All-inside Repair Research Articles

Functional Outcomes Are Similar After Arthroscopic Capsular Repair of Triangular Fibrocartilage Complex Tears Between Outside-In Technique and All-Inside Technique Using Pre-Tied Suture Device

To compare outcomes of arthroscopic triangular fibrocartilage complex capsular repair at 2-year follow-up between outside-in and all-inside techniques. In total, 58 consecutive patients (wrists) with a Palmer 1B triangular fibrocartilage complex tear without symptomatic distal radioulnar joint instability underwent arthroscopic suture repair from 2011 to 2019 including 31 patients via the outside-in technique (group A) and 27 via the all-inside technique using a pre-tied needle device (group B). Two-year follow-up included visual analog scale (VAS) pain score, motion range, grip strength, Mayo Modified Wrist Score (MMWS), the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complication rate. Correlation between functional result and patient satisfaction was analyzed. Score changes in VAS, wrist flexion-tension, supination-pronation, grip strength, MMWS, and QuickDASH at 2-year follow-up were not significantly different between group A (3.4 ± 0.8, 18.4 ± 17.5, 12.9 ± 13.3, 30.7 ± 11.2, 26.6 ± 7.9 and 19.4 ± 9.9 and group B (3.4 ± 1.0, 18.5 ± 18.3, 15.6 ± 13.7, 30.8 ± 11.4, 28.1 ± 8.6, and 7.6 ± 7.2) with P values of .400, .489, .223, .486, .240, and .223 respectively. Surgical time averaged 105 minutes (78 to 136) in group A and 94 minutes (61-126) in group B with significant difference (P= .012). Patient satisfaction averaged 1.1 (0-3.5) in group A and 1.0 (range 0-3.0) in group B. Satisfaction score was more strongly correlated with QuickDASH (coefficients: 0.863 in group A and 0.918 in group B) than with MMWS (-0.693 in group A and -0.465), grip strength (-0.619 in group A and -0.417 in group B) and VAS score (0.607 in group A and 0.222 in group B). Both techniques achieved comparable outcomes with shorter surgical time in all-inside repair using pre-tied needle device. Patient satisfaction was strongly correlated with QuickDASH score. Level III, retrospective therapeutic comparative investigation.

Repairing Complete Radial Tears of the Lateral Meniscus: Arthroscopic All-Inside Double Vertical Cross-Suture Technique Is Effective and Safe With 2-Year Minimum Follow-Up

To assess the failure rate and clinical outcomes of the all-inside, double-vertical, cross-suture technique in repairing complete radial tears of the lateral meniscus. We retrospectively reviewed records of patients with this injury on whom the present technique was employed at our institution between 2011 and 2018, with at least 24 months of follow-up. Six months postoperatively, the meniscus healing and extrusion status were evaluated through magnetic resonance imaging. Preoperative and postoperative knee function, measured through IKDC, Lysholm knee, and Tegner activity scale scores, were compared. In total, 27 patients underwent the procedure. The preoperative mean (standard deviation) IKDC score, Lysholm knee score, and Tegner activity scale scores were 53.4 ± 5.3, 63.2 ± 9.3, and 4± .7, respectively. At the last follow-up (≥24 months postoperatively), these scores increased to 92.1 ± 2.6, 90.8 ± 4.2, and 6.1 ± 1.3, respectively (all P < .05). Complete healing of the meniscus was observed in 23 patients, and 4 patients had meniscus retear or nonhealing. The overall retear or nonhealing rate was 14.8%. Healing rates between those with isolated radial tears (87.5%) and those with combined anterior cruciate ligament rupture (84.2%; P= .826) were comparable. No difference was observed in the progression of coronal and sagittal meniscus extrusion (P= .133 and .797, respectively). In patients with complete radial tears of the lateral meniscus, the arthroscopic all-inside double vertical cross-suture repair technique resulted in an 85.2% healing rate, improvements in functional outcomes and activity levels, and no identifiable progression of meniscus extrusion. The all-inside double vertical cross-suture technique is effective and safe for the repair of radial tears of the meniscus. Level IV, retrospective case series.

Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk.

