All-inside Suture Research Articles

Is MR imaging correlated with mid-term clinical results after arthroscopic all-inside meniscal repair?

Aim: To research the correlation between clinical and radiological results after arthroscopic meniscus repair with all-inside suture technique and to assess the magnetic resonance imaging (MRI) diagnostic value on previously repaired meniscus.Materials and Methods: Fifty-two patients were included in the study.All-inside suture technique with a Fast-Fix suture device was used for all patients. After at least 24 months follow-up, the affected knee was checked with 1.5 Tesla MRI if there was an additional pathology or the meniscal pathology persisted with criteria of Crues et al. International Knee Documentation Committee (IKDC) and Lysholm scores were used for evaluation of the functional status of patients. Barrett’s criteria wascriteria were used for failure rates and clinical improvement. Correlation between clinical results and MRI findings were investigated.Results: The mean follow-up was 39.6 (range, 24–60) months. The mean age was 31.4 (range, 21–45) years. At the last time follow up the mean IKDC and Lysholm scores were improved significantly (p0.001). Healing in RR zone tears were significantly better than for the RW zone according to the clinical scores (p=0.02). MRI had one false negative and 11 false positive resultsresult when compared with the clinical results. In radiological results, repairs after at least 8 weeks were different from early repairs and had significantly higher failure rates (p=0.01).Conclusion: Clinical examination and radiological investigation for meniscal healing with 1.5 Tesla MRI gave significantly different healing and failure rates (p=0.006).Evaluating a previously repaired meniscus with MRI is controversial.

Meniscus Repair and Replacement

The importance of preserving the function of the meniscus is seen with renewed interest. There has been an evolution of arthroscopic meniscus repair from inside-out, outside-in, meniscal fixators, to all-inside suturing techniques. Tear patterns once ignored or thought to be irreparable, such as root tears and horizontal cleavage tears, have recently been undergoing repair with promising results. Newer techniques have also recently allowed surgeons to address postmeniscectomy knee pain. Replacing lost tissue with scaffolds or replacing the meniscus with an allograft helps restore function and reduce degenerative changes.

Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket-Handle Meniscal Tears: A Propensity-Matched Analysis.

Background:There are limited data comparing the outcomes of all-inside versus inside-out meniscal repair techniques.Purpose:To assess failure rates and clinical outcomes after the surgical repair of bucket-handle meniscal tears utilizing either an all-inside or inside-out technique.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with bucket-handle meniscal tears undergoing all-inside or inside-out repair at a single institution between 2003 and 2013 were analyzed. A total of 28 mensici repaired utilizing second-generation all-inside suturing devices and 42 menisci repaired using an inside-out technique were eligible for inclusion. Rigorous propensity matching was performed on the basis of age, sex, tear laterality, rim width, and concomitant anterior cruciate ligament reconstruction (ACLR), resulting in a total of 40 patients equally distributed between the 2 repair techniques for comparison. Retear-free survival as well as preoperative and postoperative International Knee Documentation Committee (IKDC) and Tegner scores and physical examination findings were subsequently analyzed.Results:Twenty patients who underwent all-inside repair (14 male; mean age, 23.7 ± 6.7 years) were successfully propensity matched to 20 patients who underwent inside-out meniscal repair (15 male; mean age, 22.5 ± 7.6 years), with a mean retear-free follow-up of 4.4 years (range, 2.5-7.4 years). Four (20%) all-inside repairs and 4 (20%) inside-out repairs failed over the course of follow-up (P > .999), with a mean time to failure of 2.7 years (range, 1.3-4.4 years) and 5.0 years (range, 0.8-7.5 years), respectively (P = .25). Increasing patient age trended toward a decreased clinical retear rate, independent of the repair technique (hazard ratio, 0.86; P = .056). There were no significant differences in the Tegner scores, IKDC scores, or range of motion between the groups as a whole or when subcategorizing by age, sex, body mass index, tear complexity, rim width, isolated versus concomitant ACLR, or medial- versus lateral-sided repair. There were no complications in the all-inside group, while there was a 10% rate of minor complications in the inside-out group (P = .49).Conclusion:Overall, satisfactory clinical outcomes are achievable at short-term to midterm follow-up with both inside-out and all-inside repair techniques of bucket-handle meniscal tears in rigorously matched patients with similar meniscal tear patterns.

