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.

Microinvasive Meniscal Suture with Disposable Needle / Sutura meniscal microinvasiva com agulha descartável

Abstract The first meniscal suture was performed in 1885 and took about a century to become popular. Currently, all-inside meniscal repair devices are widely used. However, this technique presents the disadvantage of being a method dependent on specific devices, presenting a higher cost than other techniques. This high cost limits the use of such a technique in many locations. The objective of the present technical note is to describe a microinvasive meniscal suture technique as a modification of the all-inside technique, using a disposable 40 x 12 mm procedure needle. The authors believe that the proposed modification to the technique can make it more popular, enabling the use of the microinvasive technique in places with limited resources.

Resumo A primeira sutura meniscal foi realizada em 1885 e levou cerca de um século para tornar-se popular. Atualmente, os dispositivos de reparo meniscal all-inside são amplamente utilizados. Contudo, esta técnica apresenta a desvantagem de ser um método dependente de dispositivos específicos, apresentando um custo superior aos de outras técnicas. Este valor elevado limita o uso de tal técnica em muitos locais. O objetivo da presente nota técnica é descrever uma técnica de sutura meniscal microinvasiva, como uma modificação da técnica all-inside, utilizando uma agulha descartável de procedimento de 40 x 12 mm. Os autores acreditam que a modificação proposta para a técnica pode torná-la mais popular, possibilitando o uso da técnica microinvasiva em locais com recursos limitados.

Reparación artroscópica de lesiones meniscales en pacientes mayores de cuarenta años. Resultados con seguimiento mínimo de cuatro años / Arthroscopic meniscal repair in patients older than 40 years. Outcomes with minimum follow-up of 4 years

Introducción: El objetivo del siguiente trabajo es mostrar los resultados clínicos de una serie de pacientes mayores de cuarenta años, tratados con reparación meniscal, evaluar detalles de las técnicas utilizadas, índice y causa de fallas y vuelta al deporte. Materiales y métodos: analizamos retrospectivamente pacientes intervenidos quirúrgicamente por nuestro equipo entre enero de 2012 y enero de 2018, a los que se les realizó reparación de lesión meniscal, asociada o no a lesión de LCA. Se excluyeron los pacientes menores de cuarenta años, aquellos con cirugías previas y seguimiento menor a cuatro años. Resultados: evaluamos cuarenta pacientes con edad promedio de cuarenta y ocho años (rango 40­61). El seguimiento promedio fue de sesenta y seis meses (rango 48­84). El promedio de suturas utilizadas fue 3 (rango 1 a 8 puntos). Cinco pacientes presentaron fallas (12.5%): cuatro asociadas a plástica de LCA y la restante por una reparación aislada. Los scores de Lysholm, IKDC y Tegner mostraron mejoría en el postoperatorio. Conclusión: según la evidencia disponible hasta la fecha, y los muy buenos resultados obtenidos en este estudio con un índice de falla del 12.5%, la edad, como factor independiente, no debe ser tomada como una contraindicación para la reparación meniscal. La reparación meniscal en pacientes mayores de cuarenta años tiene índices de fallas comparables a las reparaciones realizadas en pacientes jóvenes después de cuatro años de seguimiento. Nivel de Evidencia: IV

Purpose: Our aim is to evaluate clinical results in a series of meniscal repair in patients over forty years old. Reviewing the used technique, index and failure cause and return to sport. Materials and methods: we retrospectively reviewed our patients who underwent an arthroscopic meniscal repair between January 2012 and January 2018, with or without concomitant ACL reconstruction surgery. We excluded patients under forty years old, previous surgery, and a follow up of less than four years. Results: forty patients met our criteria. Mean age was forty-eight years old (range 40­61). The mean follow-up was of sixty-six months (range 48­84). The average number of sutures needed to make the repair was of three (range 1­8 sutures). Five patients failed (12.5%), four had an associated ACL reconstruction surgery and the latter was an isolated repair. Lysholm Score, IKDS and Tegner Score showed great results in the post-operative period. Conclusion: as more and more patients remain active into adulthood, the ability to preserve native meniscal tissue after injury is an important goal. According to the available evidence published so far, and our very promising results shown in this study with a 12.5% failure rate, age as an independent factor should not be considered as a non-repairing factor. Meniscal repair in patients over forty years old present similar results and failure rate comparable to repairs in younger patients after four years of follow-up. Level of Evidence: IV

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.

