Arthroscopic Meniscal Repair Research Articles

Validating a Global Rating Scale to Monitor Individual Resident Learning Curves During Arthroscopic Knee Meniscal Repair

To determine whether a global rating scale (GRS) with construct validity can also be used to assess the learning curve of individual orthopaedic trainees during simulated arthroscopic knee meniscal repair. An established arthroscopic GRS was used to evaluate the technical skill of 19 orthopaedic residents performing a standardized arthroscopic meniscal repair in a bioskills laboratory. The residents had diagnostic knee arthroscopy experience but no experience with arthroscopic meniscal repair. Residents were videotaped performing an arthroscopic meniscal repair on 12 separate occasions. Their performance was assessed by use of the GRS and motion analysis objectively measuring the time taken to complete tasks, path length of the subject's hands, and number of hand movements. One author assessed all 228 videos, whereas 2 other authors rated 34 randomly selected videos, testing the interobserver reliability of the GRS. The validity of the GRS was tested against the motion analysis. Objective assessment with motion analysis defined the surgeon's learning curve, showing significant improvement by each subject over 12 episodes (P < .0001). The GRS also showed a similar learning curve with significant improvements in performance (P < .0001). The median GRS score improved from 15 of 34 (interquartile range, 14 to 17) at baseline to 22 of 34 (interquartile range, 19 to 23) in the final period. There was a moderate correlation (P < .0001, Spearman test) between the GRS and motion analysis parameters (r = -0.58 for time, r = -0.58 for path length, and r = -0.51 for hand movements). The inter-rater reliability among 3 trained assessors using the GRS was excellent (Cronbach α = 0.88). When compared with motion analysis, an established arthroscopic GRS, with construct validity, also offers a moderately feasible method to monitor the learning curve of individual residents during simulated knee meniscal repair. An arthroscopic GRS can be used for monitoring skill improvement during knee meniscal repair and has the potential for use as a training and assessment tool in the real operating room.

A case of osteonecrosis of medial femoral condyle after arthroscopic meniscus repair

A case of osteonecrosis of medial femoral condyle after arthroscopic meniscus repair

Clinical results of arthroscopic all-inside lateral meniscal repair using the Meniscal Viper Repair System

This study examined the postoperative outcome of the all-inside arthroscopic meniscal suture repair technique using the Meniscal Viper Repair System for lateral meniscus tears. Between January 2006 and December 2008, 57 patients (27 males and 30 females) with lateral meniscus tears who underwent meniscal repair using the Meniscal Viper Repair System were evaluated prospectively. Among them, 52 cases were tears involving the posterior third of the lateral meniscus, and most were longitudinal tears or bucket handle tears. The postoperative follow-up period ranged from 12months to 4years and 2months, and averaged 19months. Both Lysholm and Japanese Orthopaedic Association Score were significantly improved after surgery. Forty-nine of 57 patients (86.0%) had no locking or catching, no joint line tenderness, and a negative McMurray test at the last follow-up. Of 32 patients who underwent second-look arthroscopy, 24 achieved complete healing, while four showed partial healing and required repeat repair, and four showed no healing and meniscectomy was conducted. The failure rate in all patients was thus 14.0% (8 of 57 repairs). No major complications associated with the use of the Meniscal Viper Repair System were observed. The Meniscal Viper System is a convenient and effective device for all- inside lateral meniscal suture, with high success rate and no major complications.

Learning and Retaining Simulated Arthroscopic Meniscal Repair Skills

Previous studies of task-specific skills have suggested that a loss of technical performance occurs if the skill is not practiced for a six-month period. The aims of this study were to objectively demonstrate the learning curve for a complex arthroscopic task (meniscal repair) by means of motion analysis and to determine the impact of task repetition on the retention of this skill. Nineteen orthopaedic residents with experience in routine knee arthroscopy but not in arthroscopic meniscal repair were recruited into a randomized study. During the initial learning phase, all subjects performed twelve meniscal repairs on a knee simulator over a three-week period. A validated motion analysis tracking system was used to objectively record the performance and learning of each subject; the outcomes were the time taken, distance traveled, and number of hand movements. The subjects were then randomized into three groups. Group A performed one meniscal repair each month, Group B performed one meniscal repair at three months, and Group C performed no repairs during this interim phase. All three groups then returned at the six-month point for the final assessment phase, during which they carried out an additional twelve meniscal repairs over three weeks. All subjects demonstrated a clear learning curve during the initial learning phase, with significant objective improvement in all motion analysis parameters over the initial twelve episodes (p < 0.0001). Although some residents had reached a learning plateau by twelve episodes, others continued to make further improvements for up to another nine episodes. Importantly, Group C did not display any loss of skill between the initial learning phase and final evaluation phase despite a six-month break in task repetition (p > 0.05). In contrast to previous studies, residents did not lose any skill over a six-month interruption in task performance, and other residents took longer to produce a more consistent performance.

