Arthroscopic Meniscal Repair Research Articles

Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes?

Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes. Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was -1.1 (-2.1 to -0.05) requiring 12 patients treated with PRP and 17 without to find statistically significant differences at p = 0.05 and power = 80%. There was no difference in the proportion of patients who underwent reoperation in the PRP group (27% [four of 15]) compared with the non-PRP group (25% [five of 20]; p = 0.89). Functional outcome measures were not different between the two groups based on the measures used (mean IKDC score, 69; SD, 26 with PRP and 76; SD, 17 without PRP; p = 0.288; mean, Tegner Lysholm Knee Scoring Scale, 66, SD, 32 with PRP and 89; SD, 10 without PRP; p = 0.065). With the numbers available there was no difference in the proportion of patients who returned to work in the PRP group (100% [six of six]) compared with the non-PRP group (100% [nine of nine]) or in the patients who returned to their regular sports/activities in the PRP group (71% [five of seven]) compared with the non-PRP group (78% [seven of nine]; p = 0.75). Patients who sustain meniscus injuries should be counseled at the time of injury about the outcomes after meniscus repair. With our limited study group, outcomes after meniscus repair with and without PRP appear similar in terms of reoperation rate. However, given the lack of power and nature of the study, modest size differences in outcome may not have been detected. Future larger prospective studies are needed to definitively determine whether PRP should be used with meniscal repair. Additionally, studies are needed to determine if PRP and other biologics may benefit complex tear types. Level III, therapeutic study.

Evaluation of the results of arthroscopic meniscal repair

Introduction Menisci have a role in optimal knee function. Meniscal preservation in younger active individuals presenting with symptomatic meniscal disease is important. The success of meniscal repair depends on appropriate meniscal bed preparation and the surgical technique. Patients and methods A prospective study of 20 cases of post-traumatic meniscal tear was conducted during the period between March 2012 and December 2013. All cases were subjected to arthroscopic evaluation to confirm the diagnosis and ensure they fulfilled the criteria for repair on the basis of site, size, description, and associated injury of the tear. The inclusion criteria were vertical longitudinal tear from 1 to 3 cm in length in the red-red or red-white zone. The exclusion criteria were patient age older than 45 years, white-white zone tear, radial tear, and complex degenerative meniscal tear. The Lysholm score and International Knee Documentation Committee (IKDC) subjective and objective knee scores were used preoperatively and postoperatively for presentation of overall results. All cases were treated by means of the all-inside arthroscopic repair technique using a FasT-Fix meniscal repair device. Results Twenty patients were followed up for an average of 60 weeks. The mean age of the patients was 20.95 ± 1.60 years; the average suture used was 2.85; 70% had isolated meniscal injury, and 30% had associated anterior cruciate ligament (ACL) tear; the average tear length was 1.91 cm. The mean preoperative and postoperative Lysholm scores were 38.25 and 91.20, respectively. The mean preoperative and postoperative IKDC subjective evaluation results were 31.28 and 91.44, respectively. The preoperative IKDC objective evaluation results revealed 16 (80%) patients with severely abnormal knees (grade D) and four (20%) patients with abnormal knees (grade C). The postoperative IKDC objective evaluation results revealed two (10%) patients with abnormal knees (grade C), three (15%) patients with nearly normal knees (grade B), and 15 (75%) patients with normal knees (grade A). There is better improvement in scores if ACL reconstruction is performed simultaneously with meniscal repair, the procedure is performed for vertical longitudinal tears, the tear is in the 'red-red' zone, and the tear length is less than 21 mm. There were no differences in functional results on the basis of repair of medial meniscus or lateral meniscus, acute or chronic injuries, or age. Conclusion Better outcome of meniscal repair was seen in patients with vertical longitudinal tear in the red-red zone with a tear length of less than 21 mm and associated with ACL reconstruction.

