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

Abstract

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.