Kyste synovial induit par des sutures méniscales non résorbables

Arthroscopic meniscal repair has been a common procedure for the treatment of a torn meniscus, since the importance of meniscal preservation is widely understood. Over the years, the complications associated with suture material have been reported. Meniscal cyst is also one of those things. But ganglion cyst triggered by non-absorbable suture material was not documented in the literature. We report the case of a 19-year-old boy who underwent arthroscopic ACL reconstruction and repair of the medial meniscus by inside-out technique using 2-0 non-absorbable polyester sutures. The patient returned to our clinic at 4 year F/U with right knee pain due to medial meniscus tear and ganglion cyst. We suspect non-absorbable suture materials itself might have caused soft tissue irritation with repetitive trauma that lead to mucoid degeneration which results in ganglion cyst formation in the end.

Peripheral Nerve Injuries in Sports-Related Surgery: Presentation, Evaluation, and Management

Peripheral nerve injuries during sports-related operative interventions are rare complications, but the associated morbidity can be substantial. Early diagnosis, efficient and effective evaluation, and appropriate management are crucial to maximizing the prognosis, and a clear and structured algorithm is therefore required. We describe the surgical conditions and interventions that are commonly associated with intraoperative peripheral nerve injuries. In addition, we review the common postoperative presentations of patients with these injuries as well as the anatomic structures that are directly injured or associated with these injuries during the operation. Some examples of peripheral nerve injuries incurred during sports-related surgery include ulnar nerve injury during ulnar collateral ligament reconstruction of the elbow and elbow arthroscopy, median nerve injury during ulnar collateral ligament reconstruction of the elbow, axillary nerve injury during Bankart repair and the Bristow transfer, and peroneal nerve injury during posterolateral corner reconstruction of the knee and arthroscopic lateral meniscal repair. We also detail the clinical and radiographic evaluation of these patients, including the utility and timing of radiographs, magnetic resonance imaging (MRI), ultrasonography, electromyography (EMG), and nonoperative or operative management. The diagnosis, evaluation, and management of peripheral nerve injuries incurred during sports-related surgical interventions are critical to minimizing patient morbidity and maximizing postoperative function. Although these injuries occur during a variety of procedures, common themes exist regarding evaluation techniques and treatment algorithms. Nonoperative treatment includes physical therapy and medical management. Operative treatments include neurolysis, transposition, neurorrhaphy, nerve transfer, and tendon transfer. This article provides orthopaedic surgeons with a simplified, literature-based algorithm for evaluation and management of peripheral nerve injuries associated with sports-related operative procedures.

A ganglion cyst generated by non-absorbable meniscal repair suture material

Arthroscopic meniscal repair has been a common procedure for the treatment of a torn meniscus, since the importance of meniscal preservation is widely understood. Over the years, the complications associated with suture material have been reported. Meniscal cyst is also one of those things. But ganglion cyst triggered by non-absorbable suture material was not documented in the literature. We report the case of a 19-year-old boy who underwent arthroscopic ACL reconstruction and repair of the medial meniscus by inside-out technique using 2-0 non-absorbable polyester sutures. The patient returned to our clinic at 4-year F/U with right knee pain due to medial meniscus tear and ganglion cyst. We suspect non-absorbable suture materials itself might have caused soft tissue irritation with repetitive trauma that lead to mucoid degeneration which results in ganglion cyst formation in the end.

