Does concomitant meniscus repair and meniscectomy show different efficacy in anterior cruciate ligament reconstruction? A systematic review and meta-analysis.

Aims: Currently, it is advised to perform meniscal repair instead of meniscectomy in certain cases of primary anterior cruciate ligament reconstruction (ACLR). However, the level of evidence is low. Therefore, this study aimed to compare the effectiveness of meniscectomy and meniscus repair in addition to ACLR. Methods: The systematic search was conducted in three online databases (EMBASE, MEDLINE, and Cochrane) from inception until October 2021 for the literature on primary ACLR and concomitant meniscal surgery. Eligible studies compared the following outcomes between meniscal repair and meniscectomy groups: the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and KT-arthrometer examinations. Lastly, we calculated pooled mean differences (MDs) with 95 % confidence intervals (CIs) from the change between pre- and post-intervention values. Results: Of 10,565 studies, 22 met the inclusion criteria, with a follow-up between 6 and 43 months. We found no difference when comparing the KOOS subscale changes-only in the KOOS pain subscale (MD = -1.6; CI: -2.48, -0.72). However, these results were not clinically significant. We analyzed the lateral and media meniscal injuries separately and concluded the same results regarding KOOS changes. We found no significant differences in the Lysholm score change (MD = -2.61; CI: -5.51, 0.29), changes in IKDC score (MD = 1.08; CI: -4.05, 6.21) or the change for the KT-arthrometer side-to-side difference (MD = -0.50; CI: -1.06, 0.06). Conclusion: Based on our result, we did not find a clinically significant difference between meniscus repair and meniscectomy during primary ACLR regarding patient-reported outcomes in a short-term follow-up. Translational potential: Our research supports the prompt integration of findings into clinical practice for treating meniscus injuries during ACL reconstruction. We recommend considering both meniscus repair and meniscectomy, as the available data indicate their effectiveness. Further studies are necessary to assess the long-term impacts, particularly on osteoarthritis, and to identify patient subgroups that may benefit most from each technique.

Knee Injury and Osteoarthritis Outcome Score Interpretation Thresholds at 3 and 12 Months After Arthroscopic Meniscal Surgery. What Changes, and What Stays the Same?

OBJECTIVE: To evaluate the change in minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) thresholds for the Knee injury and Osteoarthritis Outcome Score (KOOS) from 3 to 12 months following arthroscopic meniscus surgery. DESIGN: Retrospective cohort study. METHODS: We included patients from the Knee Arthroscopy Cohort Southern Denmark who had meniscus surgery between 2013 and 2015. We calculated the interpretation threshold values for MIC, PASS, and TF using an anchor-based adjusted predictive modeling method. Thresholds at 3 and 12 months postoperatively were compared to evaluate changes over time. RESULTS: The proportions of people who reported a clinically relevant improvement, or their symptoms being acceptable, increased by 10% to 15% points from 3 to 12 months after surgery. MIC thresholds for the 5 KOOS subscales remained stable from 3 to 12 months with statistically nonsignificant differences (95% confidence intervals) ranging from -0.3 (-3.0, 2.6) to -2.4 (-6.1, 1.3). All PASS thresholds except for quality of life (QOL) decreased by -6.5 (-11.8, -1.5) to -3.7 (-7.1, -0.4) points, indicating that higher symptom levels were accepted at 12 months. In contrast, the proportion reporting their treatment to have failed remained stable over time (19% and 17%). For QOL, a 7.4 (2.0, 13.2) higher TF threshold at 12 months suggested that improved QOL was required to not consider that the treatment had failed. CONCLUSION: More patients reported being improved at 1 year compared to at 3 months following meniscus surgery. The KOOS MIC thresholds were stable over time, whereas time-specific PASS values should be applied after meniscus surgery. J Orthop Sports Phys Ther 2023;53(11):685-702. Epub 3 October 2023. doi:10.2519/jospt.2023.11993.

Arthroscopic Treatment of a "Bucket-Handle Like Tear" Lesion of the Medial Meniscus.

