Concerns of Technical Evaluation on Registration of All-inside Meniscus Suture System / 中国医疗器械杂志

OBJECTIVE@#To summarize the product registration declaration ideas and registration technical review of the all-inside meniscal suture system, and to systematically think about of the technical review concerns of the all-inside meniscal suture system products to provide technical guidance for improving the quality of registration and application and regulatory efficiency.@*METHODS@#Consult the public information of such products at home and abroad, and summarize the experience of registration review of such products.@*RESULTS@#The technical review of the all-inside meniscus suture system registration mainly focuses on product basic information, pre-clinical research, clinical evaluation and product technical requirements.@*CONCLUSIONS@#The difficulty of product registration and declaration of the all-inside meniscus suture system lies in the provision of pre-clinical research data of the product, and the applicant needs to strengthen the basic research ability, formulate scientific technical indicators and test methods to ensure the safety and effectiveness of the product, and also provide sufficient supporting data for the registration declaration.

Research progress of knee meniscal repair techniques / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of meniscus repair in recent years, in order to provide help for the clinical decision-making of meniscus injury treatment.@*METHODS@#The domestic and foreign literature related to meniscal repair in recent years was extensively reviewed to summarize the reasons for the prevalence of meniscal repair, surgical indications, various repair methods and long-term effectiveness, the need to deal with mechanical structural abnormalities, biological enhancement repair technology, rehabilitation treatment, and so on.@*RESULTS@#In order to delay the occurrence of osteoarthritis, the best treatment of meniscus has undergone an important change from partial meniscectomy to meniscal repair, and the indications for meniscal repair have been expanding. The mid- and long-term effectiveness of different meniscal repair methods are ideal. During meniscus repair, the abnormality of lower limb force line and meniscus protrusion should be corrected at the same time. There are controversies about the biological enhancement technology to promote meniscus healing and rehabilitation programs, which need further study.@*CONCLUSION@#Meniscal repair can restore the normal mechanical conduction of lower limbs and reduce the incidence of traumatic osteoarthritis, but the poor blood supply and healing ability of meniscal tissue bring difficulties to meniscal repair. Further development of new biological enhanced repair technology and individualized rehabilitation program and verification of its effectiveness will be an important research direction.

A study on repair method of type Ⅱc injury in lateral meniscus popliteal tendon area of porcine knee / 中国修复重建外科杂志

OBJECTIVE@#To investigate the repair method of type Ⅱc injury in the lateral meniscus popliteal tendon area based on the porcine knee joint.@*METHODS@#Eighteen commercially available fresh porcine knee joints were randomly divided into 3 groups ( n=6). After preparing a type Ⅱc injury in the lateral meniscus popliteal tendon area, and the anterior (group A), posterior (group B), or anterior and posterior (group C) of the popliteal hiatus (PH) was sutured by vertical mattress. The tension meter was used to apply gradient tensions of 2, 4, 6, 8, and 10 N along the tibial plateau horizontally, respectively, to pull the midpoint of the lateral meniscus popliteal tendon area. The displacement values before modeling, after modeling, and after suture were recorded. The reduction value of lateral meniscus displacement and reduction rate after suture were calculated and compared between groups.@*RESULTS@#There was no significant difference between groups ( P>0.05) in the displacement values before modeling, after modeling, and after suture under different tensions. There was no significant difference between groups A and C ( P>0.05) in the reduction value of lateral meniscus displacement and reduction rate after suture under different tensions. The reduction value of lateral meniscus displacement and reduction rate after suture in group B were lower than those in groups A and C. The reduction value of lateral meniscus displacement under tension of 2 N and the reduction rates under tensions of 2, 4, and 6 N between groups A and B showed significant differences ( P<0.05). The reduction value of lateral meniscus displacement and the reduction rate under tensions of 2, 4, and 6 N between groups B and C showed significant differences ( P<0.05).@*CONCLUSION@#Suturing the anterior area of PH is the key to repairing type Ⅱc injury of lateral meniscus popliteal tendon area.

Reparación meniscal: resultados en 234 pacientes con seguimiento mínimo de cuatro años / Meniscal repair