Outcomes after repair of bucket-handle meniscal tears tend to be satisfying in the short-term follow-up. However, the literature is scarce regarding long-term data following repair of bucket-handle meniscal tears. The aim of this study was to assess long-term follow-up outcomes, focusing on knee osteoarthritis (OA) development and failure rate, and determine risk factors associated with failure. This is a retrospective cohort study, including all patients with bucket-handle tears within 4mm of the menisco-synovial junction, who underwent meniscal repair, either isolated or combined with anterior cruciate ligament reconstruction (ACLR) between 2004 and 2015. A combination of all-inside, outside-in, and inside-out repair technique was used in all patients. Patients over 40years old, concomitant multi-ligamentous injuries, and severe cartilage lesions documented intraoperatively were excluded. During the follow-up, a meniscus was considered healed using Barrett's criteria, while knee OA evaluation was performed according to Kellgren-Lawrence (KL) classification using standing knee radiographs. Patients were assessed preoperatively as well as postoperatively in terms of knee function using International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). In total, the inclusion criteria were met by 66 patients. Median age at the time of operation was 21.9years (13-39). Median follow-up was 114 (62-176) months. Total failure rate was approximately 33% at median time of 19 (6-39) months. Osteoarthritis was statistically significantly more prevalent in patients with failed repairs (mean KL score: 2.09) in comparison to patients with successful repairs (mean KL score: 0.54) p = 0.001. In addition, successful repairs were associated with higher KOOS score as compared with failed repairs (mean ± SD, 89.6 ± 4.6 vs 77.8 ± 4.9 p < 0.001), higher IKDC score (mean ± SD, 88.2 ± 5.1 vs 79.2 ± 5.2 p < 0.001), and Lysholm score (mean ± SD, 90.3 ± 5.3 vs 78.4 ± 7.8 p < 0.001). Patients with medial meniscus repair had 4.8 higher relative likelihood of failure compared to lateral meniscus [p = 0 .014, OR = 4.8 (95% Cl 1.2, 18.6)]. Patients over 16years old had 5.7 higher relative likelihood of failure [p = 0 .016, OR = 5.7 (95% Cl 0.04, 0.85)]. Concurrent ACLR did not have a significant effect on the postoperative outcomes. A high rate of clinical failure was observed after meniscal repair of bucket-handle tears. However, successful treatment led to lower rates of knee OA development and better knee function, approximately 10 years postoperatively. Meniscal repair of bucket-handle tears is recommended to improve knee function and prevent knee OA in young patients. III.

Assessment of popliteal neurovascular safety during all-inside suturing of the posterior horn of the lateral meniscus using Upright MRIs of the knee joint

BackgroundTo examine the risk of injury to the popliteal neurovascular bundle (pNVB) during all-inside repair of the posterior horn of the lateral meniscus (PHLM) using Upright-MRIs. MethodsUpright-MRIs of 61 knees in extension (ext) and 90°-flexion (flex) were included. Distance D from the PHLM to the pNVB was compared between extended and 90°-flexed position, subgroups with/without joint-effusion and evaluated according to demographics. Portal safety was assessed simulating suturing of the PHLM via four arthroscopy portals. Distance d (shortest space from the simulated suturing-device trajectory lines to the pNVB) was compared among portals in increasing distances from the posterior cruciate ligament (PCL). ResultsD is longer in flex (17.3 ± 6.0 mm) than in ext (11.3 ± 4.2 mm, p < 0.0001). MRIs with joint-effusion displayed longer values of D than scans without joint-effusion (flex: 20.4 ± 7.1 mm vs. 16.1 ± 5.2 mm, p = 0.012). Shorter distances are associated with female gender, lower body weight and lower BMI. At 0 mm from the PCL, the 1 cm-lateral portal was the safest (p < 0.0001) whereas at 3 mm/6mm/9mm/12 mm the 1 cm-medial portal showed the longest d values (p < 0.0001 each). ConclusionAll-inside suturing of the PHLM is safer in 90°-flexion, in presence of intraarticular fluid and in male patients with increasing weight/BMI. Sutures of the PHLM at 0 mm from the PCL are safer from a 1 cm-lateral portal whereas for tears located ≥ 3 mm from the PCL a 1 cm-medial portal involves a lower neurovascular risk. Upright-MRI proves excellent for preoperative planning to minimize neurovascular risks.

