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Jaramillo Quiceno GA, Sarmiento Riveros PA, Arias Pérez RD, Jaramillo FG. Meniscocapsular release technique to reduce chronic and challenging bucket-handle meniscus tear. J ISAKOS 2024:S2059-7754(24)00041-5. [PMID: 38423359 DOI: 10.1016/j.jisako.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 01/14/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
Several surgical procedures for the repair of bucket handle meniscus tears have been reported in the literature. However, even the most skilled surgeon can find it difficult to treat chronic and locked lesions, which typically result in meniscectomies. Therefore, a repair method for bucket-handle meniscus tears that are chronic and locked is shown, along with a case series where this procedure was used. The technique consists of a release of the joint capsule attachment to the meniscal body, which increases the mobility of the meniscus and facilitates the reduction of the injury, allowing subsequent repair through a combination of both all-inside and inside-out repair techniques. The main objective of this technique is to reduce the need for meniscectomies in difficult cases of bucket-handle meniscus tears, protect the meniscal tissue, and slow the progression of osteoarthritis in the process.
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Affiliation(s)
| | | | - Rubén Darío Arias Pérez
- Orthopedic and Traumatology Resident of Pontifical Bolivarian University, St 78B # 72 A 109, Medellín, Antioquia, 050034, Colombia.
| | - Felipe García Jaramillo
- Orthopedic and Traumatology Resident of Pontifical Bolivarian University, St 78B # 72 A 109, Medellín, Antioquia, 050034, Colombia.
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Keyhani S, Movahedinia M, LaPrade RF, Qoreishy M, Vosoughi F. Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears. J Orthop Traumatol 2023; 24:12. [PMID: 37024629 PMCID: PMC10079791 DOI: 10.1186/s10195-023-00691-w] [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: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND In irreducible bucket-handle medial meniscal tears (BHMMTs), the displaced central fragment is rotated 180° or more, meaning reduction is impossible without derotation of the tear. In chronic cases, the rotated meniscus is deformed and degenerated; thus, the issue of reproducibility and repairability arises. This study presents the clinical outcomes of chronic irreducible and unstable locked BHMMTs. Radiological outcomes were also evaluated using magnetic resonance imaging (MRI). METHODS This is a retrospective study of 37 patients with 11 cases of irreducible BHMMT and 26 cases of reducible but unstable chronic BHMMT who underwent operations between 2011 and 2016. Posterior arthroscopy was performed after temporary meniscus fixation using a provisional needle fixation technique. After the posterior repair with vertical mattress sutures was completed using an all-inside technique, the classic outside-in technique was performed for the anterior third of the meniscus. The Lysholm, International Knee Documentation Committee (IKDC), and Tegner activity scores were obtained from all patients before surgery and at the latest follow-up. Radiological evaluations were performed using MRI before surgery and at 6 months postoperatively. RESULTS Between 2011 and 2016, a total of 37 consecutive patients with irreducible and chronic BHMMTs underwent surgery. The average postoperative follow-up was 7.2 ± 1.4 years (mean ± SD). Postoperative Lysholm (89.57 ± 2.7) and IKDC (87.22 ± 3.2) scores improved significantly at the last follow-up when compared with the pre-operative scores (38.44 ± 4.5 and 23.52 ± 7.8, respectively). According to the Tegner activity scale, patients' postoperative activity levels remained unchanged compared to preoperative levels at the last follow-up. CONCLUSION Posterior knee arthroscopy with the all-inside posterior suture and inside-out anteromedial suture technique presented in this study yielded excellent clinical outcomes when used to repair chronic irreducible or unstable BHMMTs. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sohrab Keyhani
- Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi Manesh Street, Shariati Street, Tehran, Iran
| | - Mohammad Movahedinia
- Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi Manesh Street, Shariati Street, Tehran, Iran.
| | - Robert F LaPrade
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, USA
| | - Mohamad Qoreishy
- Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi Manesh Street, Shariati Street, Tehran, Iran
| | - Fardis Vosoughi
- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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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: 27] [Impact Index Per Article: 6.8] [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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Using only MRI is moderately reliable in the prediction of meniscal tear reparability. Knee Surg Sports Traumatol Arthrosc 2019; 27:898-904. [PMID: 30269172 DOI: 10.1007/s00167-018-5187-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the role of surgeons' experience with meniscal repairs and meniscectomy decisions, and to determine the factors affecting the disagreement between meniscal repairs and meniscectomy decisions. METHODS In total, 223 patients with meniscal tears, 106 meniscal repairs, and 117 meniscectomies were included. Six orthopedic surgeons (3: > 5 years; 3: < 5 years' arthroscopy experience) were blinded, and they independently reviewed all preoperative MR images for over a month. Their reviews were compared with arthroscopic interventions performed by a surgeon with > 10 years' arthroscopy experience. Reparability-associated factors were also evaluated using multivariate logistic regression. RESULTS The first and second evaluation results did not differ significantly between groups (n.s.). There was good agreement between MRI predictions and arthroscopic interventions for both groups (< 5 years' experience: k = 0.248, agreement 62.3%; > 5 years' experience: k = 0.351, agreement 67.3%). Sex, side, and distance of tear from the meniscocapsular junction were not significantly different between agreements and disagreements. Disagreement regarding meniscectomy was significantly higher than those regarding meniscus repair (p = 0.002). Concomitant anterior cruciate ligament (ACL) injury, osteochondral lesions, and medial meniscal tear increased the likelihood of meniscal repair (p = 0.0063, p = 0.0010, and p = 0.0369, respectively). An increased risk of disagreement between MRI and surgical procedure was found in the presence of bucket-handle, horizontal or complex tear, chronic tear, high sports activity and expectation level. CONCLUSION Surgeon's experience level may influence the prediction of meniscus reparability. Concomitant ACL injury, osteochondral lesions, and presence of medial meniscal tear increase the likelihood of meniscal repair. Tear type, tear chronicity, patient's activity and expectation level may influence the surgeon's operative decision in addition to MRI. LEVEL OF EVIDENCE III.
