Long-term outcome after meniscal repair.

PURPOSE: the purpose of this study was to analyse the clinical and radiological results of meniscal repairs and identify factors that correlate with the success of this procedure. METHODS: a retrospective review of 119 meniscal repairs was completed. The average follow-up was 70 months. Successful meniscal repairs were observed critically in terms of radiographic changes and clinical outcomes and compared with failed meniscal repairs. RESULTS: the overall success rate of meniscal repairs was 74%. Meniscal repairs that were performed within 6 weeks of injury had better results (83%) than late repairs (52%). The best results were obtained with the inside-out technique using #0 PDS suture (80%) compared to all-inside Biofix arrows (70%) and combined repairs (63%). Patients with associated ACL injury had a better chance of a successful outcome, but this was only significant when the ACL was reconstructed at the time of repair (P < 0.05). Those patients who had failed meniscal repair had increased radiographic osteoarthritic changes (81%) on long-term follow-up compared to patients with successful repair (14%). CONCLUSION: this retrospective study shows the clinical and radiological importance of meniscal repair. Successful results in this study were associated with younger age and earlier repair using inside-out technique. Furthermore, increased success was seen in meniscal repairs performed in association with ACL reconstruction.

Plate fixation of middle-third fractures of the clavicle in the semi-professional athlete.

From 1995 to 2003, 39 semi-professional athletes (34 men and 5 women) aged 17-34 years (mountain bike racers, soccer players, swimmers and cyclists) with a displaced fracture of the middle-third of the clavicle were treated operatively using rigid plate fixation within one week after the initial trauma. In 90% of the athletes, radiographic union was achieved after 12 weeks. At 6 weeks post-operatively the mean Constant score was 88 points, the mean visual analogue pain score was 3 out of 10 and the average time for return to sports was 45 days. Seventy-five percent of the patients were very satisfied with the end-result and 95% would chose to have the same operation again. In 5% of the cases the end-result was unsatisfactory. The most frequent postoperative complication was wound infection (18% of the cases). Nevertheless, this did not affect the outcome. Other postoperative complications in our athletic population included refracture (5%), transient neurological complications (7%) and non-union (5%), which were equally low in the literature. These data suggest that rigid plate fixation of middle-third clavicle fractures gives good results in the semi-professional athlete and may result in early return to sports activity, at the expense of a significant risk for complications, which would not be considered acceptable in patients with lower functional demands.