ABSTRACT
PURPOSE: To evaluate the clinical results of arthroscopic inside-out repair leaving posterior horn tear. MATERIALS AND METHODS: Among the patients taken arthroscopic meniscal repair due to meniscus longitudinal tear from Jan. 1999 to Dec. 2004, total 32 patients were evaluated, and followed at minimum of two years(mean 32 months). Meniscal repair was done as maximum 3mm interval. The length of unrepaired posterior horn was mean 7.5mm. RESULTS: Preoperative Lysholm score was mean 62.5 and postoperative improved to 91.0. Twenty eight cases(87.5%) showed excellent or good results by Tapper and Hoover criteria. In 4 cases, symptoms recurred at 4 to 12 months after repair and 2 cases were combined with ACL deficiency. Second look arthroscopy was performed in 10 cases, 4 cases for recurred symptom and 6 cases for determining whether healing of untreated posterior horn occurred or not. We observed complete healing of 4 cases and incomplete healing of 2 cases on the acquisition of stability. CONCLUSION: It was suggested that meniscal repair leaving posterior horn tear may be healed if both stabilities of the torn area and the knee joint were maintained.
Subject(s)
Animals , Humans , Arthroscopy , Horns , Knee JointABSTRACT
PURPOSE: To evaluate the clinical results of arthroscopic all-inside suture using 2 posteromedial portals for medial meniscus posterior horn (MMPH) tears by second-look arthroscopy in patients received concurrent anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: From May 1997 to June 2001, 78 MMPH tears were treated with arthroscopic all-inside sutures with concurrent anterior cruciate ligament (ACL) reconstruction. Among these 39 patients were availablefor follow-up evaluation by second-look arthroscopy. All MMPH tears were repaired using the arthroscopic all-inside suture technique using 2 posteromedial portals. Second-look arthroscopy was performed on average 19 months (range 6 to 40 month) after the ACL reconstruction and meniscal repair. Meniscus healing status was defined and classified. According to the Henning classification, they were divided into complete healing, incomplete healing, and failure. Tear size, type and location were analyzed and compared with healing category. We determined clinical criterias for success in meniscal status as; (1) no positive among 4 clinical objective parameters: joint line pain and tenderness, locking or catching, recurrent effusions, and positive McMurry test; and (2) complete healing of all-inside sutured meniscus during second-look arthroscopy. RESULTS: Of 39 knees assessed by second-look arthroscopy, 32 (82.1%) showed complete healing, 6 (15.4%) incomplete healing without any positive findings of clinical symptoms. Furthermore, all in the incompletely healed group showed complete healing of the posterior horn, which was sutured by allinside suture, whereas incomplete healing was observed at the junctional areas between all-inside and inside-out sutures, mainly at the posteromedial corner. So the overall success rate was 97.4% (38/39) for all-inside suture healing. The one (2.6%) patient with clinical failure revealed a retear of the repaired site, and subsequent subtotal menisectomy was performed. KT-2000 arthrometry showed that sagittal knee laxity was less than 2 mm (Average 1.5 mm, SD 0.72) in all reconstructed knees. The average knee scores, Lysholm knee score and HSS score, at final follow up were 95.5 and 96.5, respectively. As expected, small, longitudinal, and more peripheral (red-red zone) tears resulted in a higher healing outcome. CONCLUSION: Accurate repair with arthroscopic all-inside vertical suture using a suture hook, resulted in a high healing rate even in large and complex vertical tears. Arthroscopic all-inside meniscal suturing may be an optimal treatment for medial meniscus posterior horn tear greater than 1 cm during concurrent anterior cruciate ligament reconstruction.
Subject(s)
Animals , Humans , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament , Arthroscopy , Classification , Follow-Up Studies , Horns , Joints , Knee , Menisci, Tibial , Suture Techniques , SuturesABSTRACT
We reported a new technique to repair of the posterior horn tear near the root of the medial meniscus. The radial posterior horn tear near the root showed total loss of the circumferential hoop tension and was similar to the total meniscectomized state. Efforts should be made to restore the circumferential hoop ten-sion and maintain stable bony insertion. We introduced a pull-out repair technique using ACL guide, suture repair set and two PDS No.1. This technique showed stable fixation and good hoop tension of the meniscus. Pull-out repair into the posterior root seems to be a useful method in the posterior horn tear near the root of the medial meniscus.
Subject(s)
Animals , Horns , Menisci, Tibial , SuturesABSTRACT
PURPOSE: To evaluate the efficiency and clinical result of all-inside repair using 2 posteromedial portals for medial meniscus posterior horn tear. MATERIALS AND METHODS: We evaluated 63 knees with m 'al meniscus posterior horn tear, which were repaired by all-inside method using 2 posteromedial portals between March 1997 and March 1999. They were assessed by variable parameters such as pain, joint line tenderness, effusion and McMurray testing. Of these, 30 knees were assessed by the second-look arthroscopy or MRI and the results were graded as healed, incompletely healed or failed. The healing rates were calculated and the effect of tear location, type of tear, the number of sutures used, ACL reconstruction and the repair technique was analyzed. RESULTS: Overall, asymptomatic healing occurred in 96.9/o of knees. At second-look arthroscopy or MRI, the healing rate was 93.3% with 83.3% healed and 10.0% incompletely healed, The failure rate was 6.7%(2 cases). There was no complication at follow up. Th rate of healing increased when tears were longitudinal in the peripheral site, the numbers of suture were smaller, when the repair was combined with the ACL reconstruction and when all-inside technique was performed independently. CONCLUSION: All-inside method using 2 posteromedial portals has a high healing rate and is an improved technique due to its safety, ease than Morgan's method and rigid fixation with vertical suture.