A novel suture technique using the FasT-Fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear.

Medial meniscus posterior root has an important role in the maintenance of knee articular cartilage. Although pullout repair of the medial meniscus posterior root tear has become a gold standard, it has several difficulties for suturing. We have developed a modified Mason-Allen suture technique using the FasT-Fix all-inside suture device combined with Ultrabraid. The present suture technique allows a strong grasping of the medial meniscus posterior horn for arthroscopic pullout repair.

A prospective randomized control trial of arthroscopic surgery for stable ramp lesion of the medial meniscus

Objective: To evaluate the necessity of arthroscopic suture repair for the stable ramp lesion. Methods: From August 2008 to April 2012, 91 patients of consecutive cases were diagnosed as anterior cruciate ligament (ACL) injury associated with stable ramp lesion in Department of Sports Medicine Service of Beijing Jishuitan Hospital. All of the diagnosis was confirmed during arthroscopic surgeries. The patients were randomized into suture repair group and control group. The ACL was reconstructed using auto grafts of hamstring. MRI was used for evaluation of the healing of the ramp lesion during the follow-up period. The stability of the knee joint was evaluated using KT-1000 device. The clinical functional outcomes were analyzed with Lysholm and International Knee Documentation Committee(IKDC) score. t test and χ(2) test were used to analyze the data, respectively. Results: There were 73 patients (80%) were available for final follow-up. The follow-up period was 24 to 72 months (mean (38.9±16.1) months). The suture repair group included 40 patients, while the control group included 33 patients. There were no statistically difference in age(t=0.458, P>0.05), gender(χ(2)=0.222, P>0.05), time interval from injury(t=0.643, P>0.05) and associated injuries(χ(2)=0.658, P>0.05). At the final follow-up, the healing rate of ramp lesion in suture repair group was 97.5% (95% of complete healed, 2.5% of partial healed, and 2.5% of non-healed), in control group the healing rate was 93.9% (87.8% of complete healed, 6.1% of partial healed, and 6.1% of non healed), there were no significant differences between the two groups (χ(2)=0.446, P>0.05). There was no statistically significant difference of postoperative knee stability (t=-0.510, P>0.05). The healing status of ramp area from MRI evaluation had statistically significant correlation with the ACL stability (χ(2)=11.919, P<0.01). For the analysis of postoperative Lysholm scores and IKDC scores, there was no significant difference between the two groups (t=-0.166, P>0.05; t=0.032, P>0.05). Conclusions: Stable ramp lesion could be well healed after arthroscopic treatment of all-inside suture repair as well as refreshment only. For patients with ACL injury and stable ramp lesion, there was no significant difference between the results of MRI evaluation in the early postoperative stage.The postoperative healing status of ramp area had statistically significant correlation with the stability of knee joint.

Clinical Results after Arthroscopic Meniscus Repair for Recurrent Subluxation of the Lateral Meniscus