Repair of popliteomeniscal fascicles tear using a posterior transseptal portal fixes hypermobile lateral meniscus

PurposeThis study investigates the effects of the all-inside repair of posterosuperior popliteomeniscal fascicle (PMF) on lateral meniscus stabilization using a posterior arthroscopic approach.MethodsBetween 2015 and 2018, 17 patients with hypermobile lateral meniscus (HLM) underwent posterior knee arthroscopy for PMF repair. The all-inside repair was performed through posteromedial transseptal and posterolateral portals using a suture hook technique. Patients were clinically assessed based on IKDC and Lysholm scores.ResultsBoth IKDC and Lysholm scores improved significantly after an average follow-up of 3.5 years (P < 0.001). No patients underwent reoperation, and no complications associated with posterior knee arthroscopy were reported.ConclusionThe all-inside suture hook technique using posterolateral and posteromedial transseptal portals fixes HLM with excellent IKDC and Lysholm scores.Level of evidenceLevel IV.

Arthroscopic classification and management for the popliteal hiatus of the lateral meniscus tears

Objective To bring forward an arthroscopic classification of the popliteal hiatus of the lateral meniscus (PHLM) tears and to assess the effects of arthroscopic all-inside repair with suture hook in management of such injuries. Methods This study involved 146 patients who underwent arthroscopic operation because of PHLM tears from April 2014 to October 2017, eliminating the patients who had discoid lateral meniscus. There were 81 males and 65 females, with 54 left knees and 92 right knees. The average ages were (34.7±3.7) years. Among the selected participants, there were 107 patients with anterior cruciate ligament (ACL) injuries, 39 patients with medial collateral ligament (MCL) injuries, and 48 patients with medial meniscus tears. The average preoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 57.7±9.2 and 54.1±8.9, respectively. The arthroscopic classification was based on the extent and degree of PHLM tears and using the arthroscopic all-inside repair with suture hook for such injuries. For the patients associated with ACL injuries, the ipsilateral autograft hamstring tendons use as the reconstruction graft for single bundle ACL reconstructions. The suture anchors were used for treatment of MCL Ⅲ injuries, and the arthroscopic all-inside repair for medial meniscus tears. Results A total of 146 PHLM tears in 146 patients were divided into type Ⅰ (tears not involved in popliteus tendon incisura; n=86, 58.9%), type Ⅱ (tears involved in popliteomeniscal fascicles; n=36, 24.7%), and type Ⅲ (tears involved in popliteus tendon incisura; n=24, 16.4%). For type Ⅰ, there were three subtypes, including type Ⅰa: longitudinal tear (n=53, 61.6%), type Ⅰb: horizontal tear (n=27, 31.4%), and type Ⅰc: radial tear (n=6, 7.0%). For type Ⅱ, there were also three subtypes, including type Ⅱa: anterosuperior popliteomeniscal fascicle tear (n=5, 13.9%), type Ⅱb: posterosuperior popliteomeniscal fascicle tear (n=20, 55.6%), and type Ⅱc: both tears (n=11, 30.6%). For type Ⅲ, there were two subtypes, including type Ⅲa: horizontal tear (n=9, 37.5%), type Ⅲb: radial tear (n=15, 62.5%). In the follow-up for an average of 15.3±2.6 months, all the patients had done well with significantly improved Lysholm (84.6±14.3) and IKDC (83.2±12.8) scores at the end of the last follow-up relative to preoperative scores (P > 0.01). Conclusion We propose that it is possible to classify lateral meniscus tears at the popliteal hiatus region for three types, which can summarize the injury characteristics of this area. The arthroscopic all-inside repair with suture hook for the PHLM tears can avoid stitching to popliteal tendon or narrowing popliteal hiatus and have satisfactory clinical results.

Influencing factors of return to sport after all-inside arthroscopic lateral collateral ligament repair for chronic ankle instability