Meniscal Treatment Options

The importance of the meniscus is well established and damage to this structure, followed by its loss, results in the development of radiographic changes. One recent systematic review indicated that, as Fairbank reported after open meniscectomy, osteoarthritic changes are present at 8 to 16 years after arthroscopic partial meniscectomy; however, clinical symptoms are not significant. Another systematic review points out that while meniscus removal has a lower reoperation rate than meniscal repair, meniscal repair is associated with better long-term outcomes. Consequently, a link between meniscal loss and diminished knee function seems reasonable and the commonly held belief that every effort should be made to repair a torn meniscus seems appropriate. Several approaches to arthroscopic meniscal repair have developed. These can be described as outside-in, inside-out, and all-inside. As the articles in this issue make abundantly clear, regardless of the technique chosen the key to meniscal repair healing is a good blood supply, the absence of meniscal degeneration, and a stable knee (intact or concurrently reconstructed ACL). Several investigators are exploring the potential for the enhancement of meniscal healing using biologic techniques, allografts, or synthetic meniscal replacement. The current literature confirms several clinically significant observations. Medial meniscus repair is more likely to fail than lateral meniscus repair, presumably because of the better blood supply associated with the lateral meniscus and the different mechanical stresses between compartments. Also, meniscal repairs performed at the time of anterior cruciate ligament reconstruction have lower failure rates than repairs done without a reconstruction. Yet, evidence exists that not all meniscal tears need repair and that some (especially the lateral meniscus) can heal or at least remain asymptomatic long term. In reviewing the literature of meniscal repair techniques, it is clear that level 1 or 2 data are lacking to support many of these conclusions. Outcome measures vary between published studies, and the continuing introduction of new “improved” repair devices makes the collection of a significant number of cases with long-term results using 1 repair technique problematic. This issue of Sports Medicine and Arthroscopy Review tackles the subject of what to do with the meniscus and gives a glimpse of future treatment options. This includes leaving the torn meniscus in situ without debridement, meniscectomy (whether this should or should not be done), and the various techniques for meniscal repair. Meniscal replacement with either an allograft or a synthetic implant is addressed, and the current state of biologic enhancement is reviewed. Finally, surgeons often focus on specific surgical techniques and overlook postoperative care. A thoughtful discussion of the area of postoperative management after meniscal repair is presented.

Outside-In Meniscus Repair

Recent advances in our understanding of knee biomechanics and load transmission have emphasized the need for meniscus preservation. However, the literature suggests that more needs to be done. The outside-in arthroscopic meniscus repair was first described by Warren in 1985. Despite the popularity of new all-inside meniscus repair devices, the outside-in meniscus repair technique is still used by many surgeons to preserve the meniscus. During the last 26 years, this technique has evolved and modified. However, its basic principles as being a minimally invasive, simple, and inexpensive meniscus repair technique have not changed. The results of outside-in meniscus repair have also stood the test of time, yielding healing rates and functional scores comparable to those of other meniscus repair techniques.

The Prevalence of Articular Cartilage Changes in the Knee Joint in Patients Undergoing Arthroscopy for Meniscal Pathology

The purposes of this study were to evaluate the prevalence of articular cartilage changes in the knee joint and to analyze predictive factors for these changes in patients undergoing arthroscopy for meniscal pathology. Between March 2005 and June 2009, 1,010 patients underwent arthroscopic meniscectomy or meniscal repair by the senior author. During surgery, a precise diagram was used to carefully note the presence, location, size, and Outerbridge grade of changes to the articular surfaces of the knee joint. The prevalence of articular cartilage changes was calculated for 6 age groups: younger than 20 years, 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, and 60 years or older. Demographic data including gender, ethnicity, smoking status, and body mass index (BMI) were acquired from patient charts. Overall, 48% of patients showed changes to the medial compartment, 25% to the lateral compartment, and 45% to the patellofemoral compartment. Eighty-five percent of patients aged 50 to 59 years and 86% of patients aged 60 years or older showed articular cartilage changes to at least 1 knee compartment. In contrast, only 13% of patients aged younger than 20 years and 32% of patients aged 20 to 29 years showed changes to at least 1 compartment. A significant relation was found between age and the development of articular cartilage changes in each of the 3 compartments (P < .0001). BMI was also significantly related to articular cartilage changes in the medial and patellofemoral compartments (P < .0001) but not the lateral compartment (P = .08). This study shows a high prevalence of articular cartilage damage as defined by the Outerbridge classification in patients undergoing arthroscopic surgery for meniscal pathology. Risk factors that correlate with articular cartilage damage include increasing age, elevated BMI, medial compartment pathology, and knee contractures. Level IV, therapeutic case series.