Evolución clínica y análisis del estado del cartílago articular por mapeo-T2 y segunda vista artroscópica a veinticuatro meses del trasplante de menisco medial / Meniscal transplantation. Clinical evolution of articular cartilage for T2-mapping and second-look arthroscopic at twenty-four months

Introducción: El objetivo de nuestro trabajo es evaluar la evolución clínica, la condroprotección y la reacción inmunológica del trasplante de menisco (TM) con aloinjerto gama irradiado (GI) versus fresco congelado (FC) a veinticuatro meses. Materiales y métodos: veinte TM mediales en veinte pacientes, se evaluaron escalas de rodilla, Mapeo-T2 y segunda vista artroscópica, así como identificación de reacciones inmunológicas con la medición de citocinas inflamatorias por PCR en sangre y líquido sinovial. Trece trasplantes con injerto FC y siete GI, edad promedio de treinta y dos años. Resultados: mejoría significativa en escalas a veinticuatro meses: KOOS (dolor 67.80/79.30; síntomas 60.80/82.10; AVD 8.05/92.40; deportes 37/63.35; CV 28.90/71.30), Lysholm (62.20/85.80), IKDCs (50.17/72.12), EVA (3.35/0.4). El cartílago del compartimento trasplantado se mantuvo dentro de valores normales, sin diferencia a los veinticuatro meses (fémur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Todos los pacientes mostraron integridad del injerto a los doce meses en la segunda vista artroscópica. Solo se observó aumento en las citoquinas plasmáticas IL-6 e IL-17 en un paciente del grupo GI, sin repercusión clínica. Conclusiones: mejoría clínica, adecuada integración y condroprotección significativa a veinticuatro meses en ambos tipos de injertos

Introduction: Our objective is to evaluate the clinical course, chondroprotection and immunological reaction of meniscus transplantation (TM) with gamma irradiated (GI) versus fresh frozen (FC) allograft at twenty-four months. Materials and methods: twenty medial TMs in twenty patients, knee scales, T2-mapping and second arthroscopic view were evaluated, as well as identification of immunological reactions with the measurement of inflammatory cytokines by PCR in blood and synovial fluid. Thirteen transplants with FC graft and seven GI grafts, average age of thirty-two years. Results: significant improvement on scales at twenty-four months: KOOS (pain 67.80 / 79.30; symptoms 60.80 / 82.10; AVD 8.05 / 92.40; sports 37 / 63.35; CV 28.90 / 71.30), Lysholm (62.20 / 85.80), IKDCs (50.17 / 72.12), EVA (3.35 / 0.4). The cartilage of the transplanted compartment remained within normal values, with no difference at twenty-four months (femur: 33.43 versus 33.50 ms, p = 0.16) (tibia: 33.57 versus 34.35 ms, p = 0.21). Conclusions: all patients showed integrity of the graft at twelve months in the second arthroscopic view. An increase in plasma cytokines IL-6 and IL-17 was only observed in one patient in the GI group, without clinical repercussion. Clinical improvement, adequate integration and significant chondroprotection at twenty-four months in both types of grafts

Arthroscopic surgery combined with platelet-rich plasma for meniscus injury:a Meta analysis / 中国骨伤

OBJECTIVE@#To evaluate clinical efficacy of arthroscopic with platelet-rich plasma (PRP) in treating meniscus injury.@*METHODS@#From January 2015 to December 2019, clinical control study on repair meniscus injury by arthroscopic with PRP between arthroscopic were searched by PubMed, Science Direct, Cochrane library, Chinese Journal Full-text Database, Wanfang and VIP database. Literature screening, data extraction and quality evaluation according to inclusion and exclusion criteria. Visual analogue scale(VAS) of knee joint and Lysholm score at 1, 6 and 12 months after opertaion between two groups were compared, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) at 3, 6 and 12 months after opertaion between twogroups were also compared.@*RESULTS@#Totally 9 literatures and 329 patients with meniscal injuries were screened, include 146 patients treated by arthroscopic with PRP and 183 patients treated by arthroscopic. There were no statistical differences in VAS between two groups at 1, 6 and 12 months after opertaion. There were differences in Lysholm score at 1 and 6 months after operation between two groups [@*CONCLUSION@#Arthroscopic with PRP for repair meniscus injury has short term efficacy of knee function and delay arthritis, while has similar effect in long term clinical efficacy and relieve pain.