Introducción: Los meniscos juegan un papel crucial para la correcta biomecánica y función adecuada de la rodilla. Las lesiones, según sean traumáticas o degenerativas, tienen orígenes, algoritmos diagnósticos y tratamientos distintos. En el pasado, la meniscectomía era el tratamiento de elección; a medida que se fue comprendiendo la importancia de estas estructuras anatómicas estos fueron migrando hacia opciones de preservación, intentando resguardar la mayor cantidad de tejido meniscal, fomentar su reparación y así disminuir el riesgo de osteoartritis de manera temprana.El objetivo de este trabajo es mostrar los resultados de las reparaciones meniscales efectuadas entre 2012 y 2018, y complementar con una revisión de las técnicas quirúrgicas que hemos realizado en el trascurso de estos años, y las causas de fallas en nuestra serie de pacientes.Materiales y métodos: evaluamos doscientas treinta y cuatro reparaciones meniscales realizadas entre el 2012 y el 2018. El promedio de edad fue de veintiocho años. Un 72% se asoció a lesión y reconstrucción del ligamento cruzado anterior. Incluimos las reparaciones meniscales aisladas, como también asociadas a plástica de LCA, de ambos sexos, con técnicas dentro-fuera, fuera-dentro, todo-adentro y la asociación de estas técnicas. Por otra parte, excluimos pacientes con datos incompletos en la historia clínica, revisiones de suturas realizadas por otro equipo quirúrgico y por falta de seguimiento. La evaluación se basó en el examen físico, la escala visual análoga (EVA) para el dolor y la funcionalidad mediante los scores de IKDC, Lysholm y Tegner.Resultados: la reparación meniscal artroscópica estuvo asociada a la reconstrucción ligamentaria del LCA en un 72% (169 casos) y en un 28% (65 casos) la sutura meniscal como único procedimiento. Se repararon ciento setenta y un meniscos internos y sesenta y tres externos. Con respecto a la técnica utilizada, la distribución fue la siguiente: 151 fueron fuera-dentro; 31, todo-adentro y 52, híbrida (mixta). El promedio de puntos de sutura fue de 3.11 (rango 2 ­ 10). El seguimiento promedio fue de sesenta meses (rango 48 ­ 72). El score de Lysholm postoperatorio fue de 94 (rango 87 ­ 96), el IKDC postoperatorio de 88 (rango 84 ­ 92) y la escala EVA fue de 1/10. Se registraron veintitrés fallas de reparación meniscal (9.8% del total), trece asociadas a plástica de ligamento cruzado anterior (LCA) (56% de las fallas y el promedio de edad de esta población fue el mismo que el de la serie general, veintiocho años). Las fallas fueron consideradas con los criterios de Barret y se confirmaron en el intraoperatorio con visualización artroscópica.Conclusión: comprendiendo la biomecánica articular y la importancia de las estructuras meniscales en la prevención de lesiones degenerativas de la rodilla, debemos intentar la reparación meniscal en todos los casos que sean posibles. En nuestra serie utilizamos técnicas reproducibles con bajo índice de complicaciones, con un índice de falla del 9.8%. Es por eso que pregonamos la importancia de "salvar el menisco". Nivel de Evidencia: IV

Introduction: Menisci play a crucial role in the proper biomechanics and adequate function of the knee. Traumatic and degenerative injuries have different origins, diagnostic algorithms, and treatments. In the past, meniscectomy was the treatment of choice. As we understood the importance of these anatomical structures, treatments shifted towards more reparative options, aiming to preserve the maximum amount of meniscal tissue, promoting its repair, and reducing the risk of early osteoarthritis.Our objective is to present the results of meniscal repairs performed between 2012 and 2018, complemented by a review of the surgical techniques we have performed over the course of these years and the causes of failures in our patient series.Materials and methods: we evaluated 234 meniscal repairs performed between 2012 and 2018. The average age was twenty-eight years. 72% were associated with anterior cruciate ligament (ACL) injury and reconstruction. We included both isolated meniscal repairs and those associated with ACL reconstruction, performed in both genders, using inside-out, outside-in, and all-inside techniques, as well as the combination of these techniques. Patients with incomplete medical records, suture revisions performed by another surgical team, and lack of follow-up were excluded. Evaluation was based on physical examination, pain assessment using the visual analog scale (VAS), and functionality using the IKDC, Lysholm and Tegner scores.Results: arthroscopic meniscal repair was associated with ACL reconstruction in 72% (169 cases) and meniscal repair as the only procedure in 28% (65 cases), which 171 were medial menisci and 63 lateral menisci. Regarding the technique used, the distribution was as follows: 151 outside-in, 31 all-inside, and 52 hybrids (mixed). The average number of sutures was 3.11, (range 2 ­ 10). The average follow-up was sixty months (range 48 ­ 72 months). The postoperative Lysholm score was 94 (range 87 ­ 96), postoperative IKDC was 88 (range 84 ­ 92), and the VAS score was 1/10. A total of 23 failures were recorded (9.8% of the total), 13 were associated with ACL reconstruction (56% of the failures), and the average age of this population was the same as the overall series (28 years old). Failures were assessed according to Barrett's criteria and confirmed intraoperatively with arthroscopic visualization.Conclusion: understanding joint biomechanics and the importance of meniscal structures in preventing degenerative knee injuries, we should attempt meniscal repair in all possible cases. In our series, we used reproducible techniques with a low complication rate, resulting in a failure rate of 9.8%. Therefore, we emphasize the importance of "save the meniscus". Level of Evidence: IV