Purpose:This study was undertaken to diagnose and to document clinical results and the technical aspects of arthroscopic meniscus repair for treating the recurrent subluxation with peripheral tears around popoliteal hiatus of the LM.Methods:Twenty two patients (23 knees) with symptomatic recurrent subluxation of the LM treated by arthroscopic meniscus repair were included. The inclusion criteria were (1) patients with knee pain, locking or snapping symptoms despite 3 months of conservative treatment, (2) non-discoid lateral meniscus, (3) stable knee, and (4) tears involving the red-white or red–red zone. All tears were repaired with either the modified all-inside suture technique only or a combination of the modified all-inside and modified outside-in techniques. Clinical results were evaluated preoperatively and at final follow-up using Tegner activity level, Lysolm knee, and Hospital for Special Surgery (HSS) scores.Results:All patients returned to their prior life activities with little or no limitations, and no reoperation was required after an average follow-up of 52.3 months(range, 24–160). At the final follow-up, all knees achieved a full range of motion. Catching sensation was experienced in three knees, and limited function during squatting and jumping was complained in two knees. However no patient had recurrence of a locking episode. At the last follow-up, the mean Tegner activity level had improved significantly from 3.7 (range, 2–6) to 7.2 (range, 3–10, p<0.0001), mean Lysolm knee score improved from 75.1 92.0 (range, 76-100) preoperatively to 92.0 (range, 76-100) at final follow-up (p < 0.0001), and mean preoperative HSS score improved from 83.4 to 94.6 at final follow-up (p < 0.0001).Conclusion:Arthroscopic meniscus repair using the modified all-inside suture and outside-in techniques showed excellent clinical outcomes for treating symptomatic recurrent subluxation with peripheral tears around popoliteal hiatus of the LM without any complications or recurrence.longitudinal tear of posterior horn of lateral meniscusThe 30° arthroscope, inserted from anteromedial portal to the posterolateral compartment, shows longitudinal tear of posterior horn of lateral meniscus (LMPH) at meniscocapsular junction area (black arrows).three vertical sutures at the longitudinal tearThe 70° arthroscope shows three vertical sutures at the longitudinal tear of the posterior horn of lateral meniscus (LMPH).

Results of arthroscopic meniscal repair

Objectives:Currently the arthroscopic treatment of meniscal pathology has become one of the most common procedures in orthopedic practice and although in most cases meniscectomy is done, meniscal sutures are the treatment of choice when a reparable lesion is diagnosed, especially in young patients. It has been reported that the meniscal repair leads to a lower incidence of developing degenerative changes in the long-term when compared with meniscectomy and nonsurgical treatment of meniscal injuries. The aim of this study was to determine the success rate of meniscal repair achieved in our sports medicine practice.Methods:Between 2006 and 2015, 62 meniscal tears in 58 patients with a mean age of 31 years (range 15-58) were repaired. Mean follow-up was 52 months (range 6-120 months). In 16 patients (28%) was associated with arthroscopic ACL reconstruction. The repair techniques used included outside-in sutures, inside-out sutures, all-inside sutures and a combination of techniques. Failure of the repair was defined by the requirement for repeat knee arthroscopy and partial or subtotal meniscectomy. The indication of arthroscopic revision was based on the presence of mechanical symptoms, after the suture.Results:Failure of meniscus repair occurred in four patients (failure rate: 6.45%), one case was associated with ACL reconstruction (failure rate: 6.25%) and 3 had undergone isolated meniscal suture (failure rate: 8%). The average time for the reoperation was 15 months (4-24). We had no intraoperative complications.Conclusion:The reported failure rate of meniscal repair in stable knees varies between 12% and 43%, with reports that demonstrate a clinical success rate of 100%. In this study, we obtained a success rate of 93.5%. These results are slightly higher than those in the literature, which can be attributed to careful selection of patients and the fact that clinical success tends to be better than the assessed arthroscopically. In summary, we consider the meniscal repair as a successful option in the treatment of meniscal rupture. Due to the importance it has recovered in the last time preserving the meniscus, in the future we should greatly increase our rate of meniscal suture. We hold that careful selection of patients and the type of injury to repair, optimizes the success of meniscal repairs.

Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view.

The purpose of this study was to evaluate and describe the clinical results and outcomes of a novel method for all-inside suture repair of medial meniscus ramp lesions through posteromedial and posterolateral transseptal portals during anterior cruciate ligament (ACL) reconstruction. Further, this investigation compared the posterolateral view to the notch view for diagnosis and repair. Between 2011 and 2014, 166 patients had ramp lesions concomitantly with ACL injury; 128 patients (107 men and 21 women) were enrolled in the study after qualification. All patients underwent repair of the posterior horn ramp lesion of the medial meniscus, using a suture hook device with PDS No. 1 through a posteromedial portal while viewing from the posterolateral transseptal portal during ACL reconstruction, with a minimum of a 2-year follow-up. Patients were followed up for a minimum of 2years (range 24-47months). Their average Lysholm score increased from 61.7±3.2 preoperatively to 87.8±3.9 at last follow-up (p<0.001). Moreover, their average IKDC scores also improved from 53.6±2.1 (pre-op) to 82.1±3.5 (at last follow-up) (p<0.001). The peroneal nerve and the popliteal neurovascular bundle were not damaged in any of the patients. This study provides evidence that the posterolateral transseptal technique protects neurovascular structures. This technique may be used safely and easily for repair of the posterior horn ramp lesion of the medial meniscus during ACL reconstruction. IV.