Objective: To investigate the outcomes and factors influencing postoperative return-to-sport of patients with chronic ankle instability (CAI) underwent all-inside arthroscopic lateral collateral ligament repair. Methods: Patients with CAI treated at Huashan Hospital of Fudan University from January 2017 to August 2019 were retrospectively recruited. Preoperative and postoperative Tegner and Karlsson scores were evaluated and compared, and a multivariate Cox regression model was applied to explore factors influencing postoperative return to desired sports postoperatively. Results: A total of 81 patients with CAI treated by all-inside arthroscopic lateral collateral ligament repair were assessed, including 44 males and 37 females with a mean age of (32.7±9.9) years. Karlsson scores (M(Q1, Q3)) increased from 55.0 (40.0,65.0) preoperatively to 90.0 (85.0,95.0) postoperatively (P<0.01), while Tegner scores increased from 3.0 (1.0,4.0) preoperatively to 5.0 (4.0,6.0) postoperatively (P<0.01). Sixty patients returned to their desired sports with a median return-to-sport time of 9.0 months. Multivariate Cox regression analysis showed that higher age (HR=0.95, 95%CI: 0.92-0.99, P<0.01) and lower preinjury activity levels (HR=1.43, 95%CI: 1.10-1.85, P<0.01) were independent factors affecting postoperative return-to-sport. The one-year postoperative return-to-sport cutoff scores were 37 years old and a Tegner score of 4, respectively. Conclusions: The all-inside arthroscopic lateral collateral ligament repair procedure can achieve good short-term outcomes for patients with CAI, permitting a high incidence of postoperative return-to-sport. Higher age and lower pre-injury activity levels are independent factors hindering postoperative return-to-sport.

Deep flexion helps to avoid popliteal artery injury during all-inside lateral meniscal repair: A cadaveric study

BackgroundArthroscopic meniscus repair rarely leads to major complications such as popliteal artery injury. The distance between the suturing device and the popliteal artery, and the risk of popliteal artery injury at different knee flexion angles during all-inside lateral meniscal repair remain unclear. MethodsAll-inside devices were inserted into 10 human cadaveric knees at the posterior horn of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120° knee flexion; posterior segment of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120°; and anteromedial portal at 90°. Distance and positional relationship between the device and popliteal artery were measured radiographically. ResultsIn posterior horn repair through the anterolateral portal, the median distance increased from 5.7 mm at 60° to 9.1 mm at 90° (P = 0.63) and 18.0 mm at 120° (P = 0.02). The device pushed the wire at 60° in three cases, 90° in one case, and 120° in 0 cases. In posterior segment repair through the anterolateral portal, the median distance was 12.6 mm at 60°, 10.4 mm at 90°, and 18.3 mm at 120° (P = 0.08). The median distance at 90° was 18.1 mm through the anteromedial portal, the same as that at 120° through the anterolateral portal (P = 0.43), but greater than that at 90° through the anterolateral portal (P = 0.04). The wire was not pushed in any case. ConclusionAlthough all-inside repair of the posterior part of the lateral meniscus through the anterolateral portal is risky, deeper knee flexion reduces the risk of popliteal artery injury.

All-Inside Knee Arthroscopic Repair Outcomes in Mongolia, Effectiveness and Challenges

Objectives: We investigated the clinical outcomes of a few initial cases of interior knee arthroscopic surgical repair conducted in Ulaanbaatar, Mongolia. Methods: Arthroscopic knee repair patients were recruited into a single-arm trial study and followed up to the third month post-surgically. Subjects were the first cohort of all-inside arthroscopic knee surgery at the National Trauma and Orthopedics Research Center (NTORC) of Mongolia. We examined the subjects by tests including MRI prior to surgery, and complete knee evaluation including symptoms, functionality, and local examinations at the baseline and the third month after surgery. Pairwise statistical methods including McNemar Test and T-test were used. Additionally, Pearson’s R Correlations tests were used. Results: Forty-nine knee arthroscopic surgery patients were included for analysis. Knee pain, some local symptoms during recovery, and functionality significantly improved post-surgically, (p &lt; 0.051). Arthroscopic knee interventions including anterior cruciate ligament reconstruction, local partial meniscectomy, and meniscal repair were predominantly conducted, strongly reflecting the knee MRI scan findings. Surgical site infections were absent in this cohort of patients. Age was correlated with post-surgical pain (p &lt; 0.050). Conclusion: Knee arthroscopic outcomes for symptom alleviation and recovery of function were satisfactory at 3 months of follow-up in this study. We conclude that we enjoyed an excellent experience with all-inside knee arthroscopy in a central Asian lower-middle income country (LMIC) setting with younger and middle-aged patients. Older age Mongolians may present with post-surgical pain more often than these subjects.

Ankle Stability: Commentary on an article by Joon Jo, MD, et al.: "Arthroscopic All-Inside Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinacular Reinforcement. A Prospective Randomized Study".