Trasplante meniscal con aloinjerto cadavérico en adolescente con meniscopatía por menisco discoideo / Meniscal allograft transplantation in adolescent with meniscectomy

La incidencia de lesiones meniscales en adolescentes ha aumentado debido a la creciente tendencia, en este grupo de edad, de realizar actividades deportivas, una mayor sospecha diagnóstica y mejora en los métodos para su detección. Estas lesiones suelen asociarse a otras patologías, como lesiones de ligamento cruzado anterior o la presencia de menisco discoideo, un factor de riesgo importante. El menisco discoideo fue descripto por primera vez por Young en 1889, es una variación congénita morfológica del menisco lateral o medial, caracterizado por una hipertrofia central y un diámetro mayor de lo normal. Puede ser asintomático o manifestarse con dolor, bloqueo, chasquidos e hinchazón. El tratamiento histórico era la meniscectomía completa, la que se asociaba a cambios degenerativos articulares tempranos, por lo que actualmente se preconiza la saucerización como tratamiento de elección; además, se describe el trasplante meniscal como procedimiento de salvataje, en caso de daño meniscal irreparable. Se presenta el caso de una paciente femenina de doce años sometida a este procedimiento con antecedentes de múltiples intervenciones quirúrgicas en la rodilla izquierda, incluida la meniscectomía parcial, sin resultado clínico favorable. Nivel de Evidencia: IV

The incidence of meniscal injuries in adolescents has increased due to the growing tendency to perform sports activities in this age group, greater diagnostic suspicion, and improvement in diagnostic methods. They are usually associated with other pathologies, such as anterior cruciate ligament injuries and an important risk factor is the presence of a discoid meniscus. The discoid meniscus, first described by Young in 1889, is a congenital morphological variation of the lateral or medial meniscus, characterized by central hypertrophy and a larger diameter than normal meniscus. It can be asymptomatic or manifest with pain, blockage, clicking and swelling. The historical treatment was complete meniscectomy, which was associated with early degenerative joint changes, nowadays saucerization is recommended as the treatment of choice. In addition, the meniscal transplant is described as a salvage procedure, in case of irreparable meniscal damage. We present the case of a twelve-year-old female patient who underwent this procedure with a history of multiple surgical interventions on the left knee, including partial meniscectomy, without a favorable clinical result. Level of Evidence: IV

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing / 中华创伤杂志(英文版)

PURPOSE@#To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair.@*METHODS@#From May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant.@*RESULTS@#Seven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both).@*CONCLUSION@#The failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

Arthroscopic classification and management for the popliteal hiatus of the lateral meniscus tears / 北京大学学报(医学版)

OBJECTIVE@#To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair with suture hook in management of such injuries.@*METHODS@#This study involved 146 patients who underwent arthroscopic operation because of PHLM tears from April 2014 to October 2017, eliminating the patients who had discoid lateral meniscus. There were 81 males and 65 females, with 54 left knees and 92 right knees. The average ages were (34.7±3.7) years. Among the selected participants, there were 107 patients with anterior cruciate ligament (ACL) injuries, 39 patients with medial collateral ligament (MCL) injuries, and 48 patients with medial meniscus tears. The average preoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 57.7±9.2 and 54.1±8.9, respectively. The arthroscopic classification was based on the extent and degree of PHLM tears and using the arthroscopic all-inside repair with suture hook for such injuries. For the patients associated with ACL injuries, the ipsilateral autograft hamstring tendons use as the reconstruction graft for single bundle ACL reconstructions. The suture anchors were used for treatment of MCL Ⅲ injuries, and the arthroscopic all-inside repair for medial meniscus tears.@*RESULTS@#A total of 146 PHLM tears in 146 patients were divided into type Ⅰ (tears not involved in popliteus tendon incisura; n=86, 58.9%), type Ⅱ (tears involved in popliteomeniscal fascicles; n=36, 24.7%), and type Ⅲ (tears involved in popliteus tendon incisura; n=24, 16.4%). For type Ⅰ, there were three subtypes, including type Ⅰa: longitudinal tear (n=53, 61.6%), type Ⅰb: horizontal tear (n=27, 31.4%), and type Ⅰc: radial tear (n=6, 7.0%). For type Ⅱ, there were also three subtypes, including type Ⅱa: anterosuperior popliteomeniscal fascicle tear (n=5, 13.9%), type Ⅱb: posterosuperior popliteomeniscal fascicle tear (n=20, 55.6%), and type Ⅱc: both tears (n=11, 30.6%). For type Ⅲ, there were two subtypes, including type Ⅲa: horizontal tear (n=9, 37.5%), type Ⅲb: radial tear (n=15, 62.5%). In the follow-up for an average of 15.3±2.6 months, all the patients had done well with significantly improved Lysholm (84.6±14.3) and IKDC (83.2±12.8) scores at the end of the last follow-up relative to preoperative scores (P > 0.01).@*CONCLUSION@#We propose that it is possible to classify lateral meniscus tears at the popliteal hiatus region for three types, which can summarize the injury characteristics of this area. The arthroscopic all-inside repair with suture hook for the PHLM tears can avoid stitching to popliteal tendon or narrowing popliteal hiatus and have satisfactory clinical results.