Results of Meniscus Repair for the Hypermobile Medial Meniscus

Objectives:There have been very few studies on hypermobile lateral meniscus, but hypermobility of the medial meniscus has not been reported; the latter is more common in our practice. It is characterized by lax peripheral attachment of the middle 1/3 of the medial meniscus without a tear existing. In its most severe form (grade III) the meniscus can be displaced to the middle of the plateau and everted more than 60 degrees by probing the meniscocapsular attachment. The purpose of the present study is to analyse the clinical features of hypermobile medial meniscus and the results of meniscus repair.Methods:14 patients (14 knees; 10 right) underwent arthroscopic meniscal repair for hypermobile medial meniscus. Men and women were equally affected; average age was 28 (14-46). The mean duration of symptoms was 18 (2-96) months. Six cases (43 %) had no history of trauma. The most common symptoms were medial joint line pain (n:14), locking (n:9), giving way (n:9), rest pain (n:9) and inability to squat (n:5). The most common clinical findings were medial joint line tenderness (n:11), positive McMurray’s test (n:9), medial retinacular tenderness (n:6), and effusion (n:3). 13 patients were rated as poor by the Lysholm scale; average 52(35-85), average Tegner activity level was 5.6 (3-9). MRI, available for eight patients, did not show any spesific findings. Arthroscopy did not reveal any other lesions to explain the mechanical symptoms. SPSS 16,00 for Windows (Statistical Program for the Social Services Inc, Chicago, IL, USA) program was used for statistical analysis. Continuous variables were defined as mean ± standard derivation. Variables were tested for normal distribution by using the Kolmogorov–Smirnow test. Differences between the groups were assessed by using unpaired t-test or Mann–Whitney U-test instead, if continuous variables did not have normal distribution. Paired sample t-test was used to compare continuous variables (data of Tegner and Lysholm scores, preoperative and at last control). P < 0.05 was accepted as statistically significant.Results:All the patients were available for follow-up; average 32 (6-59) months. 11 patients (78 %) had no mechanical symptoms. Patients’ own evaluation was; 3 very good, 7 good, 3 fair and 1 poor. 13 patients were better. At follow-up, significant improvement was obtained in Lysholm score which was 84(52-100) in average (p<0.01) ; 9 (64 %) good-excellent,4 (28%) fair and 1 (7%) poor. Tegner levels were almost regained: Decrease by 1 grade (4.7 in average (1-9)) (p=0.026). Despite satisfactory results, more than half had minor symptoms and findings.Conclusion:Hypermobile medial meniscus is characterized by medial pain and mechanical symptoms. Two types can be distinguished: traumatic and atraumatic. For significant hypermobility, the meniscus should be stabilized by repair. Patients benefit from repair, but more than half continue to have minor symptoms.

The outcome of all-inside meniscal repair with relation to previous anterior cruciate ligament reconstruction.

Arthroscopically assisted all-inside meniscal repair has become a popular treatment for meniscal tears. Previous studies have suggested a beneficial effect of concomitant anterior cruciate ligament reconstruction on meniscal repair outcomes. The effect of prior cruciate ligament reconstruction (predating the meniscal injury) on meniscal repair success is unreported. The aim of this study was to assess the success of meniscal repair in our practice. Further aims were to analyze the effect of concomitant- and past-anterior cruciate ligament reconstruction on meniscal repair outcomes. Retrospective review of all patients undergoing arthroscopic meniscal repair during a 53 month period was performed. Mean followup was 13.5 months (mean 6-50). The primary outcome measure was meniscal reoperation. Sixteen of 104 patients required reoperation, giving an overall meniscal repair success rate of 85%. Patients undergoing concomitant anterior cruciate ligament reconstruction enjoyed significantly improved outcomes (91%, p=0.049), while those with a past history of anterior cruciate ligament reconstruction had significantly worse meniscal repair success rates (63%, p=0.016). Arthroscopic meniscal repair in a selected patient group offers good success rates, especially when performed with concomitant anterior cruciate ligament reconstruction. We have identified a subgroup of patients, those with a past history of anterior cruciate ligament reconstruction predating the meniscal injury, who appear to have relatively poor outcomes from meniscal repair. Potential reasons for this finding are discussed. Level IV, case series.

Arthroscopic Repair of Horizontal Meniscal Cleavage Tears With Marrow-Stimulating Technique