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.

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.

Tratamiento de las lesiones del ligamento cruzado anterior y meniscales en adolescentes: reporte de un caso / Treatment for anterior cruciate ligament and meniscal tears in adolescents: a case report / Tratamento das lesões do ligamento cruzado anterior e meniscais em adolescentes: relatório de um caso

Dada la creciente popularidad de las actividades deportivas, el número de roturas del ligamento cruzado anterior (LCA) y lesiones meniscales ha aumentado en particular en niños y adolescentes. El manejo de estas lesiones es desafiante debido las fisis abiertas. Por un lado las opciones de reconstrucción del LCA incluyen técnicas: transfisarias, extra-articulares y intraepifisarias. Por otro lado se han descrito diferentes técnicas de reparación meniscal: "all-inside", "inside-out" y "outside-in". Estas tiene como objetivo lograr la cicatrización meniscal, evitando los efectos adversos de la meniscectomía. Presentamos un reporte de caso de un adolescente de 14 años con una rotura completa del LCA y una lesión del cuerno posterior del menisco interno que fue sometido a una reconstrucción transfisaria del LCA y a una reparación meniscal "inside-out".

With the raising popularity of sporting activity, the number of anterior cruciate ligament (ACL) ruptures and meniscal tears has increased in particular in children and adolescents. Management of these injuries is challenging due to open growth plates. On the one hand the ACL reconstructions options includes: transphyseal, extra-articular and epiphyseal-only techniques. On the other hand there have been described different meniscal repair techniques: "all-inside", "inside-out" and "outside-in". These aim to achieve meniscal healing, avoiding the adverse effects of meniscectomy. We present a case report of a 14-year adolescent with an ACL complete rupture and a posterior horn tear of the medial meniscus who underwent an ACL transphyseal reconstruction and a "inside-out" meniscal repair.

Dada a crescente popularidade das atividades esportivas, o número de rupturas do ligamento cruzado anterior (LCA) e lesões meniscais aumentou especialmente em crianças e adolescentes. O manejo destas lesões é desafiador devido às fissuras abertas. Por um lado as opções de reconstrução do LCA incluem técnicas: transfisárias, extra-articulares e intraepifisárias. Por outro lado, foram descritas diferentes técnicas de reparação meniscal: "all-inside", "inside-out" e "outside-in". Estes têm como objetivo alcançar a cicatrização meniscal, evitando os efeitos adversos da meniscectomia. Apresentamos um relatório de caso de um adolescente de 14 anos com uma ruptura completa do LCA e uma lesão do corno posterior do menisco interno que foi submetido a uma reconstrução transfisária do LCA e a uma reparação meniscal "inside-out".