Discussing Treatment Options with a Minor: The Conflicts Related to Autonomy, Beneficence, and Paternalism

A seventeen-year-old male, high-school football player presents to an orthopaedic surgeon because of recurrent right knee pain after having undergone an arthroscopic meniscal repair one year previously. The patient did well initially but now has recurrent medial joint-line pain in the knee, which developed when he planted the right leg to throw a pass during summer training camp. He was evaluated by the team's athletic trainer and by an orthopaedic surgeon, both of whom, on the basis of their physical examination of the boy, believe that he may have sustained a recurrent meniscal tear. A magnetic resonance arthrogram is acquired, which confirms the presence of a large longitudinal tear of the medial meniscus in the "red-red" zone, with no signs of degenerative change, articular cartilage damage, or other ligamentous pathology. The patient had just started summer training camp before his senior year of high-school football, and he is considered to be a potential high-level candidate for a Division-I football scholarship.The orthopaedic surgeon presents the patient and his mother with three treatment options: nonoperative management, arthroscopic partial meniscectomy, and arthroscopic meniscal repair. He also presents the relevant risks and benefits of each choice, including, for meniscectomy, the risk of the future development of osteoarthritis if a large portion of the meniscus were to be excised and, for meniscal repair, the need for an extended (four to six-month) rehabilitation period. Both the patient and his mother are apprised of the limitations of preoperative magnetic resonance imaging (MRI) in determining if a meniscal tear can be repaired1-3. The patient states that, on the basis of his symptoms of pain, intermittent locking, and swelling, he does not believe that he would be able to play football if nonoperative management was chosen. He voices a strong preference for meniscectomy, as this would allow him the most rapid return to play. He states that he is not concerned with the future risk of osteoarthritis but is fearful that missing his senior football season will place his scholarship in jeopardy. His mother states that her son would likely not attend college without a scholarship, considering the family's financial situation. The patient states that he therefore wishes to have a meniscectomy, given the likely quicker recovery and faster return to play.The patient's mother was initially in favor of a meniscal repair, if possible. However, over the course of the patient's visit with the surgeon, she is persuaded by her son to favor a meniscectomy. The surgeon again discusses in detail the risks involved with meniscectomy in an adolescent-primarily the higher risk of future knee osteoarthritis. The patient remains persistent in his choice, mainly due to his desire to avoid the prolonged postoperative course of limited weight-bearing and physical therapy and thus the loss of his final high-school season. The mother, who is the patient's legal guardian for consent, ultimately follows her son's wishes and elects to consent to only an arthroscopic meniscectomy.

Introducing Arthroscopy to a Developing Nation: When and How to Make It Sustainable

The 2010 World Cup soccer tournament in South Africa was, by most accounts, the most-watched sporting event ever. The event highlighted the ability of sports, and soccer in particular, to serve as an important source of identity, collaboration, and international unity1-3. The World Cup showcased the improving infrastructure in South Africa, and the citizens were praised for being great hosts1,4. Several other African and Latin American teams, most notably those of Ghana and Uruguay, also received recognition for their impressive play. One factor contributing to the global popularity of the event was the improved telecommunications access brought about by general socioeconomic stability in much of the developing world. Over the course of the tournament, articles also noted the popularity of soccer in Africa and the impressive number of young soccer players determined to play despite meager conditions5-7. In the developed world, youth soccer is considered a high-risk sport for knee ligament and meniscal injuries5. A significant number of these patients undergo anterior cruciate ligament (ACL) reconstruction or arthroscopic meniscal repair in the hope of returning to soccer or at least preventing early-onset arthritis. To date, most of the literature and interventions related to orthopaedics in the developing world have focused on the care of musculoskeletal trauma8-11, with some additional attention to the treatment of congenital deformities12-14. In contrast, there has been little mention of the role of arthroscopy or the treatment of sports-related injuries within the scope of musculoskeletal care in a developing nation. We report here our experience of donating arthroscopy equipment to orthopaedic surgeons in Asmara, Eritrea (in East Africa), in November 2009. We do not pretend to be experts in this area. Our goal in …

Degeneration of the Meniscus and Progression of Osteoarthritis

Our understanding of the role that meniscal degeneration plays in the natural history of OA of the knee would benefit from observational studies that address the natural history of intrasubstance signal change with compositional imaging, the clinical significance of different meniscal pathologies, and the relation of meniscal alteration to altered contact area and joint loading. In addition, the weak evidence base for many of the current treatments suggests a great need for well-designed, randomized, controlled clinical trials to assess the true effects of arthroscopic meniscal resection, meniscal repair or transplantation, or nonsurgical treatments.