The purpose of this study was to evaluate patients after arthroscopic repair of meniscal horizontal tears with a marrow-stimulating technique through clinical signs and second-look arthroscopy. We retrospectively reviewed a consecutive series of 32 meniscal repairs with horizontal cleavage tears and evaluated them through clinical assessment and second-look arthroscopic examinations. Arthroscopic meniscal repair and a marrow-stimulating technique were performed. Functional outcomes were evaluated using the visual analog scale (VAS) pain score, Lysholm knee scoring scale, and Tegner activity scale. Assessment of meniscal healing was evaluated clinically by the presence of meniscal signs; second-look arthroscopy was performed in 11 patients. Correlation between chronicity of a meniscal lesion (time from initial symptom [TFIS]) and meniscal healing was evaluated. The mean follow-up period was 45.6 ± 13.9 months. Improvements in mean VAS scores from 6.7 to 1.9 (P < .001) were observed. The Lysholm score increased from 48.0 ± 14.4 to 92.0 ± 6.3 (P < .001). The Tegner activity score increased from 3.3 ± 1.1 to 6.8 ± 0.8 (P < .001). At the last follow-up, 29 of 32 patients (91%) were evaluated as healing in the clinical assessment. Of the 11 patients who underwent second-look arthroscopy, 8 (73%) showed complete healing, 2 (18%) had incomplete healing, and 1 (9%) failed to heal. Correlation between TFIS and meniscal healing was clinically significant (P = .001) but arthroscopically insignificant (P = .085) on second-look arthroscopy. The meniscal repair procedure for horizontal cleavage tears in the present study suggests an alternative treatment option to approach the treatment of meniscal tears extending into the avascular zone and degenerative tissue. The marrow-stimulating technique using a cannulated reamer can be considered as an alternative method for the augmentation of meniscal healing. Level IV, therapeutic case series.

10 Year Outcome Following Meniscus Repair Using Inside-Out Technique: A Comparative Cohort of Patients 40 years and Older vs Patients Younger than 40

Objectives:The number of meniscus repairs being performed is increasing, as research supports the need to preserve native meniscus tissue. Although excellent short-term results have been published after meniscus repair, there are limited data available on longer outcomes in patients treated with a single type of repair. The purpose of this study was to compare failure rate and clinical outcomes 10 years following mensicus repair, using inside-out technique, by a single surgeon in patients 40 years and older and patients younger than 40 years.Methods:A prospective data registry was queried for knee arthroscopies between 1992 and 2003 for meniscus repairs performed by a single surgeon. This study was IRB approved. Patients who underwent arthroscopic meniscus repair using inside-out technique were included. Exclusion criteria included patients younger than 18 years. Repairs were considered a failure if the knee had a subsequent surgery on the same meniscus or the knee was converted to a total knee arthroplasty(TKA). If knees required subsequent surgery on the meniscus, it was documented if it was a re-repair or meniscectomy. General health measure included the SF12 physical component score (PCS) and the mental component score(MCS). Condition specific outcomes included the Lysholm score, WOMAC and IKDC score. Activity was measured by the Tegner activity scale and patient satisfaction with outcome was measure on a 1 to 10 scale with 10 being very satisfied. Outcomes and failures were compared between patients 40 years and older(40P) and patients younger than 40(40Y).Results:206 patients were met the inclusion criteria. The average age was 33 years (range, 18 to 70 years) and there were 75 females and 131 males. Sixty-four (31%) knees underwent a subsequent knee surgery; 61 patients had a second meniscus surgery on the same meniscus and three had a TKA, and were therefore considered failures. Of the 61 patients who underwent a second meniscus surgery, 47 had a meniscectomy and 14 had a meniscus repair. The average age of the failure group was 33 years (range, 18 to 65 years), with 15 over the age of 40 at time of repair. The was no difference in the number of failures between 40P group and 40Y group(p=0.975) The average time to failure was 4.9 years postoperatively (range, 0.8 months to 18.6 years). Of the remaining patients, average followup was 14 years (range, 10 to 21 years). The average PCS was 54 and the average MCS was 54. The average Lysholm at latest followup was 86, the average WOMAC was 6 and the average IKDC was 73. The median Tegner activity scale was 6 (range, 1 to 9). The median patient satisfaction with outcome was 9 (range, 1 to 10). There was no difference in any outcome measure between the 40P group and the 40Y group.Conclusion:Ten years following meniscus repair, 30% of patients required repeat surgery of the meniscus or had a TKA. Older patients did not experience increased failures. Outcomes showed excellent function, low disability and high activity level 10 years following meniscus repair.

Short- to mid-term results of arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques: a retrospective study.