A mid-term clinical follow-up study on repair of the meniscus tears by a modified arthroscopic outside-in puncture suture technique / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical effect of a modified arthroscopic outside-in suture technique in the treatment of meniscus tear using a spinal needle.@*METHODS@#From January 2015 to October 2017, 95 patients treated with this method were followed-up. Among these cases, there were 36 males and 59 females. The age of the patients ranged from 16 to 77 years, (46.79±18.07) years in average. Among them, there were 28 patieats aged 16-35, 53 patients aged 36-65, and 14 patients aged over 65 years old. 28 cases were diagnosed with medial meniscus tear, 43 cases with lateral meniscus tear and 24 cases with both medial and lateral meniscus tear. Causes of the injury included sports, sprain, etc. According to Barrett standard, the clinical healing of meniscus tear was judged. Lysholm score, knee range of motion, visual simulation score (VAS) and magnetic resonance imaging (MRI) were used to evaluate the postoperative knee function and recovery of the patients.@*RESULTS@#The 95 patients were followed up for 22 to 36 months, with an average of (28.32±3.98) months. According to Barrett standard, 90 patients (94.7%) obtained meniscus clinical healing. Meniscal healing rates were 96.43%, 96.23% and 85.71% in the three age groups, respectively. The meniscal healing rate was lower in the elderly group, but there was no significant difference in statistical results (P=0.262). Five patients had deep tenderness in the joint space of the injured side, and the overstretch test was positive. The preoperative and postoperative VAS scores, Lysholm scores and knee motion were compared in each group, and the differences were statistically significant (P < 0.01). At the end of the last follow-up, there were no cases of knee joint effusion, swelling and interlocking, and the joint function was effectively improved in most patients. No surgical site infection, periarticular vascular/nerve injury or knotting reaction was found during the follow-up.@*CONCLUSION@#This modified arthroscopic outside-in suture technique using a spinal needle has the characteristics of simple operation, small trauma and rapid recovery, and the mid-term follow-up results were satisfactory. Therefore, we consider this method to be a safe and efficient method for the treatment of meniscus anterior horn and body tear.

Sutura meniscal artroscópica con técnica fuera dentro. Evaluación de resultados funcionales / Arthroscopic meniscal repair with out-inside technique

Introducción: El propósito de este trabajo fue evaluar retrospectivamente los resultados funcionales de una serie de pacientes con lesiones meniscales, tratados mediante la sutura artroscópica del menisco con técnica fuera dentro y describir la técnica quirúrgica.Material y métodos: Se analizaron retrospectivamente 49 suturas meniscales artroscópicas de rodilla. Cuarenta fueron aisladas y 9 asociadas a rupturas del LCA. Treinta y dos fueron hombres y 17 mujeres, con una edad promedio de 24 años (12- 40), y con un seguimiento promedio de 58 meses. Treinta y seis pacientes fueron tratados solo con técnica fuera dentro y en 13 pacientes se utilizó una técnica híbrida combinando una sutura fuera dentro con dispositivos todo dentro. Se realizó una evaluación clínica con el escore de Lysholm y con el International Knee Documentation Committee (IKDC), en el pre operatorio y en el último control. Resultados: Se observo una ruptura de la reparación en 7 pacientes (15%), 6 traumáticas durante una actividad deportiva, y una espontánea. Las lesiones del menisco interno y las rupturas en asa de balde presentaron un mayor índice de falla, sin que esta diferencia sea significativa. No se observaron diferencias clínicas al comparar el grupo de pacientes con técnica fuera dentro y en aquellos que se realizó una técnica hibrida. Conclusión: La cirugía de preservación meniscal con la técnica fuera-dentro nos permitió obtener resultados funcionales favorables en casos seleccionados.Tipo de estudio: Serie de casos Nivel de evidencia: IV

Introduction: The purpose of this study was to retrospectively evaluate the functional results of a series of patients with meniscal lesions treated by arthroscopic meniscal suture with the outside in technique and describe the surgical technique.Material and Methods: 49 arthroscopic meniscal knee sutures were retrospectively analyzed. Forty were isolated and 9 associated with ACL ruptures. Thirty-two were men and 17 women with an average age of 24 years (12-40), and with an average follow-up of 58 months. Thirty-six patients were treated only with outside in technique and in 13 patients a hybrid technique was used combining a suture outside inside with devices all inside. A clinical evaluation was performed with the Lysholm score and the International Knee Documentation Committee (IKDC) in the preoperative and in the last control.Results: A re-rupture is observed in 7 patients (15%), 6 traumatic during a sport activity, and a spontaneous one. Medial meniscus and bucket handle repairs have a major failure rate, without significant difference. No clinical differences were observed when comparing the group of patients with outside in technique and in those who performed a hybrid technique.Conclusion: Meniscal preservation surgery with the outside in technique allows us to obtain favorable functional results in selected cases. Type of study: Case series. Level of evidence: IV

Reparación transtibial de la raíz posterior del menisco lateral en lesiones agudas: técnica quirúrgica y seguimiento clínico a corto plazo / Transtibial repair of posterior root of the lateral meniscus in acute lesions: surgical technique and short-term clinical follow-up