Ankle Stability: Commentary on an article by Joon Jo, MD, et al.: "Arthroscopic All-Inside Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinacular Reinforcement. A Prospective Randomized Study".

Needle Arthroscopic All-Inside Repair of Meniscal Tears Under Local Anesthesia

Needle arthroscopy has experienced a substantial increase in image quality due to technical innovation, which has brought needle arthroscopic interventional possibilities along. Repair of meniscal tears is gaining popularity relative to meniscectomy and may be such a procedure that is suitable for needle arthroscopy. We here present a needle arthroscopic technique for all-inside repair of meniscal tears in the red zone and red–white zone. With the use of local anesthesia only, the procedure is easy to perform for the surgeon and well-tolerable for the patient. Compared with conventional approaches to meniscal repair, needle arthroscopy may result in improved patient experience, decreased soft-tissue trauma, speedier recovery, and less need for personnel and hospital facilities. Combined, the advantages may lead to decreased overall costs as well.

All-Inside Double-Sided Suture Repair for Longitudinal Meniscal Tears

The current consensus in the literature is that the meniscus must be saved. Even though inside-out sutures are still considered as the gold standard, the need to alternate between intra- and extra-articular structures for every stitch makes it laborious. New generations of all-inside systems are now routinely used in operating rooms and enable easier, quicker, and safer techniques. However traditional all-inside repair with limited upper fixation does not provide uniform compression from top to down, essential precondition for satisfactory meniscal healing. This Technical Note describes a simple and accessible alternative technique that provides stable fixation and overall compression of vertical meniscal tears from top to down with standard all-inside instrumentation.

All-Inside Repair for Radial Tear at the Posterior Horn of the Lateral Meniscus: A Figure-8 Suture Technique

Arthroscopic suture repair for a radial tear at the posterior horn of the lateral meniscus poses a technical procedure for surgeons. We describe an all-inside repair technique using all-inside meniscal repair devices without adding any accessory portals. This simple technique provides precise reduction and stabilization of the meniscus by pinching 2 all-inside vertical sutures consecutively across the tear site.

Arthroscopic All-Inside Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinacular Reinforcement

The utility of inferior extensor retinacular (IER) reinforcement for arthroscopic repair of a lateral ankle injury is debatable. We hypothesized that the outcomes would not differ significantly between arthroscopic all-inside anterior talofibular ligament (ATFL) repair with and without IER reinforcement. We prospectively randomized 73 patients who had arthroscopic all-inside ATFL repair into 2 groups: those who had IER reinforcement (37 patients) and those who had no IER reinforcement (36 patients). The primary outcome was the Karlsson Ankle Functional Score (KAFS). The secondary outcomes included the Foot and Ankle Outcome Score (FAOS), Tegner activity score (TAS), ankle range of motion, and radiographic parameters. The functional outcomes were evaluated preoperatively and at 6 and 12 months postoperatively. Stress radiographs were obtained preoperatively and at 12 months postoperatively. The KAFS, all FAOS subscale scores, and TAS improved significantly at 1 year postoperatively in both groups, with no significant differences between the groups with respect to the preoperative and postoperative values. Significant differences were not observed between the ankle range of motion values recorded preoperatively and at 1 year postoperatively in both groups; the preoperative and postoperative range of motion values did not differ significantly between the groups. The mean talar tilt and talar anterior translation decreased significantly at 1 year postoperatively in both groups, with no significant differences between the groups preoperatively and postoperatively. One patient in each group had neuralgia of the superficial peroneal nerve; 2 patients in the IER reinforcement group had knot irritation causing mild discomfort. Arthroscopic all-inside ATFL repair with and without IER reinforcement showed comparable functional and stress radiographic outcomes at 1 year. Performing IER reinforcement in addition to all-inside arthroscopic direct ATFL remnant repair is not necessary. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

A comparison of the transtibial pullout technique and all-inside meniscal repair in medial meniscus posterior root tear: Prognostic factors and midterm clinical outcomes

