Resultado de suturas meniscales por técnica artroscópica "todo adentro", revisión a mediano plazo / Results of all-inside arthroscopic meniscal sutures, mid-term review

Resumen: Introducción: los dispositivos de suturas meniscal todo adentro han evolucionado y simplificado la reparación meniscal. En este estudio formulamos las siguientes preguntas de investigación: ¿cuál es la tasa de supervivencia y falla?, ¿cuáles son los factores de riesgo asociado a falla? y ¿cuáles son los resultados funcionales posterior a la cirugía de reparación meniscal? Material y métodos: estudio ambispectivo desde el 2001 al 2021 de pacientes con lesión meniscal reparable con dispositivos meniscales de sutura todo adentro. La razón de supervivencia y falla se obtuvo con el test de Kaplan-Meier, los factores de riesgo asociado con falla de la sutura meniscal se valoraron con el test de regresión logística y los resultados funcionales pre y postquirúrgicos fueron estimados con la prueba t-Student. Resultados: en 20 años de seguimiento de 316 menisco reparados con suturas meniscal todo adentro se obtuvo que la razón de supervivencia de 95.9%. La ausencia de lesión del cuerno anterior del menisco se mostró como un factor protector [OR = 0.12], junto a la no práctica de deportes de impacto [OR = 0.2]. Se mostraron resultados del IKDC y Tegner-Lysholm posterior a la cirugía de muy buenos a excelentes (p < 0.0001). Conclusión: los dispositivos de sutura de meniscal todo adentro son y seguirán siendo armas de primera línea en la reparación de las roturas meniscales. En 20 años de seguimiento se evidenció una menor tasa de falla, asociados con excelentes resultados funcionales.

Abstract: Introduction: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery? Material and methods: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student. Results: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001). Conclusion: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.

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 Prospective Study of Comparing Functional Outcome in Case of Meniscal Injury Treated with Arthroscopic Meniscectomy Vs Meniscal Repair

Background: A meniscal tear is the most common injury to theknee, occuring from both athletic events and activities of dailyliving. Generally, the results of repair have been good, withhigh long-term success rates. This study aims to compare thefunctional result of arthroscopic meniscal repair andarthroscopic meniscectomy.Materials & Methods: This study was carried out in theDepartment of Orthopaedics, Mahatma Gandhi MedicalCollege and Hospital, Jaipur for comparing the functionaloutcome of arthroscopic meniscectomy and meniscal repair. 47of Meniscectomy and 35 of Meniscal Repair was done in ourstudy. Statistical analysis was done using SPSS (Statisticalpackage for Social science) 16.0 software. Categoricalvariables are expressed as frequencies and percentages.Results: Our study showed that the mean age for MeniscalRepair was 32.86 vs 29.89 for Meniscectomy. There was nosignificant gender specific difference while comparing bothgroups with a p-value of 1.0. The mean follow-up for both thegroups were same of 1.2 years with a non-significant p-value of0.78. The duration of surgery was 84.5 minute in meniscalrepair as compared to 45.6 minute. There is significantdifference in surgical time required with p-value of 0.0001. Nosignificant differences for Lysholm Score and Tegner activitylevel reduction, hkss, womac and vas scores in such a shortterm follow up.Conclusion: We concluded that more randomized studies withlarger sample sizes and longer follow-up are needed to furthershow the benefits of meniscal repair in terms of patientsperceptions of the outcome and prevention of posttraumaticosteoarthritis.

Management of Meniscal Injury: Repair, Meniscectomy, and Transplantation / 대한정형외과학회잡지

Although total meniscectomy had been performed as a treatment of meniscal tear, many published articles reported progression of the degeneration process and development of the osteoarthritis after meniscectomy. Meniscal repair has been performed increasingly, with the increased knowledge of the biomechanical properties of the meniscus. However, resection of the meniscus is still needed for irreparable tear and should be performed as minimally as possible to maintain the important functions of the meniscus. When substantial meniscal tissue is resected, meniscal allograft transplantation is considered to be a therapeutic option for young active patients to prevent the progress of degenerative change of the cartilage. In this review, indications and outcomes after meniscectomy, meniscal repair, and meniscal transplantation for the treatment of the meniscal injury are discussed.