Introducción Las lesiones de la raíz posterior del menisco lateral (RPML) afectan la transferencia de la carga axial de la rodilla, lo cual genera una sobrecarga con el posterior deterioro del cartílago articular. Se han descrito numerosas técnicas quirúrgicas en la literatura para su tratamiento, pero aún no se ha demostrado superioridad de alguna, por ende, existen controversias sobre cual técnica es la más indicada para estas lesiones. El objetivo del estudio es describir la técnica quirúrgica y la evolución clínica de pacientes intervenidos con fijación transtibial de la RPML en una clínica especializada, durante el periodo 2016-2017. Materiales & Métodos Se realizó una descripción de la técnica quirúrgica y una serie de casos retrospectiva. Se incluyeron pacientes con lesiones agudas en la RPML, los cuales fueron intervenidos quirúrgicamente utilizando una nueva variación a técnica transtibial. Para determinar la evolución cínica de los pacientes se realizaron las escalas Lysholm e IKDC, antes y después de la cirugía. Resultados Se intervinieron seis pacientes con lesión aguda de la RPML, cuatro de sexo masculino. El tiempo entre el trauma y la cirugía fue en promedio 2,5 meses. Todos los pacientes presentaron lesión concomitante de ligamento cruzado anterior. Al comparar el estado inicial de los pacientes y el postoperatorio mediante las escalas de Lysholm e IKDC, se encontraron diferencias estadísticamente significativas (p<0,05). Asimismo, no se realizaron reintervenciones durante el seguimiento. Discusión La reparación de la RPML con la nueva variación de la fijación transtibial proporciona una mejoría en la función, el dolor y el nivel de actividad de los pacientes, lo que puede ayudar a retrasar la progresión de la osteoartrosis en la rodilla. Igualmente, este procedimiento se puede realizar de forma segura aún en casos de lesiones ligamentarías concomitantes. Nivel de evidencia: IV

Background injuries of posterior lateral meniscus root (PLMR) affect the transfer of the axial load of the knee. Several surgical techniques have been described for it treatment, but still none has demonstrated superiority. Consequently, there are controversies about which technique is most indicated for these injuries. The aim is to describe the a surgical technique and the clinical follow up of patients operated with transtibial fixation of PLMR in a specialized clinic, during the 2016-2017. Methods Retrospective case series and description of the surgical technique. We included patients with acute injuries in the PLMR, who were operated using a new variation to the transtibial technique. For the clinical follow-up, the IKDC and Lysholm scores were performed before and after surgery. Results Six patients with acute lesion in the PLMR were intervened, four were male. The time between trauma and surgery was on average 2.5 months. All the patients presented a concomitant lesion of the anterior cruciate ligament. When comparing the initial state of the patients and the postoperative period, statistically significant differences were found (p <0.05). Likewise, reinterventions were not performed during follow-up. Discussion The repair of PLMR with the new variation of the transtibial fixation provides an improvement in the function, the pain and the level of activity of the patients, which can help to delay the progression of osteoarthrosis in the knee. Likewise, this technique can be performed safely even in cases of concomitant ligament injuries. Level of clinical evidence: Level IV

Meniscectomía parcial artroscópica: resultados a más de un año de seguimiento en pacientes laborales vs. no laborales / Arthroscopic partial meniscectomy. Results to more than one year of follow-up in working compensation vs. non-working compensation patients