The purpose was to evaluate the clinical results of arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques. Single surgeon retrospective case series study. A total of 38 patients having long vertical longitudinal tears were operated using combined cruciate and horizontal suture techniques. Two patients had to undergo a meniscectomy procedure within the 1st year postoperative and those were considered failure cases; 32 patients were available for follow-up evaluation (average 4.6 years) and six were lost including the two failures. Objective IKDC, modified Lysholm knee score, SF-36 score, VAS for patients' satisfaction and VAS for pain were used for follow-up evaluation. Kellgren and Lawrence (K/L) classification of osteoarthritis was also used. Successful rate was 94.1% (32 patients), while failure was 5.9% (2 patients). Objective IKDC score revealed that 27 patients had grade "A" and 5 had grade "B," while no single patient had neither grade "C" nor "D." The average modified Lysholm score was 91.3. Average SF-36 score was 88.4. The average VAS for operation satisfaction was eight. Average VAS for pain was 1.5. Preoperatively, 30 patients were classified as normal K/L classification, while two patients were K/L classification grade "1." At the time of the follow-up, 24 patients were classified as normal K/L classification, six were grade "1," two were grade "2," and thus, six had osteoarthritis progression. Arthroscopic meniscal repair of long vertical longitudinal tears using combined cruciate and horizontal suture techniques is a safe surgical procedure with good clinical outcome. Level IV.

Strength of Arthroscopic Meniscal Root Repair Constructs

Clinical study has illustrated the prevalence of meniscal root injury and potential for degenerative sequel without repair. Repair constructs have been presented by authors, and repair strengths determined. However, prior studies have evaluated constructs placed ex vivo without method to place the strongest construct in an arthroscopic fashion nor strength evaluation of constructs placed arthroscopically. We present two new meniscal root repair constructs with arthroscopic technique and strength evaluation of arthroscopically placed repair constructs. Pullout strength, stiffness, and time of suture construct for the different meniscal repair patterns was evaluated. This will aid the clinician in determining the best method for arthroscopic meniscal root repair and aid in the development of appropriate postoperative rehabilitation plans. The hypothesis of this study is that maximum failure load, stiffness, and repair execution time will vary based upon suture construct, with higher strengths and execution times with increased repair technique complexity. Twenty cadaveric knees were mounted in a simulated surgical position, and sutures were placed arthroscopically at the root of the medial and lateral menisci. Four repair constructs were tested including 2 novel repair constructs: 2 simple stitches, 1 inverted mattress stitch, 1 double locking loop stitch, and 2 double locking loop stitches. Arthroscopic placement of suture repair construct was timed. In total 40 posterior meniscal roots, both lateral and medial from 21 cadaveric specimens were tested, with 10 trials for each construct. Specimens were dissected, and the medial and lateral menisci harvested. Individual meniscus specimens were cycled and then tested to failure on an Instron machine with a custom baseplate mimicking the transosseous suture tunnel utilized in meniscal root repair. The Kruskal-Wallis Test was used to evaluate for statistical significance between groups. The mean maximum failure loads were: 2 simple stitches (2SS) 137±49 N, 1 inverted mattress stitch (1MS) 126±44 N, 1 double loop locking stitch (1DLS) 201±44 N, 2 double loop locking stitches (2DLS) 396±69 N. Inter-construct comparison revealed statistical difference between 2DLS (p < 0.01) and all three remaining constructs (< 0.01), and 1DLS when compared to 2SS and 1MS (p <0.01, <0.01). Statistical significance was not found between 2SS and 1MS (p=0.8). The average time for repair of the 4 fixation techniques were: 2SS 1.78 ± 0.87 minutes, 1MS 2.40 ± 1.90 minutes, 1DLS 4.67 ± 2.01minutes, 2DLS 5.38 ± 0.62 minutes. Constructs with four suture limbs within the simulated repair tunnel illustrated stiffer constructs. Arthroscopically placed locking loop repair constructs are stronger than current arthroscopic techniques with increase in time of repair. As complexity of the repair construct increases so does time for fixation and pullout strength. With this study, an arthroscopic technique is presented to produce stronger meniscal root repair constructs with little increase in surgical time.

Evaluation of Skill Level Between Trainees and Community Orthopaedic Surgeons Using a Virtual Reality Arthroscopic Knee Simulator

