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Experimental studies have reported nonsteroidal anti-inflammatory drugs (NSAIDs) could impair tendon healing. The purpose of this study was to investigate whether NSAIDs could affect recovery of knee joint function in patients after anterior cruciate ligament (ACL) reconstruction. Material/Methods We enrolled 40 patients treated with celecoxib and 40 patients treated with tramadol, who underwent ACL reconstruction from January 2011 to December 2017. Visual analogue scale (VAS) and functional outcomes were collected and evaluated. The follow-up period was 12 months. Results In both groups, all patients obtained pain release after surgery, compared with that before surgery. But no significant differences were observed between the 2 groups in VAS scores. We also did not find any differences between the 2 groups at 1 year of follow-up, in terms of anterior drawer test, Lachman test, side-to-side laxity assessed by KT-2000, IKDC score, Lysholm score, and Tegner scale. However, the celecoxib group showed a reduced incidence of nausea compared to the tramadol group (P=0.048). Conclusions The use of NSAIDs after ACL reconstruction is relatively safe and could decrease adverse side effects which were caused by opioid drugs.
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Affiliation(s)
- Heng'an Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Tongji University School of Medicine, Shanghai, China (mainland)
| | - Centao Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Suzhou University School of Medicine, Suzhou, Jiangsu, China (mainland)
| | - Amrit Shrestha
- Shiva Jyoti Hospital and Research Center PVT. Ltd., Kathmandu, Nepal
| | - Peng Wu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Biao Cheng
- Department of Orthopeadics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Arthroscopic All-Inside Repair of Medial Meniscus Grade 2 Horizontal Cleavage Tear Using Additional Posteromedial Portal. Arthrosc Tech 2018; 7:e939-e943. [PMID: 30258775 PMCID: PMC6153368 DOI: 10.1016/j.eats.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/06/2018] [Indexed: 02/03/2023] Open
Abstract
Management of intrasubstance horizontal cleavage meniscal lesions of microtraumatic origin remains poorly defined in young patients. For grade 2 lesions resistant to conservative measures, the standard technique is debridement of the intrasubstance tear and open suture repair via a posteromedial approach. The objective of this Technical Note is to propose an arthroscopic alternative to this open technique, using an arthroscopic additional posteromedial portal. This technique facilitates an approach to the lesion via its peripheral portion without creating an iatrogenic lesion of the free edge of the meniscus, which is located in the white zone and thus exhibits limited vascularity.
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Atsumi S, Hara K, Arai Y, Yamada M, Mizoshiri N, Kamitani A, Kubo T. A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes: 3 case reports. Medicine (Baltimore) 2018; 97:e9888. [PMID: 29443758 PMCID: PMC5839842 DOI: 10.1097/md.0000000000009888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Considering the risk of osteoarthritis following resection of a horizontally torn meniscus of the knee, repairing and preserving the meniscus as much as possible is preferred. We report 3 cases of restoration of horizontally torn menisci using a novel arthroscopic method we have called "all-inside interleaf vertical suture" that afforded preservation. PATIENT CONCERNS The 3 patients (aged 14, 17, and 21 years) had knee pain through sports activity. DIAGNOSES All patients had horizontal tears in the posteromedial part of the meniscus. INTERVENTIONS The method uses Fast-Fix, whereby a first anchor is inserted from the tibial surface of the tear's superior leaflet and a second anchor is inserted from the femoral surface of the tear's inferior leaflet, and the 2 leaflets are closed using vertical suture. In all cases, the suture knots were embedded between the superior leaflet and inferior leaflet, avoiding contact with the articular cartilage, and superior leaflet and inferior leaflet crimping was good. OUTCOMES All 3 were able to resume competing in sport and ≥ 1 year after surgery they had no pain and their postoperative mean Lysholm scores were 99.7. There were no complications or recurrence. On magnetic resonance imaging, the signal intensity of all the horizontal tears was high before surgery but low after surgery, suggesting that the repaired tear was healing. LESSONS The all-inside interleaf vertical suture procedure is a new surgical technique that can repair posteromedial horizontal meniscal tears of the knee of young people by easy crimping of the superior and inferior leaflets without the suture knots causing complications.
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Affiliation(s)
- Satoru Atsumi
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Kunio Hara
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine
| | - Manabu Yamada
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Naoki Mizoshiri
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Aguri Kamitani
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yokoi H, Mae T, Iuchi R, Take Y, Tachibana Y, Shimomura K, Ohori T, Shino K, Yoshikawa H, Nakata K. Novel flat and wide meniscal repair material improves the ultimate load of knot breakage in a porcine trans-capsular meniscal repair model. J Exp Orthop 2017; 4:41. [PMID: 29260438 PMCID: PMC5736508 DOI: 10.1186/s40634-017-0114-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background In the meniscal repair procedures, a high ultimate load capacity and low cyclic creep at the repair site are favorable and lead to good biological incorporation of the tear site after surgery. Previous biomechanical tensile tests of the meniscal sutures have identified the suture knot as the weakest point. We hypothesized that the strength of a suture knot depends on the suture shape, and therefore, we compared three differently shaped suture materials composed of the same material and quantity per length. The purpose of this study was to determine whether a novel flat and wide repair material (FWRM), which consists of braided multi-threads that are cross-sectionally flat and wide, improves the ultimate load of knot breakage in a biomechanical experiment using a porcine trans-capsular meniscal repair model. Methods Eighteen fresh-frozen porcine knees (n = 6 in each group) were used. A longitudinal tear in the middle segment of the medial meniscus was created and repaired with a trans-capsular inside-out method using the following suture materials: No. 2–0 braided polyester conventional suture, hollow suture, and FWRM. After the separation of the inner segment of the meniscus with leaving, the suture stability of the repaired menisci was biomechanically analyzed with a video camera system for widening after a cyclic load between 5 and 20 N was applied 300 times. Ultimate failure load and stiffness at 5 mm/ min were also analyzed. Results We found no significant difference in suture widening after cyclic load tests [conventional suture, mean 0.51 mm (S.D. 0.39 mm); hollow suture, mean 0.23 mm (S.D. 0.11 mm); and FWRM, mean 0.54 mm (S.D. 0.08 mm)]. The failure mode in all specimens was knot breakage. Compared with those of the other groups, the ultimate failure load of FWRM was statistically significantly higher in the load-to-failure tests (conventional suture, mean 58.8 N [S.D. 8.25 N]; hollow suture, mean 79.4 N [S.D. 10.2 N]; and FWRM, mean 97.4 N [S.D. 3.65 N]; p < 0.05). Conclusion FWRM improves the ultimate load of knot breakage without altering stability. This material may contribute to safe and stable meniscus repair.
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Affiliation(s)
- Hiroyuki Yokoi
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ryo Iuchi
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Yasuhiro Take
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuta Tachibana
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Kazunori Shimomura
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
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