Evolução funcional da reparação do menisco por implante absorvível / Functional evolution of meniscal repair using absorbable implants

OBJETIVO: Avaliar a evolução funcional dos joelhos submetidos à reparação da ruptura longitudinal do menisco com o implante absorvível flecha (arrow). MÉTODOS: Entre junho de 1997 e fevereiro de 2001, 23 pacientes com idade média de 26 anos foram avaliados. O seguimento médio foi de quatro meses (45-96). Realizaram-se 19 reparações mediais e quatro laterais. Os pacientes foram avaliados no pré e no pós-operatório quanto à função, de acordo com a escala de Lysholm e, no pós-operatório, pelo IKDC. RESULTADOS: Para melhor compreensão, os 23 indivíduos tratados foram divididos em três grupos. Vinte e um apresentaram lesão do ligamento cruzado anterior e 11 foram submetidos à reconstrução ligamentar (grupo I), com resultados considerados satisfatórios. Dez dos 21 pacientes com lesão do LCA não foram submetidos à reconstrução ligamentar (grupo II), dos quais cinco evoluíram satisfatoriamente, sem necessidade de reconstrução ligamentar, cinco, com queixa de instabilidade e foram submetidos à reconstrução ligamentar. Quatro desses pacientes apresentaram o menisco íntegro e uma ruptura do menisco medial. Dois apresentaram LCA intacto (grupo III), um evoluiu satisfatoriamente e outro apresentou ruptura do menisco lateral. De acordo com a escala de Lysholm, a média pré-operatória foi de 57,53 e a média pós-operatória, de 86,95, representando melhora estatisticamente significativa (Wilcoxon p < 0,01). Foi utilizada a ANOVA não paramétrica para dados ordinais com medidas repetidas para avaliar as medidas no pré e pós-operatório, considerando os grupos I e II. Avaliou-se a estabilização do joelho e não se detectou diferença estatisticamente significativa entre os grupos I e II (p = 0,648). Mesmo supondo que houvesse diferença entre os dois grupos, ambos tiveram o mesmo comportamento. Na avaliação pós-operatória pelo IKDC, quatro pacientes foram classificados como A; 13, como B; e 6, como C. Dos seis pacientes com resultados C, apenas dois apresentaram...

OBJECTIVE: To evaluate the functional evolution of knees after repair of longitudinal meniscal rupture with absorbable arrow implant. METHODS: Between June 1997 and February 2001, 23 patients with a mean age of 26.3 years were evaluated. The mean follow-up time was 72.87 months (45-96). We performed 19 medial and 4 lateral meniscal repairs. The patients were pre- and postoperatively evaluated regarding joint function according to the Lysholm scale, and, postoperatively, according to IKDC. RESULTS: For better understanding, the 23 treated cases were divided into three groups. Twenty one had ACL injuries, eleven of whom were submitted to ligament reconstruction (Group I). All these 11 cases were regarded as satisfactory. The remaining 10 cases of the 21 with ACL lesion were not submitted to ligament reconstruction (Group II). Of these, 5 evolved satisfactorily, not requiring ligament reconstruction. The remaining five evolved with complaint of ligament instability, being all submitted to reconstruction. Four of these had an integral meniscus and one presented a failure of the medial meniscus. The remaining two cases who did not present ACL injury (Group III), one patient evolved satisfactorily and one developed a failure of the lateral meniscus. According to the Lysholm scale, preoperative mean score was 57.53 and the postoperative mean score was 86.95, evidencing a statistically significant improvement (Wilcoxon p < 0.01). The non-parametric ANOVA was employed for ordinal data with repeated measurements to assess pre- and postoperative measurements, considering Groups I and II. We assessed knee stabilization and found no statistically significant difference between Groups I and II (p = 0.648). Even if there were differences between the two groups, both had the same behavior. On postoperative assessment with IKDC, 4 patients were grade A, 13were grade B, and 6 were grade C. Two C results were caused by a meniscal rupture. CONCLUSION: Of...