Reparación de lesiones meniscales horizontales. Resultados a dos años de seguimiento / Horizontal-cleavage meniscus tears. Two years follow-up

Introducción: Las lesiones meniscales horizontales tipo "cleavage" se extienden desde el margen interno libre del menisco, a través de la sustancia intrameniscal, hasta la unión menisco-capsular, y dividen el menisco en láminas superiores e inferiores. Se cree que son lesiones asociadas a meniscos degenerativos, por lo que tienden a ser más comunes en pacientes mayores. El tratamiento clásico consiste en realizar una meniscectomía parcial de la lámina superior o de la inferior, generando sobrecarga compartimental, la que puede desarrollar cambios degenerativos e inestabilidad. Actualmente, trabajos científicos nos presentan la posibilidad de reparar estas lesiones con diversas técnicas. El objetivo del siguiente trabajo es mostrar los resultados clínicos de una serie de pacientes tratados con reparación de las lesiones horizontales, los detalles de las técnicas utilizadas, índices de fallas y vuelta al deporte. Materiales y métodos: realizamos un estudio retrospectivo en el que analizamos una serie de veinticuatro pacientes con lesión meniscal horizontal tratados artroscópicamente con sutura entre 2014 y 2018 en el Hospital Universitario Austral y en el Sanatorio Mapaci. Evaluamos la cantidad y tipo de suturas meniscales, el dolor postoperatorio a través de la escala visual análoga (EVA), y la función con la escala de Lysholm e IKDC a los dos años de seguimiento. Evaluamos también el retorno al deporte y complicaciones.Resultados: la edad promedio fue de 27.8 años; ocho fueron mujeres y dieciséis, hombres. El menisco externo fue el más afectado con diecinueve casos y cinco fueron lesiones del menisco interno. En tres casos, cuando el menisco interno fue afectado, se realizó la técnica de "pie-crust" del ligamento colateral medial. Diez casos fueron asociados a reconstrucción del ligamento cruzado anterior. El promedio de cantidad de suturas meniscales fue de cuatro por paciente. El score de Lysholm a los dos años postoperatorio fue de 94, el IKDC postoperatorio de 88 y la escala EVA fue de 1/10. Todos los pacientes retornaron al deporte a los seis meses (casos aislados) y entre el noveno y el décimo mes (asociados a la reconstrucción del LCA).Conclusión: la reparación meniscal horizontal proporciona buenos resultados funcionales a mediano plazo al preservar la mayor cantidad de tejido meniscal. Creemos que es momento de un cambio de enfoque para este tipo de lesiones, la meniscectomía total o parcial no debería seguir siendo la "indicación de elección" en lesiones meniscales horizontales. En cambio, la preservación meniscal debería ser nuestro objetivo principal, siempre que sea posible. Nivel de Evidencia: IV

Introduction: Horizontal-cleavage meniscus tears begin at the inner edge of the meniscus and continue toward the capsule, dividing the meniscus in to a superior and inferior surface. They are typically associated to degenerative tears, therefore mainly affect elder people. Classically, treatment consisted of partial meniscectomy of either superior or inferior surface, resulting in a compartment overload and developing degenerative changes and instability. The latest publications shows that this type of tears can be repaired with several techniques. The aim of this study was to show the treatment for horizontal cleavage meniscus tears, by displaying a detailed evolution of the used techniques in a case series, evaluating results and outcomes, failure rate and return to sport.Materials and methods: twenty-four patients who underwent and arthroscopic repair of horizontal cleavage tears between 2014 and 2018 at Hospital Universitario Austral and Sanatorio Mapaci where retrospectively reviewed. We review the quantity and type of meniscal sutures, post-operative pain through Visual Analog Scale, Lysholm score and IKDC at two years follow-up. Also, we evaluated return to sports and complications.Results: the age average was of 27.8 years old. Eight patients where females and sixteen males. The most affected meniscus was the lateral in nineteen cases, and the medial in five. In three cases a medial collateral ligament (MCL) pie-crust technique was required when de medial meniscus was repaired. In ten cases a concomitant ACL reconstruction surgery was performed. The mean number of sutures per patient was four. Lysholm score at two years follow-up was of 94, IKDC of 88 and AVS of 1/10. The isolated cases returned to sports at six months after surgery, and the ones with ACL associated surgery between nine and ten months.Conclusion: by preserving more meniscal tissue, meniscal repair of horizontal-cleavage tears provides good functional outcomes at mid-term follow up. We believe that it is time for a change when approaching this type of injury, "treatment of choice" in horizontal cleavage injuries should not be partial or total meniscectomy. Instead, the main goal should be, whenever possible, meniscal tissue preservation. Level of Evidence: IV