Repair of isolated horizontal meniscal tears with all-inside suture materials using the overlock method: outcome study with a minimum 2-year follow-up.

BackgroundThis study aimed to consider the use of a meniscal repair in patients in order to close the horizontal cleavage extending up to the avascular zone. The hypothesis was to examine the clinical and arthroscopic outcomes following meniscal repair of degenerative horizontal cleavage tears with new-generation all-inside suture materials using the overlock method.MethodsWe retrospectively reviewed a consecutive series of 55 patients which had a horizontal pattern, and finally, 27 patients with a horizontal tear only which required no additional intra-articular surgical intervention were included in the study. Arthroscopic meniscal repair was performed using the overlock method. Functional outcomes were evaluated using Lysholm knee scoring scale, Cincinnati scores, subjective International Knee Documentation Committee (IKDC) criteria and Tegner activity scale. Assessment of meniscal healing was evaluated clinically by the presence of meniscal signs. The preoperative and postoperative MRIs were examined.ResultsThe mean follow-up period was 29 months (range, 24–38). The mean Lysholm score improved significantly from 59.5 ± 12.4 points preoperatively to 90.0 ± 4.7 points postoperatively (P < 0.0001). The Cincinnati score increased from 14.8 ± 5.3 to 26.9 ± 1.6 (P < 0.0001). The Tegner activity score increased from 3.7 ± 1.4 to 6.4 ± 1.6 (P < 0.0001). The mean IKDC subjective score also improved significantly from 48.5 ± 9.8 preoperatively to 90.4 ± 5.0 postoperatively (P < 0.0001).ConclusionMeniscal repair of degenerative horizontal tears using the overlock method resulted in improved Lysholm and IKDC subjective scores. With careful selection of the patients and the horizontal meniscus tears, the success of the meniscus repairs increases. Repair can be recommended for all horizontal meniscus tears which can be repaired arthroscopically.

Repair of Meniscal Ramp Lesions Through a Posteromedial Portal During Anterior Cruciate Ligament Reconstruction: Outcome Study With a Minimum 2-Year Follow-up

To evaluate the results of arthroscopic all-inside suture repair of medial meniscal ramp lesions through a posteromedial portal during anterior cruciate ligament (ACL) reconstruction. All patients who underwent a suture of the posterior segment of the medial meniscus using a suture hook device through a posteromedial portal during ACL reconstruction with minimum 2 year-follow-up were included in the study. Repair was performed for longitudinal tears within the rim of less than 3mm (capsulomeniscal junction or red-red zone) or 3 to 5mm (red-white zone) of an unstable torn meniscus. Patients were assessed pre- and postoperatively with IKDC score and Tegner activity scale. Instrumented knee testing was performed with the Rolimeter arthrometer. Complications including reoperation for failed meniscal repair were also recorded. One hundred thirty-two patients met the inclusion criteria. The mean follow-up time was 27months (range, 24 to 29months). The average subjective IKDC rose from 63.8 ± 13.5 (range, 27 to 92) preoperatively to 85.7 ± 12 (range, 43 to 100) at last follow-up (P < .0001). The Rolimeter test decreased from a side-to-side difference in anterior knee laxity of 7mm (range, 5 to 14mm) to a mean value of 0.4mm (range,-3 to 5mm) at last follow-up (P < .0001). The Tegner activity scale at the last follow-up (6.9 ± 1.72) was slightly lower than that before surgery (7.2 ± 1.92; P= .0017). Nine patients (6.8%) had failure of the meniscal repair. In 5 cases, recurrent tears were related to a newly formed tear located anterior to the initial tear. Our results show that arthroscopic meniscal repair of ramp lesions during ACL reconstruction through a posteromedial portal provided a high rate of meniscus healing at the level of the tear and appeared to be safe and effective in this group of patients. Level IV, therapeutic study, case series (no control group).