Treatment Result of Preserving Peripheral Rim of Torn Lateral Discoid Meniscus

PURPOSE: To evaluate the clinical results of preserving the peripheral rim of meniscus in the injuries of lateral discoid meniscus. MATERIALS AND METHODS: We analyzed 38 patients, 40 knees. Mean follow-up period was 17.4 months and mean age was 34.9 years old(10~62). We classified the lesion according to Watanabe and Ahn(classifying the type of tear according to arthroscopic finding). Clinical results were analyzed by Ikeuchi's clinical grading system and the Lysholm knee scoring scale. Radiographic evaluations were analyzed with plain radiographs. The common clinical results were pain in 40 cases(100%), locking in 16. Radiological degenerative arthritis changes were 31 persons(33 cases, 82.5 %) by simple initial X-ray. The common radiological changes were hypoplasia of lateral femoral condyle in 29 cases (72.5%), widening of lateral joint space in 26. RESULTS: Partial meniscectomy was undergone in 14 patients(15 cases) and partial meniscectomy with meniscal repair was undergone in 24 patients(25 cases). The patients were categorized using Watanabe's classification: complete, 25 cases(62.5%) and incomplete, 15 cases(37.5%). There were longitudinal tears(type 2) in 15 cases(37.5%), complex tears(type 7) in 12 cases. The mean Lysholm score was improved from 56.7 points to 86 points postoperatively after the partial meniscectomy, and from 62.7 points to 88 points after the partial menisccectomy with meniscal repair, which were not statistically significant(p>0.05). According to Ikeuchi's grading system, 11 cases(73.3%) had either excellent or good ratings in the partial menisectomy and 21 cases(84%) in the partial menisectomy with meniscal repair, which were not statistically significant(p>0.05). CONCLUSION: We believe that preserving peripheral meniscus by using partial menisectomy and partial menisectomy with meniscus repair lead to good function and satisfactory results.

Arthroscopic Meniscal Repair using Fibrin Clot for Horizontal Tear in Young Adults: A Case Report

To evaluate outcomes of arthroscopic meniscal repair using fibrin clot for horizontal tears in young adults, we investigated clinical and morphological results after the meniscal repairs were performed. Between August 1995 and August 1997, we treated five patients with horizontal tears of the meniscus, of which the meniscal tears were not accompanied any concomitant intra-articular lesions or meniscal degeneration. We assessed outcomes using Lysholm score, magnetic resonance imaging(MRI) and second-look arthroscopy. In all 5 cases, MRI showed the following results 1 complete healing, 1 incomplete healing, and 3 with no healing. Two patients underwent second-look arthroscopy, one complained of persistent pain for two years after surgery, showing meniscal tears on the MRI and received partial meniscectomy, while the other showed complete healing using second-look arthroscopy after 3 months postoperative recuperation and MRI 68 months after surgery. According to Lysholm score, two cases were assessed with less than 70 points. For the horizontal meniscal tears in young adults, arthroscopic meniscal repair using fibrin clot produced satisfactory clinical results however, it exhibited morphologically poor results.

Results of Arthroscopic All-Inside Sutures in Medial Meniscus with Concomitant Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

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.

Prognostic Factors Related to Meniscal Healing in Arthroscopic Meniscal Repair / 대한정형외과학회잡지

PURPOSE: This study analyzed the significant prognostic factors in terms of age, rupture side (lateral or medial), existence of associated lesion, length and zone-that affect clinical healing after meniscal repair. MATERIALS AND METHODS: Data were obtained from 55 patients who had been observed at least for 18 months after meniscal repair. Healing was decided based on the patients'clinical symptoms, and analyses were made according to clinical data. RESULTS: The clinical healing rate of meniscal repairs was found to be 82% (45 patients), and was higher in ruptures accompanied by anterior cruciate ligament injury than meniscus rupture alone, when the length of the meniscal rupture was less than 2 cm. Age and rupture side (lateral or medial, peripheral or central) had no significant effect upon clinical healing. CONCLUSION: The length of meniscal rupture and meniscal rupture associated with ACL were found to be infinately correlated with good prognosis, but age, site, and zone of meniscal rupture probably do not affect prognosis.

