Clinical outcomes of meniscus repair and partial meniscectomy: Does tear configuration matter?

PURPOSE: We report our experience with the effect of location and configuration of meniscal tears on clinical outcomes. METHODS: A retrospective review of patients who underwent partial meniscectomy or meniscal repair between 2008 and 2016 was conducted. One hundred fourteen knees in 106 patients were included, comprising 43 partial meniscectomies and 71 meniscal repairs. Patients were graded pre- and postoperatively with the International Knee Documentation Committee (IKDC) score and Tegner Activity Level Scale. Meniscal tears were classified according to location (anterior horn, body, posterior horn, and others) and type (radial, horizontal, longitudinal, and complex) and subgroups were analyzed for their effect on outcomes. RESULTS: All tears, whether treated with partial meniscectomy or repair, showed significant improvement in postoperative scores (p < 0.05); 39.47% of tears involved the posterior horn alone, 10.53% involved the body alone, 3.51% involved the anterior horn alone, and 46.49% were complex tears that spanned more than one area. Complex tears treated with repair had significantly better scores (IKDC, p = 0.002; Tegner, p = 0.008) than complex tears treated with meniscectomy. Longitudinal tears showed results suggesting better short-term outcomes with meniscectomy than with repair (IKDC, p = 0.036; Tegner p = 0.018), a potential statistical anomaly. Horizontal and radial tears showed no significant difference in outcomes, regardless of treatment. Tears in different locations (anterior horn, body, posterior horn, and others) showed no significant difference in outcomes, regardless of treatment. CONCLUSION: Meniscal surgery yields significant improvement in postoperative scores. Complex tears showed significantly better postoperative scores when treated with repair.

Gap formation after single lateral row versus dual-row suture bridge cuff repair: An ovine biomechanical model.

BACKGROUND: The aim of this study is to compare two types of suture bridging constructs; a laterally based bridging single row (SR) construct and a classic dual row (DR) suture bridge construct. The hypothesis is that the DR construct will demonstrate superior biomechanical properties. METHODS: Six matched pairs of sheep infraspinatus tendon tears repaired with these two different types of suture bridging techniques were tested for gap formation, ultimate failure load and mode of failure. The specimens were pre-cycled for 10 cycles before they were subjected to a constant pre-load of 10N. The specimens were then subjected to cyclic loading at a speed of 8.33 mm/s. The test was stopped after every 500 cycles for a total of 3000 cycles. RESULTS: Mean gap formation after 3000 cycles was lower in the DR group (0.81 ± 0.2 mm versus 2.44 ± 0.27 mm; p = 0.002). Mean change in gap (with every 500 cycles) was also lesser for the DR group after 1500 cycles. DR repairs failed at a higher load (523.4 ± 80.4 N) compared to the SR repairs (452.3 ± 66.3 N) but this did not reach significance. All repairs failed with sutures pulling through the tendon during load to failure testing. CONCLUSIONS: Gap formation is significantly lower with a dual row suture bridge construct than a laterally based bridging single row construct. LEVEL OF EVIDENCE: Biomechanical study.

A comparative study of anterior cruciate ligament reconstruction with double, single, or selective bundle techniques.

PURPOSE: Reconstruction of the anterior cruciate ligament (ACL) is the most frequently performed reconstructive surgery in the knee. Biomechanical studies have shown that double bundle (DB) reconstruction is better than single bundle (SB) reconstruction with regard to rotational stability. It is postulated that resection of ACL fibres that remain in continuity may be counterproductive for the knee as these fibres have the capacity to produce collagen. In this study, we aimed to evaluate the efficacy among selective bundle, DB and SB ACL reconstructions over a 2-year post-operative follow-up period. METHODS: A retrospective comparative study was conducted for comparison between selective bundle, DB and SB reconstructions. Between 2012 and 2014, 291 ACL reconstructions were performed. Of these, 68 patients had selective ACL reconstructions (group SLB), 147 had DB ACL reconstructions (group DB) and 76 had SB ACL reconstructions (group SB). Institutional Review Board approval was obtained, and all patients provided informed consent. Clinical results were assessed with the International Knee Documentation Committee (IKDC), Lysholm and Tegner scores. Stability was measured using Lachman, pivot shift and anterior drawer stress tests using the KT1000 at 30° of knee flexion. RESULTS: There was no significant difference in ligament grade, function grade, IKDC grade, as well as Tegner and Lysholm means among all three groups after a 2-year follow-up period. CONCLUSION: Selective bundle reconstruction provides comparable results to DB and SB reconstruction techniques. It is a viable alternative for patients with partial tears.