A suture technique for easier reduction and repair of bucket-handle meniscal tears while using the all-inside devices.

Arthroscopic repair of bucket-handle meniscal tears is difficult due to their complex pathology. Many meniscal repair techniques such as all-inside, inside-out, and outside-in have been described for the treatment of these tears. Loss of reduction is a likely complication with the use of new-generation, all-inside suture instruments, as the tip of the needle is extracted following advancement of the first implant behind the capsule. The complication may be encountered quite often and renders the use of the meniscus repair instrument unusable and causes an irreparable iatrogenic injury in the meniscus. The application of a simpler and more efficient technique is necessary until surgical experience is gained. The aim of this study was to define a new, simpler, and more efficient combination of suturing method in the treatment of bucket-handle meniscal repairs and minimize the rate of complications which may be caused by this technique.

Outcomes of arthroscopic treatment of osteochondritis dissecans of the capitellum and description of the technique

We hypothesize that a technique for all-arthroscopic fixation of capitellum osteochondritis dissecans (OCD) lesions using suture fixation and autogenous iliac crest bone grafting offers a successful alternative to open internal fixation techniques as shown by 2-year validated patient-reported outcomes. Our technique uses arthroscopic all-inside suture fixation with iliac crest autogenous bone grafting. The procedure was performed on 4 elite-level, adolescent athletes presenting with 5 unstable capitellum OCD lesions resulting in elbow pain, limited range of motion, and decreased ability to play. Magnetic resonance imaging showed an unstable OCD lesion, which was correlated with arthroscopy. Postoperatively, patients were evaluated by the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire; Oxford Elbow and Mayo Elbow scores; visual analog scale; postoperative range of motion; and return to play. Three female patients and one male patient aged 13 to 15years underwent the procedure. The mean final follow-up period was 2.8years. Union was achieved in all patients, as seen on magnetic resonance imaging at a mean of 3 months. At follow-up, the mean loss of extension was 2°. Mean flexion was 153°. There was no loss of supination or pronation. The mean score on the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire was 11. The mean Mayo Elbow score was 88. The mean Oxford Elbow score was 42. The mean visual analog scale score was 2. The mean time to return to play was 4months. All patients continued to compete at an elite level. There were no infections or cases of fixation failure, and no patients required conversion to open surgery or needed revision surgery. Arthroscopic all-inside fixation of unstable OCD lesions is a successful technique, facilitating athletes to return to an elite level of play.

The Effect of Knee Flexion Angle on the Neurovascular Safety of All-Inside Lateral Meniscus Repair: A Cadaveric Study

To evaluate if different knee flexion angles can modify the neurovascular injury risk during lateral meniscus repair. Twenty cadaveric knees were studied. An all-inside suture device (FasT-Fix; Smith & Nephew, Andover, MA) was placed at the posterior horn and at the medial and lateral limits of the popliteal hiatus. The minimal distances between the device and the popliteal artery and peroneal nerve were measured with the knee at 90°, 45°, and 0° of flexion through a limited posterolateral arthrotomy. The distance between the device when inserted at the lateral edge of the popliteal hiatus and the peroneal nerve decreased from a median of 26 mm (interquartile range [IQR], 3.5 mm; range, 19 to 29 mm) at 90° to 21.5 mm (IQR, 4.5 mm; range, 14 to 25 mm) at 45° and 15.5 mm (IQR, 6.5 mm; range, 4 to 20 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the peroneal nerve decreased from 16 mm (IQR, 3.3 mm; range, 9 to 21 mm) at 90° to 12 mm (IQR, 4.3 mm; range, 9 to 16 mm) at 45° and 7 mm (IQR, 4.0; range, 4 to 15 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the popliteal artery decreased from 21 mm (IQR, 5.0 mm; range, 11 to 27 mm) at 90° to 19 mm (IQR, 5.0 mm; range, 10 to 23 mm) at 45° and 16 mm (IQR, 7.5 mm; range, 10 to 23 mm) at 0° (significant differences, P < .001). The distance between the device when inserted 5 mm lateral to the posterior root of the lateral meniscus and the popliteal artery decreased from 13 mm (IQR, 4.3 mm; range, 7 to 27 mm) at 90° to 10.5 mm (IQR, 4.3 mm; range, 4 to 19 mm) at 45° and 5.5 mm (IQR, 4.0 mm; range, 0 to 14 mm) at 0° (significant differences, P < .001). The risk of injury to the popliteal artery or to the peroneal nerve during all-inside repair of the posterior half of the lateral meniscus is lower at 90° of flexion and increases with knee extension to 45° and 0°. All-inside meniscal repair of the lateral meniscus is safer with the knee at 90° of flexion.