Paper # 277: Biomechanical Consequence of Posterior Medial Meniscal Root Tears with Subsequent Repair Using a Physiologic Loading Model

A physiologic load, simulating a knee squat and a pressure sensitive, capacitive, electronic sensor were used to investigate the biomechanical consequence of a meniscal root tear, subsequent repair and total meniscectomy. Posterior root tears of the medial meniscus cause a detachment of the meniscus at its insertion onto the posterior tibial plateau. Recent literature has identified these tears as common and clinically significant entities associated with meniscal extrusion and the development of degenerative arthritis. Recent studies demonstrated that meniscal root tears are biomechanically equivalent to total meniscectomy in axial load models, while these same studies also report that repair of the meniscal root corrects compartment loading (Marzo, 2008; Allaire et. al. 2008). The current study investigates the effect of posterior medial meniscal root tears on medial compartment loading using a physiologic model that recreates a knee squat. An all arthroscopic meniscal root repair technique which uses a retrograde reaming device (FlipCutterTM, Arthrex, Naples, FL, USA) to create a blind socket at the tibial insertion into which the meniscal root is advanced, recreating the tibial attachment, was then performed to repair the posterior root tear(Nicholas et al 2009). The knees were then similarly loaded after root repair and subsequent total meniscectomy, examining their effect on medial compartment loading. Nine fresh-frozen cadaver knees were dissected of soft tissue to the joint capsule while preserving the insertion and entire length of the quadriceps and hamstring tendons. Knee moments during squatting were simulated in a custom testing jig by application of angle specific loads to the quadriceps and hamstring tendons (based on body mass) with an axial compressive load at the tibia used to flex the knee to the desired angle (simulating the ground reaction force). Anterior and posterior, submeniscal arthrotomies were made allowing for passage of a pressure sensitive, capacitive, electronic sensor, custom made to approximate the medial tibial plateau shape and surface area. This sensor measures both contact area and peak pressures. Each specimen was then tested in four conditions: medial meniscus intact, after creation of posterior root tear, after repair of the meniscal root, and after total medial meniscectomy. Each condition was tested at 15, 45 and 90 degrees of knee flexion. Transection of the meniscal root significantly decreased the contact area of the medial compartment by 13% (p=0.002). After meniscal root repair, contact area was not significantly different from the intact meniscal state (decreased 6%, p=0.302). Additionally, total meniscectomy reduced contact area by 53% (p=0.025). Root transection also resulted in an overall increase in peak contact pressure of 21% (p=0.167) in the medial compartment. Meniscal root repair showed no difference when compared to the intact meniscal state (increased 10% p=0.425) and total meniscectomy increased peak contact pressure by 97% at 15 degrees (p=0.015) with no significant effect at 45 or 90 degrees of knee flexion. Our study differs from previous studies in the use of a physiologic load model that recreates the loads seen in the knee during the performance of a squat rather than an axial load model using supraphysiological loads and/or non-angle specific loading. In contrast to previous reports, our results show that meniscal root tears are not equivalent to total meniscectomies. The reduction in tibiofemoral contact area with meniscal root transection was approximately 25% of that seen with total meniscectomy. The previously described meniscal root repair technique (Nicholas et al 2009) recreated normal compartment loading.

Paper # 164: The Result of Isolated Arthroscopic Meniscal Repairs: Evaluation of Return to Function and Incidence of Re-Tear

Paper # 164: The Result of Isolated Arthroscopic Meniscal Repairs: Evaluation of Return to Function and Incidence of Re-Tear

Comparison of Inside-Out and All-Inside Techniques for the Repair of Isolated Meniscal Tears