Several virtual reality simulators have been developed to assist orthopaedic surgeons in acquiring the skills necessary to perform arthroscopic surgery. The purpose of this study was to assess the construct validity of the ArthroSim virtual reality arthroscopy simulator by evaluating whether skills acquired through increased experience in the operating room lead to improved performance on the simulator. Using the simulator, six postgraduate year-1 orthopaedic residents were compared with six postgraduate year-5 residents and with six community-based orthopaedic surgeons when performing diagnostic arthroscopy. The time to perform the procedure was recorded. To ensure that subjects did not sacrifice the quality of the procedure to complete the task in a shorter time, the simulator was programmed to provide a completeness score that indicated whether the surgeon accurately performed all of the steps of diagnostic arthroscopy in the correct sequence. The mean time to perform the procedure by each group was 610 seconds for community-based orthopaedic surgeons, 745 seconds for postgraduate year-5 residents, and 1028 seconds for postgraduate year-1 residents. Both the postgraduate year-5 residents and the community-based orthopaedic surgeons performed the procedure in significantly less time (p = 0.006) than the postgraduate year-1 residents. There was a trend toward significance (p = 0.055) in time to complete the procedure when the postgraduate year-5 residents were compared with the community-based orthopaedic surgeons. The mean level of completeness as assigned by the simulator for each group was 85% for the community-based orthopaedic surgeons, 79% for the postgraduate year-5 residents, and 71% for the postgraduate year-1 residents. As expected, these differences were not significant, indicating that the three groups had achieved an acceptable level of consistency in their performance of the procedure. Higher levels of surgeon experience resulted in improved efficiency when performing diagnostic knee arthroscopy on the simulator. Further validation studies utilizing the simulator are currently under way and the additional simulated tasks of arthroscopic meniscectomy, meniscal repair, microfracture, and loose body removal are being developed.

Tissue Engineered Meniscus Repair: Influence of Cell Passage Number, Tissue Origin, and Biomaterial Carrier.

Objective:Studies have shown that meniscal repairs have better outcomes over both partial and total meniscectomies. Tissue engineering strategies to repair meniscus tears have been explored using cell sources that involve a donor as well as a period of in vitro cell expansion before use. This study explored cell sources that could be easily harvested and rapidly isolated by enzymatic digestion and cannulated delivery.Methods:Bovine menisci were used to create a bucket handle tear. Cell lines were established from meniscus, synovium, and adipose tissue and fluorescently labeled. At passages P2, P4, and P8, cells were added to the defect from the following experimental groups: cells alone, collagen gel, collagen scaffold, or hyaluronic acid. Menisci constructs were xenografted subcutaneously onto the dorsum of athymic rats and incubated for 3, 6, and 9 weeks, at which time they were retrieved and processed for histology.Results:Meniscal cells were able to repair defects faster and significantly better than adipose or synovium derived cells. Adipose cells were the least effective in comparison. Repair was significantly better at 9 weeks compared with 6 and 3 weeks. Macroscopic examination of menisci that received cell implants showed the thickest tissue in menisci that had collagen implants, and the thinnest fill occurred in menisci treated with cells alone. Histology confirmed no cells or integrative repair in the control specimens.Conclusions:Delivery of cells alone outperformed the additional use of biomaterials. Our results suggest a strategy that would use both meniscus and synovial cells for arthroscopic meniscal repair.

Second-Look Arthroscopic Results after Repair of Medial Meniscus Root Tears

Purpose: The purpose of this study is to evaluate the healing rate of medial meniscus root repair according to the duration of symptom and to determine the association between healing status and the clinical result after medial meniscus root repair. Materials and Methods: Eighty-four patients who underwent arthroscopic meniscal root repair and second-look arthroscopy were included. Second-look arthroscopy evaluation of meniscal healing status was performed by dividing medial meniscal posterior root into the anterior half and posterior half and classifying by contact degree on the surface of the tibia and continuity. Clinical results were analyzed according to International Knee Documentation Committee (IKDC) subjective scores and Lysholm scores. In addition, after dividing cases according to acute group and chronic group by six-month symptomatic period, differences were evaluated. Results: Significant differences in post-operative clinical results were observed between the acute group and chronic group. A significant difference in meniscal healing status was observed between the two groups (p<0.001). A higher postoperative IKDC score and Lysholm score was observed for the completely healed group, as confirmed by second-look arthroscopy, than for the other groups. Conclusion: In the aspect of improving the clinical result, arthroscopic medial meniscal posterior root repair is a good treatment modality. Early repair of medial meniscal posterior root may lead to improvements in the clinical result such as meniscal healing status.