Arthroscopic Meniscal Repair: "Modified Outside-In Technique".

Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named "modified outside-in technique" aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with meniscal injuries by our new technique were evaluated. The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients' satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months. Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%). Patients' satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported. The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.

All-inside suture device is superior to meniscal arrows in meniscal repair: a prospective randomized multicenter clinical trial with 2-year follow-up.

PurposeMultiple techniques and implants are available for all-inside meniscal repair, but the knowledge about their failure rates and functional outcome is still incomplete. The hypothesis was that there might be differences between meniscal arrows and suture devices regarding reoperation rates and functional outcome. Thereby, the aim of this study was to compare clinical results following repair with the Biofix® arrows or the FasT-Fix® suture devices.MethodsIn this RCT, 46 patients were treated either by Biofix® (n = 21) or FasT-Fix® (n = 25). The main outcome was reoperation within 2 years. Knee function and activity level were evaluated by KOOS and Tegner activity scale.ResultsTwelve out of 46 (26 %) patients were reoperated within 2 years, nine out of 21 (43 %) in the Biofix®-group versus three out of 25 (12 %) in the FasT-Fix®-group (p = 0.018). The relative risk of reoperation was 3.6 times higher for Biofix® compared to FasT-Fix® (95 % confidence interval 1.1–11.5). Both treatment groups had significant increase in all KOOS subscales, but there were no major differences between the groups. The subgroup of reoperated patients differed from the other patients with higher Tegner score preoperatively (median 5 vs. 4) (p = 0.037) and at 3-month follow-up (median 4 vs. 3) (p = 0.010).ConclusionsThese results indicate that FasT-Fix® suture is superior to Biofix® arrows with significant lower failure rate. Functional outcome did not depend on repair technique. Higher activity score preoperatively and at 3-month follow-up in the reoperated patients indicates that activity level may influence on the risk of reoperation.Level of evidenceI.

Arthroscopic repair of bucket-handle tears of the lateral meniscus

This study was undertaken to document the clinical results of arthroscopic meniscus repair for treatment of displaced bucket-handle tears of the lateral meniscus. From 2002 to 2010, 13 patients with symptomatic displaced bucket-handle tears of the lateral meniscus treated by arthroscopic meniscus repair were included in this study. Inclusion criteria were (1) displaced bucket-handle tear of the lateral meniscus demonstrated on magnetic resonance imaging, (2) non-discoid lateral meniscus, (3) stable knee, and (4) tears involving the red-white or red-red zone. Median age at operation was 20 years (range 14-54 years), and the median follow-up period was 4.0 years (range 2-10.7 years). All tears were repaired with either a modified all-inside suture technique only or a combination of the modified all-inside suture and modified outside-in techniques. Clinical results were evaluated preoperatively and at the final follow-up using Tegner activity level, Lysholm knee, and Hospital for Special Surgery (HSS) scores. All patients returned to their prior life activities with little or no limitations, and no reoperations were required during the follow-up period. On the final follow-up, all knees achieved full range of motion, except two knees with limited function during squatting and jumping due to pain. No patient had recurrence of a knee-locking episode. The median Tegner activity level improved significantly from 3 (2-6) to 7 (4-9) (p < 0.0001), mean Lysholm knee score improved from 78.5 ± 10.7 preoperatively to 94.6 ± 5.4 (p < 0.0001), and mean preoperative HSS score improved from 80.3 ± 8.5 to 95.9 ± 4.2 (p < 0.0001) during the follow-up period. Arthroscopic meniscus repair using the modified all-inside suture and modified outside-in techniques showed excellent clinical outcomes for treatment of symptomatic displaced bucket-handle tears of the lateral meniscus and were free of any complications or episodes of recurrence. Case series, Level IV.

