Clinical and Functional Effects of Surgical Technique After Repair of Bucket Handle Meniscus Tears

Abstract

All-inside meniscus repair has recently been explored as an alternative to inside-out meniscus repair of bucket handle meniscus tears. Current evidence suggests there are comparable outcomes between inside-out and all-inside repairs for bucket handle meniscus tears. However, there are limited data that directly compares all-inside with inside-out repairs, particularly with relatively long term follow up of functional outcomes. The aim of the current study was to determine if there are clinical and functional differences between all-inside and inside-out repairs of bucket-handle meniscus tears. All patients who underwent repair for bucket handle meniscus tears at a single institution from 2007 to 2017 were eligible for inclusion in the study (n = 77). Failure rates for this cohort were evaluated through chart review and confirmed via phone. Of this cohort, 9 patients who underwent all-inside meniscus repair were able to be contacted for functional assessment. These patients were then double matched by concomitant procedure (ACLR, chondroplasty, and/or microfracture) with patients who underwent inside-out repairs (n = 18). The patients were called and assessed for repeat surgery, as well as administered the KOOS, IKDC, and Marx activity scale to assess patients functionally. The mean age for the cohort was 27.42 (SD = 9.49) years with a mean follow-up of 6.19 (SD = 2.96) years. Of the patients who underwent All-inside (AI) repair (n=19), 15.78% had repeat surgery (n = 3), and 20.69% (n = 12) of patients who underwent inside-out (IO) repair (n = 58) underwent repeat surgery. Of the matched patients (n = 27), those who underwent all-inside meniscal repair had lower mean KOOS scores than patients with inside-out repairs in each sub-category (means and standard deviations are listed all-inside; inside-out): KOOS – Pain: mean = 78.08 (SD = 22.37); 87.74 (9.67), KOOS – Sports: 64.44 (25.67); 75.29 (22.8), KOOS – Symptoms: 78.97 (11.90); 81.09 (12.54), KOOS – QOL: 43.06 (33.7), 65.44 (22.32), KOOS – ADL: 81.37 (24.2); 94.55 (8.13). All-inside patients had a lower mean IKDC score (AI: mean = 66.4, SD = 27.64; IO: mean = 77.96, SD = 16.77) as well as lower Marx activity scores (AI: mean = 5, SD = 5.83; IO: mean = 7.05, SD = 5.03). The current study suggests that patients who undergo all-inside meniscus repair have worse functional outcomes but a slightly lower failure rate than those who undergo inside-out repair.