Menisci are involved in providing shock absorption, knee stability, and load transfer. Age, tear pattern, location, size and extent, repair time and technique, and patient habits are among various factors that affect meniscal healing. Meniscus repair has become the procedure of choice for the treatment of meniscal tears. However, treatment of meniscal tears in patients over 40 years of age is still debatable. Rare patterns of lesions have been described in the literature. We report a zone 2, partial thickness, "bucket-handle like tear" medial meniscal lesion with two attached ends in a 48-year-old male patient with persistent symptoms after six months of conservative treatment. Arthroscopic excision and debridement were performed. At a six-month follow-up, the patient regained 90% of his functional capacity.

Bacterial contamination of irrigation fluid and suture material during ACL reconstruction and meniscus surgery : Low infection rate despite increasing contamination over surgery time.

PURPOSE: During knee arthroscopy, irrigation fluid from the surgical site accumulates in the sterile reservoir. Whether these fluid collections and also suture material used during the arthroscopic surgical processes show bacterial contamination over time during surgery remains unclear. The purpose of this study was to determine this contamination rate and to analyze its possible influence on postoperative infection. MATERIALS AND METHODS: In this study, 155 patients were included. Fifty-eight underwent reconstruction of the anterior cruciate ligament (ACL), 63 meniscal surgery and 34 patients combined ACL reconstruction and meniscus repair. We collected pooled samples of irrigation fluid from the reservoir on the sterile drape every 15 min during the surgery. In addition, we evaluated suture material of ACL graft and meniscus repair for bacterial contamination. Samples were sent for microbiological analysis, incubation time was 14 days. All patients were seen in the outpatient department 6, 12 weeks and 12 months postoperatively and examined for clinical signs of infection. RESULTS: A strong statistical correlation (R2 = 0.81, p = 0.015) was found between an advanced duration of surgery and the number of positive microbiological findings in the accumulated fluid. Suture and fixation material showed a contamination rate of 28.4% (29 cases). Despite the high contamination rate, only one infection was found in the follow-up examinations, caused by Staphylococcus lugdunensis. CONCLUSION: Since bacterial contamination of accumulated fluid increases over time the contact with the fluid reservoirs should be avoided. LEVEL OF EVIDENCE: IV.

High quality rehabilitation to optimize return to sport following lateral meniscus surgery in football players.

There is a paucity of studies in the literature pertaining about how to guide rehabilitation and return to sport (RTS) progression for football players that have sustained a lateral meniscus injury and subsequent surgery. These patients are clinically challenging. If they return to sport too soon, before the rehabilitation process is completed and RTS criteria have been met, functional outcomes could be non-optimal and/or associated with higher reinjury risk. The aims of this paper are (I) to provide a brief overview of the current trends in acute lateral meniscus tears surgery in football players and (II) to suggest a framework for clinicians on how to progress the player following lateral meniscus surgery. Post-operative rehabilitation approaches are different for meniscus repair and for the other surgical techniques. The main goal of all involved practitioners should be to balance the "short term success" with the "long term protection" of the athlete's health. Specific key goals and interventions in early-, mid-, and late-stage rehabilitation are provided. The most important principle is to manage the progressive increase in loading through multiple measurements including frequent medical control consultations and functional tests detailing movement quantity and quality. RTS monitoring needs to be comprehensive and interdisciplinary, incorporating state of the art tests, to achieve recovery of sport-specific fitness, optimal movement quality and on-field rehabilitation progression.

Clinical and Radiological Outcomes After Isolated Anterior Horn Repair of Medial and Lateral Meniscus at 24 Months' Follow-up, With the Outside-In Technique.