Introducción: El objetivo del trabajo es evaluar y comparar de manera retrospectiva los resultados de una serie de pacientes laborales y no laborales con lesiones meniscales, tratadas mediante meniscectomía parcial artroscópica. Material y métodos: Se evaluaron 60 pacientes tratados en nuestro centro, entre junio 2016 y mayo 2017, los cuales presentaban lesiones meniscales agudas que no respondieron a tratamiento conservador. Todas las lesiones fueron diagnosticadas con RM previa. Se trataba de 30 pacientes laborales y 30 no laborales, 53 de sexo masculino y 7 de sexo femenino. La edad fue entre 18 y 45 años. Treinta y seis meniscos internos y veinticuatro meniscos externos. El seguimiento promedio fue 18 meses. Se realizó score de Lysholm y EVA. Resultados: De los 30 pacientes no laborales 28 evolucionaron favorablemente, con mejoría en el score de Lysholm de 53 a 93 puntos y EVA de 7 a 1 puntos en promedio, con retorno a la actividad previo a la lesión. Dos de ellos continuaron con molestias leves, sin afectar sus rutinas diarias. En los pacientes laborales 14 evolucionaron favorablemente, con mejoría en el score de Lysholm de 48 a 74 puntos y EVA 7 a 2 puntos en promedio con retorno a su actividad laboral habitual. Dieciséis de ellos presentaban dolor moderado con retorno laboral parcial o requirieron cambio de tareas. Conclusión: Los resultados de la meniscectomía parcial en pacientes no laborales fueron excelentes a buenos, con retorno a sus actividades cotidianas en un 96%. En cuanto a los pacientes laborales se obtuvieron resultados regulares, con retorno a su actividad laboral habitual en un 53%. Tipo de estudio: Serie de casos. Nivel de evidencia: IV

Introduction: The aim of the study is to evaluate and compare retrospectively the results of arthroscopic partial meniscectomy for meniscus tears in working compensation vs. non-working compensation patients Material and methods: Sixty patients treated in our institution between June 2016 and May 2017 with the diagnosis of acute meniscus tears that did not respond to conservative treatment were evaluated. All lesions were diagnosed with previous MRI. There were 30 patients under working compensation insurance and 30 under another insurance system (53 men, and 7 women). The age ranged between 18 and 45 years. Thirty-six tears were located in the internal menisci and twenty-four in the external menisci. The average follow-up was 18 months. Lysholm and EVA scores were obtained. Results: Of the 30 non-working compensation patients, 28 evolved favorably with an improvement in the Lysholm score of 53 to 93 points and EVA of 7 to 1 points on average and returned to activity prior to the injury. Two of them continued with mild discomfort, without affecting their daily routines. In working compensation, patients 14 evolved favorably, with improvement in the Lysholm score of 48 to 74 points and EVA 7 to 2 points on average and return to their usual work activity. Sixteen of them presented moderate pain with partial job return or required change of tasks. Conclusion: The results of partial meniscectomy in non-work-related patients were excellent to good, with 96% return to daily activities. Regarding work-related patients, regular results were obtained, with a return to their usual work activity of only 53%. Type of study: Case series. Level of evidence: IV

Lesiones meniscales ramp, y lesiones del ligamento meniscotibial posteromedial / Meniscal ramp lesions, and posteromedial meniscotibial ligament lesions

Las lesiones meniscales son las lesiones más frecuentemente asociadas a lesiones del Ligamento Cruzado anterior (LCA), encontrándose 9,3 a 16,9% en el segmento posteromedial y comprometiendo el ligamento meniscotibial. Descritas por Strobel por su apariencia artroscópica de rampa, se ha presentado su importancia dado el subdiagnóstico y el efecto biomecánico de una lesión posteromedial del menisco sobre el LCA y que su reparación restaura la traslación nativa de la tibia en conjunto con la reconstrucción del pivote central. Se ha demostrado que la mejor forma para diagnosticar lesiones ramp, es por visiones artroscópicas accesorias, una a través del surco intercondíleo y la otra por un portal posteromedial, logrando diagnosticar y manejar aquellas lesiones que sean inestables, a través de suturas dentro tanto por el portal anterior como por el posterior. Los resultados quirúrgicos son buenos, con mayor riesgo de falla en casos que la lesión se extiende al cuerpo meniscal. Es una lesión que debe buscarse bajo lupa, ya que pasarla por alto puede llevar a progresión de la lesión y a un mayor riesgo de rerotura del ligamento cruzado reconstruido.