IntroductionThere is a paucity of comparative clinical data between arthroscopic all-inside end-to-end meniscal root suture and transtibial pullout technique in medial meniscus posterior root tears (MMPRT). Therefore, this study aimed to compare treatment failure, mid-term clinical and radiological outcomes of all-inside meniscus root repair versus the transtibial pullout technique and to analyze prognostic factors of postoperative clinical and radiological outcomes. Material and methodsForty-four patients were included in two therapeutic group: arthroscopic all-inside meniscal suture (MS: 13 knees) and transtibial pullout technique (TP: 31 knees).Primary clinical outcomes at a minimum of 27.2 months postoperatively included Knee injury and Osteoarthritis Outcome Score (KOOS) and Lysholm Knee Questionnare (LKQ). Radiographic assessment of the knee was performed to determine osteoarthritis severity using the Kellgren-Lawrence (KL) grading system.In addition, pre and postoperative MRI scans and intraoperative arthroscopic findings were recorded and the correlations between these findings, as outcome predictors and postoperative patients reported subjective outcome were assessed. ResultsNo significant differences in postoperative KOOS and LKQ scores were found between the MS and TP group (p = 0.38 and 0.17, respectively).During follow-up one patients (7.7%) in the MS group and two (6.5%) in the TP group underwent total knee arthroplasty. The difference did not reach the statistical significance (p = 0.88).No differences were observed in postoperative MRI findings such as meniscal extrusion, osteochondral defect, chondromalacia patella, and bone morrow edema (p = 0.25, 0.97, 0.97, and 0.88, respectively).A univariate model revealed that the presence of postoperative meniscal extrusion; osteochondral defect; chondromalacia patella; increased BMI; age (>40 years) and longer time lapse between clinical onset to surgery (>6 months) were predictors of poor clinical outcome. The presence of meniscal extrusion, osteochondral defect and chondropatia patella portended worst postoperative outcomes in a multiple linear regression model. ConclusionsIt can be concluded that both techniques can reach good results when performed properly and if the injury pattern allows meniscal suture may be considered a treatment option for the management of MMPRT in well-selected patients.Patients with increased BMI, preoperative meniscal extrusion, chondromalacia patella, and osteochondral defect were at higher risk of poor clinical outcomes.

A Simple Way to Fix a Lateral Meniscal Root Tear

Background: Meniscal posterior root tears, which are often associated with anterior cruciate ligament (ACL) injury, lead to the loss of normal biomechanical and kinematic behavior of menisci. Several arthroscopic techniques have been introduced to address this kind of injury. In this video, a simple all-inside technique to repair posterior lateral root tear (PLRT) is presented. Indications: To repair type 1, type 2, and type 4 PLRT. Technique: The torn lateral meniscus root is sutured to the medial fibers of the posterior cruciate ligament (PCL), with an arthroscopic all-inside repair system, with the purpose of reproducing the stabilizing function of the meniscofemoral ligaments. Results: This procedure allows restoration of the correct position of the detached horn, and restores meniscal stability with satisfactory clinical outcomes. Discussion/Conclusion: The technique described represents a simple and fast arthroscopic all-inside procedure to repair PLRT in association with concomitant procedure, such as ACL reconstruction. However, outcome reports of this technique are still lacking in the literature, and further studies are needed to confirm the authors’ results.

All-Inside Arthroscopic Meniscal Stacked Suture Repair for Hypermobile Lateral Meniscus With FASTFIX 360

Even though inside-out repair of meniscal tears is still the gold standard, the need for a posterior incision is a certain disadvantage of this approach. However, all-inside arthroscopic meniscal stacked suture repair can be performed for hypermobile lateral meniscus using all-inside devices and slotted canula. This technique is able not only to reduce surgical invasion but also preserve meniscal mobility, since sutures are placed on the peripheral area of the lateral meniscus. To successfully use the devices required for this procedure, surgeons must understand proper insertion techniques. The purpose of this Technical Note is to demonstrate this technique using FASTFIX 360.