The double flipped meniscus sign: Unusual MRI findings in bucket-handle tear of the lateral meniscus

Bucket-handle meniscal tears are either longitudinal, vertical, or oblique in direction with an attached tear fragment displaced from the meniscus. Magnetic resonance imaging (MRI) signs are widely used in the diagnosis of these tears, including the ‘fragment within the intercondylar notch sign’, ‘flipped meniscus sign’, ‘double anterior horn sign’, ‘absence of the bow tie sign’, ‘double posterior cruciate ligament (PCL) sign’, ‘posterior double PCL sign’, and ‘triple PCL sign’. We report an unusual case, not yet described in previous studies, of a bucket-handle tear presenting as a double longitudinal tear of the lateral meniscus (LM). Two longitudinal tears were observed in the white–white zone and the red–white zone of the LM, where both fragments were shown to be displaced and locked within the intercondylar notch. Partial menisectomy was performed for the central fragment and a repair with modified all-inside sutures was performed for the peripheral fragment.

Comparison of an All-Inside Suture Technique With Traditional Pull-Out Suture and Suture Anchor Repair Techniques for Flexor Digitorum Profundus Attachment to Bone

One goal in repairing zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study compares an all-inside suture repair technique biomechanically with pull-out suture and double-suture anchor repairs. Repairs were performed on 30 cadaver fingers. In all-inside suture repairs (n = 8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n = 8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were 2 suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n = 7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n = 7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation greater than 2 mm at the repair site for all pull-out suture repairs and for 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and 5 of the Depuy Micro Mitek repairs failed by anchor pull-out. This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. This study introduces a new FDP reattachment technique that avoids some of the shortcomings of current techniques.

Lateral meniscus allograft transplantation using a single-incision technique

The aim of this work is to introduce and evaluate a novel arthroscopically assisted meniscus allograft transplantation (MAT) technique that requires only one small anterior incision for an arthrotomy. In the novel technique, the posterior horn of the allograft meniscus was repaired using the modified all-inside suture technique instead of the conventional inside-out technique. By doing this, an additional posterior incision could be avoided. Thirteen consecutive patients with total or subtotal meniscectomy of the lateral meniscus underwent lateral MAT using the novel technique from August 2010 to October 2011. The clinical outcomes were evaluated according to Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, and Tegner activity level scales. The median follow-up period was 21.0 months (range 13-28 months). The post-operative median Lysholm score improved to 85.0 (range 77-95, P < 0.05). The median IKDC subjective score was 80.0 (range 63-99, P < 0.05) at last follow-up. The median Tegner activity level of 6.0 (range 4-7) was improved compared with the median preoperative level (P < 0.05). None of the patients presented with symptoms requiring a secondary surgical procedure at the time of final follow-up. The novel method requires only one small arthrotomy incision except for arthroscopic portals. In addition to the minimal number of incisions, this technique has several advantages over previous techniques. This single-incision technique could be effective and satisfactory option for lateral MAT. Case series with no comparison group, Level IV.

Lateral meniscus allograft transplantation: an arthroscopically-assisted single-incision technique using all-inside sutures with a suture hook

We present an arthroscopically-assisted single-incision technique using all-inside sutures with a suture hook in the lateral meniscus allograft transplantation. Although this technique is technically demanding, it provides vertically oriented and secure sutures with good tissue approximation without the accessory skin incision.