Evaluation of accelerated rehabilitation protocol after arthroscopic meniscus repair

Evaluation of accelerated rehabilitation protocol after arthroscopic meniscus repair

Clinical Outcomes of Revision Meniscal Repair

Background: Meniscal preservation results in better clinical outcomes than meniscectomy; however, no studies have evaluated the results of revision meniscal repair. Hypothesis: Revision meniscal repair can achieve good clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: The study participants were 16 patients with symptomatic meniscal retears of a total of 96 patients who underwent primary arthroscopic meniscal repair. Fifteen of these 16 patients underwent revision meniscal repair. The mean age at revision was 27 years, and the mean duration between the primary operation and revision was 27 months. Eight patients had degenerative changes of the meniscus at revision. Clinical outcomes were assessed using the Lysholm score and the Tegner sports activity score, and image assessment was performed using magnetic resonance imaging. Results: Five patients had re-retears of a resutured meniscus, and the mean duration between revision and the re-retear was 25 months (range, 8-68 months). The mean follow-up of patients without re-retears was 41 months (range, 24-74 months), and the mean Lysholm score in those without re-retears significantly improved from 81.4 points (range, 73-89 points) at pre-revision to 97.4 points (range, 90-100 points) at the final survey (P = .0001). Degenerative changes of the meniscus at the revision site were observed in all 5 patients with re-retears but in only 3 of the 10 patients without re-retears. Conclusion: Revision meniscal repair should be considered in the setting of a retorn meniscus without degenerative changes.

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.

Is the Meniscal Healing of Importance on Long-Term Clinical Outcomes or Incidence of Osteoarthritis After Meniscal Repair?

Is the Meniscal Healing of Importance on Long-Term Clinical Outcomes or Incidence of Osteoarthritis After Meniscal Repair?

Magnetic Resonance Imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair

The purpose of this study was to assess the MRI features of the all-inside repaired meniscus in the long-term. Among 27 consecutive all-inside arthroscopic meniscal repairs, 23 patients aged 25 ± 5 years at the time of surgery were reviewed at a median follow-up of 10 ± 1 years. Retrospective clinical examinations and imaging assessments using a 1.5-T MRI after all-inside arthroscopic meniscal repair were conducted. At follow-up, Lysholm and IKDC averaged 89 ± 11 and 95 ± 8, respectively. MRI examinations revealed no meniscal signal alteration in three patients (13%), a vertical signal located in the previously torn area in seven (30%), a horizontal grade 3 in nine (39%), and a complex tear (grade 4) in four (17.5%). There were no differences between medial and lateral menisci (p = 0.15), stable and stabilised knees (p = 0.56). Several abnormal vertical and/or horizontal hypersignals are still present on MRI examination ten years after arthroscopic all-inside meniscal repair. The appearance of early signs of osteoarthritis is rare, suggesting a chondroprotective effect of the repaired meniscus.

Cross-sectional Analysis of Trends in Meniscectomy and Meniscus Repair

Knee arthroscopy to address meniscus tears is among the most common orthopedic procedures performed, and technical advances in the treatment of meniscus tears have affected the treatment options available to orthopedic surgeons. The purpose of this study was to perform a large cross-sectional analysis of orthopedic patients to investigate trends in arthroscopic meniscectomy and meniscus repair in the United States. Patients who underwent arthroscopic meniscectomy (Current Procedural Terminology codes 29881 and 29880) and arthroscopic meniscus repair (Current Procedural Terminology codes 29882 and 29883) were identified using the PearlDiver Patient Record Database, which is a national database of insurance records. The authors identified 187,607 arthroscopic medial or lateral meniscectomies and repairs performed between 2004 and 2009. Ninety-six percent of patients underwent meniscectomy and 4% underwent repair. No change occurred in the incidence of medial or lateral meniscectomy. The incidence of medial meniscus repair decreased from 5.3 cases per 10,000 patients in 2004 to 3.8 in 2009 (P<.001), although no significant change occurred in the incidence of lateral meniscus repair. Medial meniscectomy was most commonly performed in patients aged 50 to 59 years, whereas lateral meniscectomy demonstrated a bimodal age distribution. Conversely, meniscus repairs were most frequently performed in patients aged 10 to 19 years. Sex differences were more pronounced with meniscus repair (63% male vs 37% female) compared with meniscectomy (53% male vs 47% female). A high frequency of meniscus debridement can be expected in arthroscopic knee surgery. Despite advances in meniscus repair techniques and devices, no increase occurred in the performance of meniscus repair compared with meniscectomy.