Good Surgical Outcomes After Concomitant Repair of Double Radial Tears of the Lateral Meniscus and Anterior Cruciate Ligament Reconstruction

PurposeTo describe double radial tears of the lateral meniscus (LM), report early clinical treatment outcomes, and determine reoperation and failure rates.MethodsTwenty-one (N = 21) consecutive cases of arthroscopic-treated lateral meniscus double radial tears treated between 2012 and 2018 were reviewed, including 15 males (71.4%) and 6 females (28.6%). Meniscus repairs were all performed at the time of anterior cruciate ligament (ACL) reconstruction. Patients with associated fractures or prior surgeries were excluded. Concomitant injuries were reported, as were preinjury and postoperative Tegner scores, preoperative and postoperative visual analogue pain scale (VAS) scores, and postoperative International Knee Documentation Committee (IKDC) subjective scores. Reoperation and failure rates were documented.ResultsTwenty-one (N = 21) tears were located in the posterior horn of the meniscus near the root attachment; 15 (71.4%) underwent all-inside repair, 4 (19.0%) underwent transtibial pull-through repair, 1 (4.8%) was partially debrided, and 1 (4.8%) was left untreated. Twenty-one tears (N = 21) were in the body of the meniscus; 7 (33.3%) were repaired, 7 (33.3%) were partially debrided, and 7 (33.3%) were left untreated. Thirteen patients (62%) had associated medial collateral ligament (MCL) injuries. Mean follow-up was 2.6 years. VAS at rest and with activity improved by 2.1 points (P < .001) and 3.1 points (P = .017) after surgery. The mean postoperative Tegner activity score was 6.4, and the mean IKDC score was 83.2 at final follow-up. Reoperation was required in 5 patients (23.8%), and the surgical treatment failed in 1 patient (4.7%).ConclusionsDouble radial tears of the LM are uncommon injuries that occur in the setting of ACL tears, usually combined with MCL injury. The variety of surgical treatment techniques have a low failure rate at short-term follow-up. Patients tend to have good clinical outcomes with improvement in pain and overall function after surgically treating these injuries with simultaneous ACL reconstruction.Level of EvidenceLevel IV, therapeutic study, case series

Unstable Type III Wrisberg-type Lateral Discoid Meniscus: All-inside Arthroscopic Repair

Background: The Type III Wrisberg-type represents the rarest subtype of discoid meniscus. It exhibits a normal non-discoid “C”-shape with possible posterior horn hypertrophy, but meniscotibial ligaments and capsular restraints are lacking, leading to a clinical scenario of knee pain, popping, and catching due to meniscal hypermobility. Moreover, concomitant tears can be present due to repeated meniscal traumas. Indications: Type III Wrisberg-type lateral discoid meniscus with hypermobility, dislocation, or tear. Technique Description: Through standard arthroscopic portals, the meniscus is reduced in its anatomical position (if displaced). Abnormal mobility and anatomy should be noted. All-inside sutures are used in the posterior horn and body to stabilize the meniscus to the capsule and popliteus tendon. In the case of radial tears, horizontal stitches are used. Results: Patients are expected to return to sport approximately 4 to 5 months after the procedure with relief of pain, popping sensation, and knee locking. Conclusion: Arthroscopic all-inside repair is an effective treatment for unstable and displaced Type III Wrisberg-type lateral discoid meniscus. However, the diagnosis can be challenging, especially without frank meniscal dislocation.

All-inside repair of bucket handle meniscus tears – Mid-term outcomes with postoperative magnetic resonance imaging

PurposeThe purpose of this study was to evaluate our results of bucket handle meniscus tear (BHMT) repairs with an all-inside repair technique using postoperative radiological imaging to evaluate meniscus reduction and healing and use them as criteria for evaluation of repair success. MethodsProspective recruitment of 20 patients with 21 BHMT repairs performed with an all-inside techniqueover a period from 2013 to 2015. All patients had an International Knee Documentation Committee (IKDC) Subjective Knee Form (SKF), Lysholm Score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner Activity Level Scale obtained pre-operatively and at a minimum of 24 months after surgery. All patients had postoperative knee magnetic resonance imaging (MRI) performed between 18 and 24 months after surgery to assess the stability or failure of their repairs.At 5 years after surgery, the patients were assessed with regard to whether they had undergone repeat surgery or not. ResultsAt 2 years, the mean postoperative SKF, Lysholm and KOOS grand scores were 78.9, 88.5 and 86.8, respectively. The mean pre-injury Tegner Activity Scale was 7.6 and postoperatively it was 6.0. There was a significant difference in all pre- and postoperative outcome scores (P < 0.01).The postoperative MRIs showed that 19 of the 21 BHMT repairs had stable reduction of the tear fragment and two patients had displacement of the torn bucket handle fragment. At 5 years, one patient had undergone revision surgery. ConclusionBHMTs can be repaired with all-inside techniques with good results and successful outcomes.