Fractura de espina tibial y lesión en asa de balde de menisco interno / Tibial spine fracture and a bucket handle medial meniscus injury

Introducción: Las fracturas de la espina tibial son entidades con una baja incidencia, pero frecuentemente asociadas a lesiones concomitantes. La RM es el estudio considerado patrón de oro para estudiarlas y descartarlas.Presentación del caso: se presenta un caso de fractura de espina tibial desplazada y lesión en asa de balde concomitante. El tratamiento artroscópico de la lesión consistió en la fijación de la fractura de espina tibial con dos pines biodegradables y sutura meniscal interna con tres sistemas todo-adentro Meniscal Cinch® y dos puntos verticales fuera-dentro con FiberWire 2.0®. Conclusión: el paciente tuvo una excelente evolución clínica, sin presentar complicaciones inherentes a la lesión inicial ni al tratamiento implementado, con un retorno a sus actividades deportivas al mismo nivel previo a la lesión.Tipo de estudio: Reporte de caso.

Introduction: Tibial eminence fractures are uncommon injuries but are frequently associated to concomitant injuries. MRI is considered the Gold Standard; it allows a detailed evaluation of any soft tissue involvement with the injury. Case presentation: an unusual presentation case is reported: a displaced tibial spine fracture and a bucket handle medial meniscus injury. Arthroscopic reduction and fixation were performed, using two bioabsorbable pins for the tibial spine fixation; and three all-inside and two vertical outside-in sutures were needed for the medial meniscus repair. Conclusion: the patient presented excellent clinical outcomes, without presenting inherent complications due to primary injury nor realized treatment, achieving sport activity levels prior to injury. Type of study: Case report

Risk factors for the postoperative effect of symptomatic discoid lateral meniscus after arthroscopy / 中国骨伤

OBJECTIVE@#To explore the influencing factors of the postoperative effect of arthroscopic treatment of symptomatic discoid lateral meniscus (DLM).@*METHODS@#From September 2008 to September 2015, patients with symptomatic DLM treated by arthroscopic surgery were retrospectively analyzed. The knee function was evaluated by Lysholm scoring system. According to the scoring results, it was divided into excellent (≥90 points), good (80 to 89 points), fair (70 to 79 points) and poor (<70 points). Sixteen research factors were collected, namely gender, operation age, body mass index, work intensity, symptom duration, history of knee injury, involved knee side, DLM classification, DLM injury type, DLM injury site, medial meniscus injury, knee cartilage injury site and degree, Kellgren-Lawrence (K-L) classification, operation method, and latest follow-up time. According to the data type, Kruskall-Wallis rank sum test or @*RESULTS@#According to the inclusion and exclusion criteria, 502 patients were included. Lysholm functional grade at the latest follow-up was higher than that before operation (@*CONCLUSION@#Arthroscopy is a safe and effective method for the treatment of symptomatic DLM. The gender, body mass index, work intensity, age of operation, duration of symptoms and degree of knee cartilage injury are independent influencing factors for the postoperative efficacy of symptomatic DLM.

Clinical oberservation on rotator cuff suture threader and strapping suture in meniscus tear under arthroscopy / 中国骨伤

OBJECTIVE@#To explore clinical effect of arthroscopic meniscus tear strapping suture by rotator cuff suture threader.@*METHODS@#Forty patients with meniscus tear injury admitted from July 2015 to May 2019, including 27 males and 13 females, aged from 20 to 55 years old with an average of (36.0±1.4) years old. Menisci laceration was sutured with rotator cuff suture thread under arthroscopy. Postoperative complication was observed, Lysholm knee joint score before and after operation at 12 months were used to evaluate clinical effects, visual analogue scale (VAS) and range of knee flexion and extension were applied to evaluate recovery of pain and function.@*RESULTS@#All patients were followed up from 12 to 15 months with an average of (12.6±0.7) months.No complication such as joint effusion, suture failure occurred. Two patients occurred mild pain after activity without clinical physical abnormality, and 1 patient manifested moderate pain with joint space tenderness, the other rest without abnormal. Lysholm knee joint score was increased from (49.55±1.21) preoperatively to (98.95±0.42) at 12 months after operation, VAS score decreased from (5.18±0.78)preoperatively to (1.03±0.77) at 12 months after operation, and range of knee joint flexion and extension activity increased from (50.63±9.20)°preoperatively to (130.38±4.99)°after operation, and there were statistical differences in Lysholm knee joint score, VAS and range of knee joint flexion and extension activity (@*CONCLUSION@#Arthroscopic strapping suture by rotator cuff suture threading device applies to most meniscus injuries, including medial meniscus posterior horn tears, lateral meniscus body tears and lateral meniscus posterior horn tears. This technique meets the need of full-internal meniscus suture without specialmeniscus suture, and has advantages of convenient operation, less complications and good postoperative function.