Classification and Treatment of the Tear of Lateral Discoid Meniscus

PURPOSE: It is widely accepted that partial meniscectomy has done in case of the discoid meniscus. Authors classify the type of the discoid meniscus and report the results of different treatment according to type of tear. MATERIALS AND METHODS: We analyze the 68 patients, 70 knees. After classifying the type of tear according to the arthroscopic findings, we compare the findings of physical examination and X-ray each other, predict arthroscopic findings by MRI findings and report the results of different treatment according to type of tear. RESULTS: There are type 1(no tear) 8 knees(l 1.4%), type 2(longitudinal tear) 4 knees(5.7%), type 3(horizontal tear) 19 knees(27.1%), type 4(central hole) 9 knees(12.9%), type 5(peripheral tear) 10 knees(14.2%), type 6(transverse tear) 8 knees(11.4%) and type 7(complex tear) 12 knees(17.1%). We has performed partial meniscectomy after meniscal repair of tear site in some cases of type 5,6,7 and got the good results at the follow up period. There is no progressive arthritic changes. CONCLUSION: It is necessary to diagnose the exact type of tear and to treat according to it.

The Clinical Study of Meniscal Repair / 대한정형외과학회잡지

PURPOSE: To analyze and report the analyzed clinical results of meniscal repair. MATERIALS AND METHODS: Thirty-two cases were reviewed after arthroscopic meniscal repair. The meniscal repair was indicated by unstable tears in red-red or red-white zone with the tear size longer than 10mm. The location, pattern of the tear and associated injury were examined respectively, and the clinical results were evaluated with preoperative, postoperative Lysholm score and findings of physical examination. Physical examination was focused on tenderness, click, effusion and McMurray test. Also, a second look arthroscopy was performed in the case of bucket-handle tears and other types with recurring symptoms and positive physical findings. RESULTS: The number of medial meniscus tear was higher than lateral meniscus tear and the were no considerable differences in the number between the right and the left knees. The most common location of tear was the red-red zone tear in 30 cases, and the most common tear pattern was longitudinal tear in 22 cases. The number of bucket-handle tear was nine. The most common associated injury was ACL injury. Acording to clinical assessment, 29 out of 32 cases showed satisfactory results, and the results of 7 out of 9 bucket-handle tears were good. CONCLUSION: An analysis of the clinical results of meniscal repair has been carried out, showing that meniscal repair is regarded as a reliable treatment modality in meniscal tear with proper patient selection.

The Result of Arthroscopic Meniscal Repair

PURPOSE: To analyze the clinical results and functional evaluation of arthroscopic meniscal repair in meniscus tear. MATERIALS AND METHODS: Twenty nine patients who underwent arthroscopic meniscal repair were eval- uated from January 1995 to December 1998. Mean age was 32 years old(13-56) and mean follow up was 28 months. Lysholm score and Ikeuchi grading were used for functional analysis. Tegner activity score was used for physical activity evaluation. RESULTS: Lysholm score revealed 81.3 points in acute injury group(>8 week), 79.2 points in chronic injury group(<8 week). The functional results were similar between acute and chronic injury group. Twenty five patients(86%) was rated as excellent and good grade in subjective functional evaluation of Ikeuchi. Tegner activity scores at last follow up were slightly decreased from 6.3 to 6 in ACL reconstruc- tion and normal ACL group compared with the pretrauma state, but Lysholm score and Tegner activity score was more reduced in ACL partial injury and repair group. CONCLUSTION: The excellent and good grade was 86% in the subjective functional evaluation of Ikeuchi after arthroscopic meniscal repair and the stability of anterior cruciate ligament seemed to be important in the prognosis of meniscus.

Arthroscopic Meniscal Repair / 대한정형외과학회잡지

Peripheral longitudinal tears of the menisci in nine patients(eight men and one woman) were repaired by arthroscopic techniques from December 1985 to November 1986. Six lateral and three medial menisci were repaired. The results of the repairs were classified by Tapper and Hoover scale as excellent 2, good 4, fair 2 and poor 1. The aversge durstion of follow up was 17.6 months(range : twelve to twenty-four months). One patient had a rerupture and two patients had hemarthrosis. The repairs of peripheral meniscal tears hsve been shown to be an effective and successful procedure. Arthroscopic instruments and techniques have been improved to allow for the repair of some of these tears.