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Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2018; 26:787-792. [PMID: 28258328 DOI: 10.1007/s00167-017-4420-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE This study was undertaken to diagnose and to document the clinical results and technical aspects of arthroscopic meniscus repair for recurrent subluxation with peripheral tears around the popliteal hiatus of the lateral meniscus. METHODS Twenty-three patients (24 knees) with symptomatic recurrent subluxation of the lateral meniscus treated by arthroscopic meniscus repair were included. The inclusion criteria were: (1) patients with knee pain, locking or snapping symptoms despite 3 months of conservative treatment; (2) non-discoid lateral meniscus; (3) stable knee, and (4) tears involving the red-white or red-red zone. All tears were repaired by either the modified all-inside suture technique only or a combination of the modified all-inside and modified outside-in suture techniques. Clinical results were evaluated preoperatively and at final follow-up according to Tegner activity level, Lysholm knee, and Hospital for Special Surgery (HSS) scores. RESULTS No reoperations were required after a median follow-up of 41 months (range 24-124). Although recurrence of a locking episode was documented in one knee and catching sensations were experienced in three knees, those patients did not require reoperation. At the last follow-up, the median Tegner activity level had improved significantly from 4 (range 2-6) to 7 (range 3-10, p < 0.0001), the median Lysholm knee score improved from 76 (range 25-90) preoperatively to 94 (range 76-100) at final follow-up (p < 0.0001), and the median preoperative HSS score improved from 86 to 95 at final follow-up (p < 0.0001). CONCLUSION The described arthroscopic meniscus suture technique is effective for treating symptomatic recurrent subluxation of the lateral meniscus without any complications or recurrence. Clinical suspicion and understanding of recurrent subluxation with lateral meniscus are important to diagnose the disease especially when definite meniscal tear signs are absent on magnetic resonance imaging. LEVEL OF EVIDENCE IV.
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Liang X, Tian Y, Wang S, Zheng Y. [Clinical efficacy of arthroscopic simultaneous treatment for anterior cruciate ligament injury combined with meniscus bucket-handle tear]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:547-552. [PMID: 29798543 DOI: 10.7507/1002-1892.201612066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the clinical efficacy of arthroscopic simultaneous both anterior cruciate ligament (ACL) reconstruction and suture of the meniscus bucket-handle tear (BHT). Methods Between January 2013 and April 2014, 22 patients (22 knees) with ACL injury and BHT, who accorded with the inclusion criteria, were studied. There were 14 males and 8 females with a mean age of 30.68 years (range, 15-44 years). The left side was involved in 10 cases and the right side in 12 cases. Injury located at the medial meniscus in 14 patients, and at the lateral meniscus in 8 patients. The median of interval from injury to operation was 40 days (range, 9 hours to 4 years). BHT was sutured, and then single bundle reconstruction of ACL was performed under arthroscopy. Results All incisions healed by first intention, and there were no serious complications such as infection, vascular injury, and nerve injury. The patients were followed up for 26.7 months on average (range, 12-42 months). At 6 weeks after operation, one patient had limited motion of the knee, the function was recovered after release under anesthesia; and one patient had joint space tenderness, which was relieved after conservative treatment. The total effective rate was 90.9% (20/22). At last follow-up, the anterior drawer test, Lachman test, and McMurray test were negative in all the cases. The visual analogue scale (VAS), Tegner activity level score, and Lysholm score were significantly improved at 12 months after operation when compared with preoperative scores ( P<0.05). At 6-12 months after operation, complete healing was obtained in 7 cases, and partial healing in 11 cases, and nonunion in 4 cases based on MRI evaluation criteria by Crues et al. There was no rupture of reconstruc-tive ligament during follow-up. Conclusion Arthroscopic simultaneous both ACL reconstruction and suture of BHT can improve the symptoms, reduce the risk of re-tear of sutured meniscus effectively, delay degeneration of articular cartilage, and maintain the stability of the knee joint.
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Affiliation(s)
- Xuezhen Liang
- Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250355, P.R.China
| | - Yuan Tian
- Operation Room, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250011, P.R.China
| | - Shaoshan Wang
- Department of Orthopedics, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250011,
| | - Yueyue Zheng
- Operation Room, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan Shandong, 250011, P.R.China
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