Application of pie-crusting technique of deep medial collateral ligament under arthroscopy in repairing posterior horn of medial meniscus tears / 中国骨伤

OBJECTIVE@#To explore effectiveness and safety of an inside-out, arthroscopic deep medial collateral ligament pie-crusting release in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.@*METHODS@#From January 2016 to December 2017, 61 patients (61 knees) were underwent arthroscopic partial meniscectomies for PHMM tear in tight medial tibiofemoral compartment of knee joint, who were divided into valgus group and pie-crusting group according to exposure of PHMM region . There were 28 patients in valgus group, including 12 males and 16 females aged from 27 to 60 years old with an average age of (35.75±7.57) years old;who were performed conventional valgused knee to exporsure PHMM region. There were 33 patients in pie-crusting group, including 15 males and 18 females aged from 26 to 58 years old with an average age of (36.06±7.93) years old;who were treated with inside-out, arthroscopic deep MCL pie crusting release technique with MM-Ⅱ meniscus suture package (Smith & Nephew). Operation time, preoperative and postopertaive Lysholm score of knee joint, injury of MCL between two groups were recorded and compared.@*RESULTS@#All patients were followed up from 12 to 18 months with an average of (15.19±2.22) months. The incisions were healed at stageⅠ. There were no statistical difference in anatomical classification of PHMM between two groups(@*CONCLUSION@#The inside-out, arthroscopic deep MCL pie-crusting release for the treatment of posterior horn of medial meniscus tear in tight medial tibiofemoral could expand working apace, shorten operation time, reduce injury to MCL and obtain good clinical efficacy.

Biomechanical study on different high-strength sutures and suture site for repairing posterior root tear of the medial meniscus / 中国骨伤

OBJECTIVE@#To compare biomechanical characteristic of different high-strength sutures and suture sites for repairing posterior root tear of the medial meniscus with modified Mason-Allen technique.@*METHODS@#Forty-eight specimen of medial meniscus of knee joint from fresh porcine (female, aged from 5 to 9 months with an average of 7 months) were chosen and established experimental model. The samples were divided into red zone fixation group and red-white zone fixation group according to suture sites, 24 in each group; and then were randomly divided into 3 subgroups which 8 in each group, and fixed with Ethibond suture, Ultrabraid suture and FiberWire suture, respectively. Biomechanical tests were performedon universal electromagnetic and mechanical testing machine. Each specimen was underwent 1 000 cyclic tests on the first time, then pull out test until failure. The maximum failure load, yield load, stiffness and displacement were analyzed.@*RESULTS@#All specimen were successfully completed biomechanical tests. The failure mode of Ethibond group was caused by suture fracture; 6 cases of Ultrabraid suture group was caused by suture fracture which belong to red zone fixation group, 10 cases were caused by suture pull out, which 2 cases belong to red zone fixation group, 8 cases belong to red-white zone fixation group;8 cases of FiberWire group was caused by suture pull-out. Biomechanical test showed that:(1)In terms of suture strength, comparison of the maximum failure load, yield load and stiffness showed that Ethibond suture group

Modified single-needle arthroscopic repair technique for the treatment of longitudinal meniscal tear / 中国骨伤

OBJECTIVE@#To compare therapeutic efficacy of modified single-needle arthroscopic repair technique and Fast-Fix technique in repairing longitudinal meniscus injuries.@*METHODS@#From July 2016 to July 2017, patients with longitudinal meniscus injuries who underwent meniscal repair surgery were retrospectively analyzed. Ninety-one patients treated with modified single-needle technique and 77 patients were treated with Fast-Fix technique, the average age were (26.7±7.6) and (27.9±6.1) years old respectively, the average lengths of follow-up were (32.5±9.2) and (33.2±11.9) months, respectively. Operation cost, suture time, intraoperative failure rate and postoperative failure rate were used as clinical outcomes, MRI of knee joint was used as main diagnosis and evaluation basis; 2000 IKDC subjective score, Lysholm score and Tegner activity scale were compared between two groups preoperatively, 12 months after operation and at the latest follow-up. Intraoperative and postopertaive complications were observed.@*RESULTS@#Compared with Fast-Fix group, patients in modified single-needle technique group had lower operation costs [(645.7±133.1 vs.(12 184.8±4 709.8), @*CONCLUSION@#Modified single-needle arthrscopicrepair technique could achieve the similar therapeutic efficacy as Fast-Fix technique, and it has advantageds of simple opertion and more economical. This study recommends clinical application of modified single-needle arthrscopic repair technique in treating meniscus injuries.