Trends in Meniscus Repair and Meniscectomy in the United States, 2005-2011

Background: Meniscus deficiency may lead to degenerative arthritis in the knee. There is a significant emphasis on meniscus preservation, particularly in the young patient, to reduce the risk of arthritis. Purpose: To report on the incidence of meniscus repair and meniscectomy, with and without concomitant anterior cruciate ligament (ACL) reconstruction, in the United States (US) over the past 7 years. Study Design: Descriptive epidemiology study. Methods: Patients who underwent arthroscopic meniscectomy (Current Procedural Terminology [CPT] codes 29880 and 29881), meniscus repair (CPT codes 29882 and 29883), and ACL reconstruction (CPT code 29888) for the years 2005 through 2011 were identified using the PearlDiver Patient Record Database. Age group and sex were collected for each patient. Patient groups included meniscectomy alone, meniscus repair alone, meniscus repair followed by meniscectomy, ACL reconstruction with concomitant meniscus repair, and ACL reconstruction with concomitant meniscus repair followed by meniscectomy. Linear regression and Student t tests were utilized for comparisons, with an α value of .05 set as significant. Results: The database represented approximately 9% of the US population under 65 years of age. There was no significant change in the number of patients in the covered population during the study time frame (P = .138). From 2005 to 2011, there were a total of 387,833 meniscectomies, 23,640 meniscus repairs, and 84,927 ACL reconstructions. There was a significant increase in the total number of isolated meniscus repairs performed (P = .001) and a doubling of the incidence of repairs from 2005 to 2011. There was no significant increase in the total number of meniscectomies performed (P = .712), while the incidence of meniscectomies increased only 14% from 2005 to 2011. There was no significant change in the number of meniscus repairs performed at the same time as ACL reconstruction during the study time frame. The total number and incidence of meniscectomies after repair with and without ACL reconstruction significantly decreased. Conclusion: There has been an increased number of isolated meniscus repairs being performed in the US over the past 7 years without a concomitant increase in meniscectomies over the same time frame. These data suggest that meniscus repairs are preferentially being performed over meniscectomies.

Long-term outcomes of all-inside meniscal repair

The mean reported healing rate after meniscal repair is 60% of complete healing, 25% of partial healing and 15% of failure. However, partially or incompletely healed menisci are often asymptomatic in the short term. It is unknown whether the function of the knee with a partially or incompletely healed meniscus is disturbed in the long term. The purpose of this study was to assess the long-term outcomes of meniscal repairs according to the initial rate of healing. Forty-one consecutive meniscal repairs were performed between 2002 and 2003. The median age at the time of surgery was 22 years (9-40). There were 25 medial and 16 lateral menisci. When present, all ACL lesions underwent reconstruction (61.3% of cases). According to Henning's criteria, by Arthro-CT at 6 months, twenty cases had healed completely, seven partially healed and four cases healed incompletely. At a mean follow-up of 114 ± 10 months, 31 patients were retrospectively followed for clinical and imaging assessments. Objective IKDC score was good in 92% of the cases (17 IKDC A, 8 B and 2 C). The mean KOOS distribution was as follows: pain 94.3 ± 9; symptoms 90.9 ± 15; daily activities 98.7 ± 2; sports activities 91.1 ± 14; and quality of life 91.5 ± 15. Twenty-three patients displayed no signs of osteoarthritis when compared to the non-injured knee, six patients had grade 1 osteoarthritis and two grade 2. The subjective IKDC score did not decrease with time (ns). Moreover, there were no differences between lateral and medial menisci (ns), in stable or stabilised knees (ns). The initial meniscal healing rate did not significantly influence clinical or imaging outcomes (ns). Four patients with no healing underwent a meniscectomy (12.9%). Arthroscopic all-inside meniscal repair with hybrid devices may provide long-term protective effects, even if the initial healing is incomplete. Case series, Level IV.

Common peroneal nerve palsy as a postoperative complication in lateral meniscus repair

Arthroscopic lateral meniscus repair using an inside-out technique can potentially be hazardous to the common peroneal nerve. This is true even for a longitudinal incision posterior to the posterior border of the iliotibial band, which allows visualization of the lateral joint capsule. A 37-year-old woman presented with common peroneal nerve dysfunction after an arthroscopic lateral meniscus repair using this technique. After confirmation of nerve entrapment by magnetic resonance imaging (MRI), an early exploration to decompress the involved nerve eventually resulted in the recovery of neurological function. In addition, an all-inside technique using a FasT-Fix suture device was used as an effective and safe remedy after untying the earlier sutures from the lateral meniscus repair that were trapping the nerve.