Background: Arthroscopic meniscal repair techniques are continuing to evolve. Most studies to date comparing the healing rate of inside-out to all-inside meniscal repair techniques are confounded by associated anterior cruciate ligament reconstruction or deficiency. Purpose: This review was conducted to compare the effectiveness and complications of the inside-out repair technique to that of the all-inside repair technique in isolated unstable peripheral longitudinal (“bucket-handle”) meniscal tears. Study Design: Systematic review. Methods: Computerized keyword searches of MEDLINE, EMBASE, CINAHL, ACP Journal Club, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were performed. Two reviewers independently performed searches and article reduction. Studies that included stratified data for isolated unstable longitudinal meniscal tears in stable knees, repaired with either an inside-out or all-inside repair technique, were selected. Data on clinical failure, subjective outcome measures, and complications were summarized. Results: Nineteen studies included data specific to isolated meniscal tears. The rate of clinical failure was 17% for inside-out repairs and 19% for all-inside repairs. Lysholm scores and Tegner activity scores were similar between the 2 repair methods (87.8 vs 90.2 and 5.6 vs 5.5, respectively). The prevalence of nerve injury/irritation was higher with the inside-out technique (9% vs 2%). All-inside techniques had a higher rate of local soft tissue irritation, swelling, and implant migration or breakage. The use of older generation, rigid, all-inside implants is associated with chondral injury. Conclusion: There are no differences in clinical failure rate or subjective outcome between inside-out and all-inside meniscus repair techniques. Complications are associated with both techniques. More nerve symptoms are associated with the inside-out repair and more implant-related complications are associated with the all-inside technique. Clinical Relevance: Rates of structural healing and complications are comparable for inside-out and all-inside repair techniques for isolated meniscal injury. Differences in observed healing rates after meniscal repair may be more dependent on tear pattern and associated anterior cruciate ligament reconstruction rather than an inside-out versus all-inside surgical approach.

Meniscus Tears in the Young Athlete

The purpose of this study was to evaluate the results of arthroscopic repair of the meniscus in children and young athletes. Arthroscopic meniscus repairs performed on 49 knees in 31 male and 14 female patients <18 years old were reviewed. All repairs were done using an inside-out technique, and 31 patients required concomitant anterior cruciate ligament (ACL) reconstruction. Age at time of injury, time to surgery, and the extent, type, and location of meniscus tear were noted. All patients underwent postoperative rehabilitation and clinical evaluation. The level of activity at follow-up and postoperative outcomes scores was determined. Analysis included t tests, Wilcoxon tests, χ tests, and Fisher exact tests, with a level of significance of P ≥ 0.05. Excellent clinical outcomes were noted in 43 of 45 patients, with mean length of follow-up of 27 months. Between the groups with and without ACL tears, there were no significant differences in mean age at the time of injury or surgery, or in the distribution of open versus closed physes, medial versus lateral repairs, or level-of-activity at follow-up. However, patients with ACL reconstruction had significantly longer return-to-activity times (mean 8.23 mo vs. 5.56 mo) and significantly lower Tegner scores (mean 6.8 vs. 8.0) than patients without simultaneous reconstruction. The clinical results after arthroscopic meniscus repair in the adolescent were excellent, despite long average time from injury to surgery and a high number of tears in poorly vascularized areas. Meniscal tears in skeletally immature athletes may have greater reparative potential, with and without simultaneous ligament reconstruction. Attempts at repair regardless of time from injury or location of tear should be strongly considered in this age group. Level III retrospective cohort series.

Amount of Meniscal Resection after Failed Meniscal Repair

Background The failure rate after arthroscopic meniscal repair ranges from 5% to 43.5% (mean, 15%) in the literature. But little is known about the amount of meniscal tissue removed after failed meniscal repair. Hypothesis The volume of subsequent meniscectomy after failed meniscal repair is not increased when compared with the volume of meniscectomy that would have been performed if not initially repaired. Study Design Case series; Level of evidence, 4. Methods From January 2000 to December 2009, 295 knees underwent arthroscopic meniscal repair for unstable peripheral vertical tears. When present (219 cases), all anterior cruciate ligament (ACL) tears underwent reconstruction. Patients with multiple ligament injuries and posterior cruciate ligament injuries were excluded from the analysis. Thirty-two medial and 5 lateral menisci underwent subsequent meniscectomy after failed repair at a mean of 26 months postoperatively (range, 3-114 months). Five parameters were specifically evaluated: the amount of meniscectomy related to the initial tear, the ACL status, the appearance of chondral lesions, the time from the initial injury to meniscal repair, and the time from repair to meniscectomy. Results The posterior segment of the meniscus was involved in all tears and retears. Among failures, resection of the meniscal segments primarily repaired occurred for 17 medial and 2 lateral meniscal tears (52%); the tear extended in 5 cases (all medial menisci), and healing of some repaired segments led to a partial resection of the initial lesion in 35% of cases (10 medial menisci, 3 lateral menisci). The time from injury to meniscal repair was correlated with an increasing volume of meniscus removed (P < .05) and with the presence of stage 2 or 3 chondral lesions at revision (P < .03). All knees with extended tears (5 cases) and/or with significant chondral degeneration (8 cases) occurred in ACL-reconstructed knees. Among them, 50% (6 of 12) of ACL-reconstructed knees were ACL deficient. Conclusion There are few detrimental effects when repairing a repairable meniscal lesion, even if it fails. The amount of meniscectomy is rarely increased when compared with the initial lesion. This study supports the hypothesis that the meniscus can be partially saved and that a risk of a partial failure should be taken when possible.