Reparación meniscal con técnica dentro-fuera / Inside-out meniscal repair technique

Sabemos que la meniscectomía lleva al desarrollo temprano de osteoartritis, es por ello que en la actualidad se tiende a reparar más que a resecar meniscos. La reparación meniscal Dentro-Fuera es una técnica que ha probado ser efectiva tanto así que sigue siendo el estándar de oro. Aunque la técnica todo dentro ha sido mejorada, la técnica Dentro-Fuera ofrece ventajas como el poder reparar diferentes tipos de patrones de lesiones así como utilizar diferentes tipos de puntos y suturas. La desventaja es que requiere de una incisión extra y una adecuada disección de los tejidos blandos para evitar complicaciones iatrogénicas y anudar los puntos directamente sobre la cápsula. En el artículo describimos la técnica que utilizamos

It is well known that meniscectomy leads to the early development of knee arthritis, that is the reason that nowadays we favour meniscal repair rather than meniscectomy. The Inside-out meniscal repair technique has proven to be effective, has passed the test of time and has withstanded as the gold standard of meniscal repair techniques. Even when the All-inside technique has improved the inside-out offers advantages like the possibility of repairing all tear patterns and the chance of using several stitch configurations and different kinds of sutures. The main disadvantage is that it requires an extra incision and some deep dissection to tie the knots against the capsule. We describe the technique we currently use

Lesión de la raiz meniscal. Actualización, técnica quirúrgica y experiencia personal / Meniscal root tears. Actualization, surgical technique and personal experience

Las lesiones de la raíz meniscal se definen como avulsiones de la raíz o lesiones radiales hasta 1 cm de la inserción meniscal, representan del 10% al 21% de todas las roturas meniscales. Se asocian con dolor, discapacidad y rápido deterioro articular. Pueden ocurrir en pacientes jóvenes como resultado de un trauma de alta energía, pero es más común en pacientes entre 45 y 60 años en el contexto de cambios degenerativos meniscales.El objetivo del siguiente trabajo es realizar una actualización de la literatura, mostrando cual es la técnica quirúrgica preferida en nuestra institución

Meniscus root tears are now being recognized as a significant cause of pain, disability, and rapid joint deterioration. They can occur in younger patients as a result of high energy trauma, but are more common in patients between 45 and 60 as a result of degeneration of the meniscus.The aim of this article was to review and summarize the recent literature regarding various diagnosis and treatment strategies of meniscus root repair, and to show the preferred technique used in our institution

Lesión tipo rampa meniscal. Actualización, técnica quirúrgica y experiencia personal / Meniscal ramp lesions. Actualization, surgical technique and personal experience

Las lesiones meniscales en rampa son un desgarro longitudinal de la fijación periférica del cuerno posterior del menisco interno a nivel de la unión meniscocapsular, asociadas a la lesión del Ligamento Cruzado Anterior (LCA). Su diagnóstico clínico puede ser dificultoso debido a que pueden cursar de manera asintomática, la resonancia magnética tiene una sensibilidad menor al 50% para detectarlas, y en la artroscopía, desde el portal anterolateral habitual puede pasar desapercibida. Para diagnosticar y tratar estas lesiones es necesario buscarlas sistemáticamente visualizando de manera directa la unión meniscocapsular posterior a través del espacio intercondíleo y trabajando desde un portal posteromedial. Esto hace que este tipo de lesiones sean de difícil diagnóstico y tratamiento. Presentamos la técnica quirúrgica para la detección y reparación de las lesiones en rampa meniscal

Meniscal ramp lesions are a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular union, associated with the anterior cruciate ligament (ACL) injury. They can be difficult to diagnose clinically because they can be asymptomatic; magnetic resonance imaging has a sensitivity of less than 50%; and arthroscopically, from the anterolateral portal these lesions are hard to find. For diagnosing and treating these lesions, it is necessary to systematically look for them by direct visualization of the posterior meniscocapsular junction through the intercondylar space and working from a posteromedial portal. These types of injuries are difficult to diagnose and treat. We present the surgical technique for the detection and repair of meniscal ramp lesions

Uso de plasma rico en plaquetas en sutura meniscal / Platelet-rich plasma in meniscal repair

