1
|
Vicens MH, Pujol O, Portas-Torres I, Aguilar M, Joshi N, Minguell J, Castellet E, Casaccia M. Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06241-1. [PMID: 38942964 DOI: 10.1007/s00264-024-06241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/15/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE Meniscal wrapping is a fully arthroscopic technique that involves enhanced meniscal repair with a tissue-engineered collagen matrix wrapping. This study aims to investigate the feasibility of using the meniscal wrapping technique for the treatment of chronic or complex meniscal tears. The primary objective is to assess its failure rate. The secondary objectives are to analyse complication rate, functional outcomes and overall patient satisfaction. METHODS This retrospective case series study included patients who sustained chronic and complex tears undergoing meniscal wrapping with autologous liquid bone marrow injection. Failure rate was considered if the patient underwent partial or complete meniscectomy or knee replacement during the follow-up, while other unexpected knee reoperations were considered as complications. Clinical outcomes were evaluated through the IKDC score, Tegner Activity Score and Short Assessment of Patient Satisfaction. RESULTS Twenty-one patients were included (15 non-acute bucket-handle tears, three non-acute horizontal tears and three non-acute complex injuries). The failure rate was 9.5% at 33 months. The rate of other unplanned reoperations was 14.3%, but none of these complications were apparently directly related to the wrapping technique. The average postoperative IKDC was 73.3/100. No statistically significant difference was encountered between preinjury and postoperative Tegner Activity Score. The mean overall patient satisfaction was 88.3/100. CONCLUSIONS Meniscal wrapping can be safely used as an adjunctive technique to meniscal repair in such difficult-to-treat cases to preserve the meniscus. The technique achieves a low failure rate and promising results of knee function, and patient satisfaction.
Collapse
Affiliation(s)
- Marga H Vicens
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Pujol
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Irene Portas-Torres
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marc Aguilar
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Nayana Joshi
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Minguell
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Enric Castellet
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Reconstructive Surgery of the Locomotor System Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Marcelo Casaccia
- Departament de Cirurgia I Ciències Morfològiques, Universitat Autònoma de Barcelona, Barcelona, Spain
- Knee Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Santoso A, Poetera CY, Marindratama H, Anugrah JY, Anwar IB, Sibarani TSMHS. Both medial and lateral bucket-handle meniscus tears associated with chronic ACL injury: A rare presentation of triple-PCL sign. Int J Surg Case Rep 2021; 87:106413. [PMID: 34537525 PMCID: PMC8449230 DOI: 10.1016/j.ijscr.2021.106413] [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: 08/24/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background Several types of meniscal tear could be presented in both acute and chronic anterior cruciate ligament injury. The incidence of bucket-handle meniscus tears can be up to 30% of the overall meniscus tears cases. The case of both compartment (medial and lateral) bucket-handle meniscus is rarely occurred. Case A case of both medial and lateral bucket-handle meniscus tears was reported in a male of 21 years old. The patient also had a chronic anterior cruciate ligament injury. The magnetic resonance imaging also showed a rare presentation of the triple-PCL sign with the sagittal view. Arthroscopic surgery with a meniscus repair and anterior cruciate ligament reconstruction was performed on the patient. Conclusions Several specific imaging signs including triple-PCL sign could be presented in a rare case of both medial and lateral bucket-handle meniscus tears. Recognition of this sign is important to have accurate preoperative diagnosis and proper treatment plan. Both medial and lateral meniscus bucket-handle tears is a rare case. Several specific magnetic resonance imaging (MRI) findings can be showed in this special case. This case presented a rare “triple-PCL sign” on sagittal MRI. Arthroscopic surgical treatment performed to this patient.
Collapse
Affiliation(s)
- Asep Santoso
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia; Division of Adult Reconstructive Surgery and Sport Injury, Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia.
| | - Cakradenta Yudha Poetera
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Hasmeinda Marindratama
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Jiva Yori Anugrah
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Iwan Budiwan Anwar
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia; Division of Adult Reconstructive Surgery and Sport Injury, Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia
| | - Tangkas S M H S Sibarani
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia; Division of Adult Reconstructive Surgery and Sport Injury, Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia
| |
Collapse
|