Diagnostic Values of 3 Methods for Evaluating Meniscal Healing Status After Meniscal Repair

Background: The main diagnostic methods for evaluating repaired menisci include second-look arthroscopy, clinical assessment, and magnetic resonance imaging (MRI). None of the previous studies applied all 3 methods for each consecutive case nor made any systematic comparison among them. Purpose: This study was undertaken to compare the diagnostic values of the 3 different methods in an attempt to propose suggestions for evaluating meniscal healing results. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Eighty-one patients (89 menisci), with a mean age of 25.4 years (standard deviation [SD], 7.7; range, 15-50 years), underwent arthroscopic meniscal repair, including 65 medial menisci and 24 lateral menisci. Follow-up evaluation for each meniscus included clinical assessment, second-look arthroscopy, and postoperative MRI, with a mean follow-up time of 25.4 months (SD, 6.0; range, 17.4-48.3 months). Defined criteria for unhealed meniscus were any symptoms such as joint-line tenderness, swelling, locking, or positive McMurray test for clinical assessment; cleft or instability on second-look arthroscopy; and grade 3 signal intensity shown at the repaired site on postoperative MRI. Results: Seventy-seven menisci were confirmed completely healed by second-look arthroscopy, with a total healing rate of 86.5%. Clinical assessment found 63 menisci healed, with a clinical healing rate of 70.8% (sensitivity, 58.3%; specificity, 75.3%; accuracy, 73.0%). By using the second-look arthroscopy as the standard, the sensitivity, specificity, and accuracy, respectively, were calculated for MRI in 5 sequences: sagittal T1: 91.7%, 58.4%, 62.9%; sagittal proton density (PD): 83.3%, 40.3%, 46.1%; sagittal T2: 58.3%, 89.6%, 85.4%; coronal PD: 75.0%, 74.0%, 74.2%; and coronal T2: 41.7%, 98.7%, 91.0%. Conclusion: Second-look arthroscopy was the most dependable way to determine meniscal healing. Clinical assessment had obvious limitations in diagnosing healed menisci. On MRI examination, T2-weighted sequences had obviously higher specificity and accuracy, while PD and T1 had higher sensitivity. The diagnostic value could be improved by a combined application of different sequences.

Cross-Sectional and Longitudinal Validity of the Hughston Clinic Knee Questionnaire in Arthroscopic Meniscal Repair

Aim: To examine the cross-sectional and longitudinal convergent and discriminant validity and the sensitivity to change of the Hughston Clinic Knee Questionnaire (HCQ) in young adults with meniscal repair. Method: Seventeen young adults completed the HCQ and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at 1 week and at 6 weeks after an arthroscopic meniscal repair. Convergent validity was assessed by evaluating the correlation between the HCQ and the SF-36 physical function subscale. Discriminant validity from pain measure was assessed by examining the HCQ with the physical function and bodily pain subscales of the SF-36. Sensitivity to change was assessed using standardised response means. Spearman correlation coefficients were also calculated. Results: The HCQ showed moderate to strong cross-sectional and longitudinal convergent validity with the SF-36 physical function subscale; however, discriminant validity was not evident for the HCQ. The HCQ showed a larger standardised response mean than did the SF-36 physical function subscale. Conclusion: Cross-sectional and longitudinal convergent — but not discriminant — validity was established for the HCQ. Although the HCQ was more adept in detecting change scores than did the SF-36 physical function subscale, the reason for this finding was unclear.