Background The effects of repair of isolated anterior horn meniscus lesions have not been thoroughly described in the literature. We aimed to evaluate outcomes with subjective clinical scores and imaging modalities after repair of isolated anterior horn tears, at 24 months' follow-up. Methods Records of all patients that opted for surgical repair of isolated, anterior horn tears of the medial and lateral meniscus were retrospectively reviewed, between 2016 and 2018. All patients were treated with arthroscopic outside-in technique by the same surgeon. Preoperative and postoperative clinical files were accessed to recover records of preoperative symptomatology, patient-reported scores [International Knee Documentation Committee (IKDC) rating, Lysholm score and Tegner activity level], preoperative and postoperative MRI data and time from injury to surgery. Results Mean age of eight patients was 25.25 years (range 18-37 years). Diagnostic preoperative MRI revealed isolated anterior horn tear of the lateral meniscus and medial meniscus in five patients and an isolated anterior horn tear of the medial meniscus in three patients. Mean time from injury to surgical repair was 23.75 days (range 7-43). We considered seven out of eight repairs to be successfully healed. At 24 months' follow-up: Mean Lysholm score was 92.25 (range 89-95), Tegner activity scale score was 6.5 (range 5-8) and IKDC score was 91.78 (range 87.8-94.4). All scores significantly improved compared to preoperative values (p<0.001). Conclusions Outside-in is a reliable technique to repair meniscal anterior horn tears, both medially and laterally, with high healing rates and patient satisfaction in young, active patients.

Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002-2014.

BACKGROUND:: Few population-based descriptive studies on the incidence of anterior cruciate ligament (ACL) reconstruction and concomitant pathology exist. HYPOTHESIS:: Incidence of ACL reconstruction has increased from 2002 to 2014. STUDY DESIGN:: Descriptive clinical epidemiology study. LEVEL OF EVIDENCE:: Level 3. METHODS:: The Truven Health Analytics MarketScan Commercial Claims and Encounters database, which contains insurance enrollment and health care utilization data for approximately 158 million privately insured individuals younger than 65 years, was used to obtain records of ACL reconstructions performed between 2002 and 2014 and any concomitant pathology using Current Procedures Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9) codes. The denominator population was defined as the total number of person-years (PYs) for all individuals in the database. Annual rates were computed overall and stratified by age, sex, and concomitant procedure. RESULTS:: There were 283,810 ACL reconstructions and 385,384,623 PYs from 2002 to 2014. The overall rate of ACL reconstruction increased 22%, from 61.4 per 100,000 PYs in 2002 to 74.6 per 100,000 PYs in 2014. Rates of isolated ACL reconstruction were relatively stable over the study period. However, among children and adolescents, rates of both isolated ACL reconstruction and ACL reconstruction with concomitant meniscal surgery increased substantially. Adolescents aged 13 to 17 years had the highest absolute rates of ACL reconstruction, and their rates increased dramatically over the 13-year study period (isolated, +37%; ACL + meniscal repair, +107%; ACL + meniscectomy, +63%). Rates of isolated ACL reconstruction were similar for males and females (26.1 vs 25.6 per 100,000 PYs, respectively, in 2014), but males had higher rates of ACL reconstruction with concomitant meniscal surgery than females. CONCLUSION:: Incidence rates of isolated ACL reconstruction and rates of concomitant meniscal surgery have increased, particularly among children and adolescents. CLINICAL RELEVANCE:: A renewed focus on adoption of injury prevention programs is needed to mitigate these trends. In addition, more research is needed on long-term patient outcomes and postoperative health care utilization after ACL reconstruction, with a focus on understanding the sex-based disparity in concomitant meniscal surgery.

"Horizontal butterfly" technique in repair of radial meniscus tears: A biomechanical study.

INTRODUCTION: Radial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complete radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique. AIM: We developed a new suture technique named Horizontal Butterfly (HB). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop (HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (HB vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests. MATERIAL-METHOD: We used 22 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:11) menisci were repaired with standard horizontal loop technique, and in the second group (n:11) horizontal butterfly technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cycle X 5-30 N). RESULTS: Both groups have similar failure load (71,4 ± 17,52 N vs. 77,9 ± 28,49 N; p:0,559) and stiffness (24,46 ± 19,19 N vs. 24,48 ± 15,87 N; p:0,818). HB group has less peak displacement (6,26 ± 1,24 mm vs. 8,4 ± 1,92 mm; p:0,010). CONCLUSION: This novel repair technique decreases the amount of displacement according to standard technique while as strong as standard technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use.