Meniscal tears are the most frequently associated lesions in Anterior Cruciate Ligament (ACL) rupture, 9.3 to 16.9% on them in the posteromedial segment compromising the meniscotibial ligament. Described by Strobel for its arthroscopic ramp appearance, has gained importance given the underdiagnosis and biomechanical effect of a posteromedial meniscal lesion on the ACL, and that its repair restores the native anterior tibial translation when the central pivot is also reconstructed. It has been shown that the best way to diagnose ramp lesions is by accessory portals, one through the intercondylar notch and the other through a posteromedial portal, useful to diagnose and repair those lesions that are unstable, through all-inside sutures within both Anterior and posterior portals. Surgical results are good, with increased risk of failure in cases where the lesion extends to the meniscal body. It is a lesion that must be looked for in a direct way, since misdiagnosing it can lead to ramp lesion progression and increased risk of re rupture of the reconstructed ACL.

Suturas meniscales: nuestra experiencia / Meniscal sutures. Our experience

La sutura meniscal se ha convertido en el tratamiento de elección para situaciones específicas de lesión meniscal. El objetivo de este trabajo es evaluar a corto y mediato plazo la evolución de un grupo de pacientes a los que se realizó sutura meniscal. Material y métodos: En el periodo comprendido entre marzo de 2010 y marzo de 2013, fueron practicadas en nuestro servicio 702 artroscopías simples y 777 reconstrucciones de LCA, todas a cargo del mismo equipo quirúrgico. Se seleccionaron de forma retrospectiva los casos en los que se había realizado la sutura meniscal -46 casos-. Se realizó la técnica "afuera-adentro" para las lesiones del cuerpo y cuerno anterior, y la técnica "todo adentro" para las lesiones del cuerno posterior. De los 46 casos analizados de sutura meniscal, en 33 de ellos se realizó ligamentoplastía de LCA asociada y en 13 casos se realizó la sutura meniscal aislada. Dicha población de pacientes presentaron al momento del análisis un seguimiento de al menos 3 años desde la reparación meniscal. Se evaluó a los pacientes con RMN en un periodo promedio de 6 a 24 meses de postoperatorio. Resultados: De las 46 suturas meniscales evaluadas, 35 fueron realizadas en el menisco medial (76,08% de los casos) mientras que 11 de ellas correspondieron al menisco lateral (23,91% de los casos). A su vez 33 de las suturas realizadas estuvieron asociadas a ligamentoplastia de LCA. En 12 se constató una re ruptura meniscal representando el 26.08% de falla. La tasa de éxito de sutura de menisco medial con técnica "afuera-adentro" del menisco medial asociada a ligamentoplastía de LCA fue cercana al 82%. Conclusión: Sabiendo los efectos adversos a futuro de la menisectomía y teniendo en cuenta la tasa de éxito lograda con la reparación meniscal, la técnica de sutura meniscal se ha convertido en el tratamiento de elección para lesiones meniscales específicas, con el objetivo de restituir la homeostasis articular

The meniscal suture has become the treatment of choice for specific situations of meniscal injury. The objective of this work is to evaluate the evolution of a group of patients who underwent meniscal suture in the short and medium term. Material and methods: In the period between March 2010 and March 2013, 702 simple arthroscopies and 777 ACL reconstructions were performed in our department, all by the same surgical team. The cases in which the meniscal suture had been performed (46 cases) were selected retrospectively. The technique "outside-in" was performed for the injuries of the body and anterior horn, and the technique "all in" for the lesions of the posterior meniscal horn. Of the 46 cases analyzed meniscal suture, in 33 of them an ACL ligamentoplasty was performed and in 13 cases an isolated meniscal suture was performed. Said population of patients presented a follow-up of at least 3 years from the meniscal repair at the time of the analysis. The patients with MRI of control were evaluated in an average period of 6 to 24 months postoperatively. Results: Of the 46 meniscal sutures evaluated, 35 were performed in the medial meniscus (76.08% of cases) while 11 of them corresponded to the lateral meniscus (23.91% of cases). In turn 33 of the sutures performed were associated with ACL ligamentoplasty. 12 were cases in which a meniscal re-rupture was found representing 26.08% failure. The success rate of medial meniscus suture with "Out-In" technique associated with LCA Ligamentoplasty was close to 82%. Conclusion: Knowing the future adverse effects of menisectomy and taking into account the success rate achieved with meniscal repair, the meniscal suture technique has become the treatment of choice for specific meniscal lesions, with the aim of restoring homeostasis articulate