El plasma rico en plaquetas (PRP) ha sido utilizado en distintos tipos de cirugías ortopédicas, incluyendo músculos, hueso, tendones y ligamentos. El PRP podría acelerar o mejorar el proceso reparativo, permitiendo un retorno precoz a las actividades deportivas de los pacientes. El PRP se obtiene de la sangre autóloga, la cual es centrifugada, obteniendo plaquetas y factores de crecimiento en cantidades superiores a la sangre normal.La combinación de reparación meniscal con el uso de PRP no ha atraído la misma cantidad de investigación científica que la cirugía ligamentosa. Hasta el momento, pocos estudios sobre el tema han sido publicados, y la mayoría de ellos con números insuficientes para probar el efecto del PRP en las reparaciones. Con la evidencia actualmente disponible no podemos asegurar la utilidad del PRP como aumentación de reparaciones meniscales, sin embargo, nueva evidencia nos indica que en pacientes donde existiría bajo potencial de cicatrización (lesiones aisladas, indicación extendida) podría existir una indicación

Platelet Rich Plasma (PRP) has been used in different aspects of orthopedics, including muscle, bone, tendons and ligament surgery. PRP might accelerate or improve the healing process, allowing an earlier return to sports activities. PRP is obtained from autologous blood, which is centrifuged, obtaining platelets and growth factor concentrations higher than those of regular blood.Meniscal repair with the use of PRP has not attracted the same amount of investigation compared to ligamentous surgery. Currently, there are few published studies available regarding the effect of PRP on meniscal repair outcomes, and most of them are underpowered to assess repair failure as a primary outcome measure. With the actual evidence we cannot recommend for the use of PRP in every meniscal repair, but encouraging evidence is being published supporting its use in patients with higher risk of failure (isolated repairs, extended indications)

Sutura meniscal en niños. ¿En qué hemos avanzado? / Meniscal repair in children

La real incidencia de las lesiones meniscales en niños y adolescentes sigue siendo desconocida, aunque se estima que estas han aumentado en los últimos años. En este grupo de pacientes, tanto el examen físico como la resonancia magnética han reportado un menor rendimiento, por lo que la sospecha clínica debe ser alta. Aunque la literatura es escasa en niños y las bases del manejo de estas lesiones se extrapolan del manejo en adultos, la tendencia actual es la preservación meniscal. Dado el alto potencial de cicatrización y la mayor vascularización del menisco pediátrico, se extiende la indicación de sutura meniscal a toda aquella lesión reparable, independiente del patrón, extensión o tiempo de evolución en este grupo étareo. La literatura reporta buenos resultados tras la reparación meniscal en pacientes pediátricos, con tasas de cicatrización promedio por sobre el 70%, que son al menos comparable a lo reportado en adultos. A la fecha, la técnica todo-dentro es la más utilizada por su fácil utilización y menor tiempo quirúrgico. Sin embargo, debemos ser especialmente cuidadosos para evitar una lesión neurovascular iatrogénica dado el menor tamaño y proximidad del paquete neurovascular en rodillas pediátricas. La principal complicación es la falla de la sutura, reportándose tasas comparables a la población adulta a pesar de su indicación extendida en niños y adolescentes. Se han identificado como factores protectores para la reparación meniscal la menor edad, la fisis abierta, roturas de patrones simples y la reconstrucción concomitante de ligamento cruzado anterior. En el presente artículo realizamos una detallada revisión de la literatura disponible sobre reparación meniscal en niños y adolescentes, enfatizando las diferencias versus población adulta. También presentamos nuestra experiencia y protocolo de rehabilitación para sutura meniscal en pacientes pediátricos

The true incidence of meniscal injuries in children and adolescents remains unknown, though estimated to have increased during the last years. Clinical suspicion must remain high since physical examination and magnetic resonance imaging have reported less accuracy for meniscal tears in pediatric patients. Although literature is scarce in children and adolescents and the basis for managing these lesions is extrapolated from adult population, the current trend is meniscal preservation. Considering the greater healing potential and vascularization of the pediatric meniscus, indications for meniscal suture are extended to all those tears amenable to repair in spite of their size, tear pattern and time to repair. Literature has demonstrated good outcomes for meniscal repair in children, with healing rates above 70%, comparable to those reported for adults. To date, the all-inside technique is the most frequently used for meniscal repair thanks to its simplicity and shorter operative time. However, we must be especially careful to avoid iatrogenic neurovascular injury given the smaller size and proximity of the neurovascular package in the pediatric knee. Suture failure is the main complication, with rates comparable to adult population despite widespread indication of repair in children. Younger age, open physis, simple tear patterns and simultaneous anterior cruciate ligament reconstruction appear to benefit meniscal repair in children. This article summarizes the available literature regarding meniscal repair in children and adolescents, emphasizing the differences with adult population. We also present our experience in the treatment of these injuries and our preferred rehabilitation protocol