Concurrent Anterior Cruciate Ligament Reconstruction Research Articles

Low meniscus reoperation rates following meniscus repair during anterior cruciate ligament reconstruction in Turkey: an in-depth national analysis of 8-years

BackgroundConcomitant knee injuries, such as meniscal tears, are observed in up to 80% of cases and can have a detrimental impact on outcomes following anterior cruciate ligament reconstruction (ACLR). Over recent decades, there has been a growing recognition of the importance of preserving meniscal tissue. Consequently, the prevalence of meniscal-preserving procedures has been on the rise.PurposeThe objective of this study was to examine the prevalence of concurrent meniscal procedures, assess the success rate, and identify factors associated with the failure of meniscal repair in patients undergoing ACLR.MethodsAll patients who underwent ACLR due to anterior cruciate ligament (ACL) injury between January 2015 and December 2022 were extracted from the Republic of Türkiye National health system using operation-specific procedure codes. Patients with multiple ligament injuries, revision ACL patients, and patients with missing data were excluded from the study. The treatment methods were grouped into the subsets of meniscectomy, meniscal repair, transplantation, and meniscectomy + repair. The distribution of ACLR and meniscus treatment methods according to years, age and sex groups, hospital characteristics, and geographical regions was examined. A secondary analysis was performed to assess the effect of patient demographics and hospital healthcare level on revision meniscal procedures in the ACLR + concomitant meniscal repair group.ResultsA total of 91,700 patients who underwent ACLR between 2015 and 2022 were included in the study. A concomitant meniscal procedure was noted in 19,951(21.8%) patients (16,130 repair,3543 meniscectomy). In the 8 years studied, meniscus repair rates increased from 76.3%to87.9%, while meniscectomy rates decreased from 23.7%to12.1% (p < 0.001). The revision meniscus surgery rate following ACLR + meniscal repair was 3.7%at a mean follow-up of 50 ± 26 months. The interval between primary and revision surgery was 20.5 ± 21.2 months. The meniscectomy rates were higher in community hospitals, while private hospitals showed the lowest revision meniscus surgery rates. Younger age was associated with increased meniscus repair failure rates.ConclusionThe propensity towards using repair techniques to treat meniscal tears during concurrent ACLR has significantly increased in Turkey. Age and the healthcare level of the treating hospital affect the success of meniscal repair.

Good mid- to long-term outcomes after meniscus bucket-handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction.

To evaluate mid- to long-term clinical outcomes after arthroscopic bucket-handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty-five patients with an average follow-up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post-operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. The failure rate was 9%. Medial BHMT repair showed superior post-operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post-operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow-up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post-operative outcome measures was observed but did not reach statistical significance for most items. Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow-up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level IV (retrospective case series).

Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction.

The purpose of this study was to compare the rates of secondary knee surgery for patients undergoing meniscus repair with or without concurrent anterior cruciate ligament reconstruction (ACLr). Utilizing a large national database, patients with meniscal repair with or without concurrent arthroscopic ACLr were identified. The two cohorts were then queried for secondary surgical procedures of the knee within the following 2 years. Frequency, age distribution, rates of secondary surgery, and type of secondary procedures performed were compared. In total, 1,585 patients were identified: meniscus repair with ACLr was performed for 1,006 (63.5%) and isolated meniscal repair was performed for 579 (36.5%). Minimum of two year follow up was present for 487 (30.7% of the overall study population). Secondary surgery rates were not significantly different between meniscus repair with concurrent ACLr and isolated meniscus repairs with an overall mean follow up of 13 years (1.5-24 years) (10.6% vs. 13.6%, p = 0.126). For the 2 year follow up cohort, secondary surgery rates were not significantly different (19.3% vs. 25.6%, p = 0.1098). There were no differences in survivorship patterns between the two procedures, both in the larger cohort (p = 0.2016), and the cohort with minimum 2-year follow-up (p = 0.0586). The current study assessed secondary surgery rates in patients undergoing meniscus repair with or without concurrent ACLr in a large patient database. Based on this data, no significant difference in rates of secondary knee surgery was identified.

Ten-Year Outcomes of Second-Generation, All-Inside Meniscal Repair in the Setting of ACL Reconstruction.

Meniscal repair is the goal, whenever possible, for the treatment of meniscal injury. The purpose of this study was to evaluate the long-term clinical success of meniscal repair performed with a second-generation, all-inside repair device with a concomitant anterior cruciate ligament (ACL) reconstruction. This was a retrospective review of prospectively collected patients who underwent meniscal repair by a single surgeon using the all-inside FAST-FIX Meniscal Repair System (Smith & Nephew) in conjunction with a concurrent ACL reconstruction. Eighty-one meniscal repairs (81 patients) were identified: 59 medial repairs and 22 lateral repairs. Clinical failure was defined as repeat surgical intervention involving resection or revision repair. Clinical outcomes were assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Marx Activity Rating Scale score. Ten-year follow-up was obtained for 85% (69) of 81 patients. Nine patients (13% of 69) underwent a failed meniscal repair (6 medial, 3 lateral), corresponding to a failure rate of 12% (6 of 50) for medial repairs and 16% (3 of 19) for lateral repairs. The mean time to failure was 2.8 years (range, 1.2 to 5.6 years) for the medial repairs and 5.8 years (range, 4.2 to 7.0 years) for the lateral repairs (p = 0.002). There was no difference in mean patient age, sex, body mass index, graft type, or number of sutures utilized between successful repairs and failures. Postoperative KOOS and IKDC outcome scores significantly improved over baseline scores (p < 0.001). There was no significant difference in patient-reported outcomes at 10 years between the group with successful repairs and those who had a failed repair. This report of long-term follow-up results of primary second-generation, all-inside meniscal repair demonstrates its relative success when it is performed with concurrent ACL reconstruction. After a minimum follow-up of 10 years, 84% to 88% of the patients continued to demonstrate successful repair. Failure of medial meniscal repairs occurred significantly earlier compared with lateral meniscal repairs. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Higher Risk of Medial Meniscal Repair Failure Following Concurrent Anterior Cruciate Ligament Reconstruction with a Hamstring Tendon Autograft: Results from the New Zealand ACL Registry

Higher Risk of Medial Meniscal Repair Failure Following Concurrent Anterior Cruciate Ligament Reconstruction with a Hamstring Tendon Autograft: Results from the New Zealand ACL Registry

Meniscal repair failure following concurrent primary anterior cruciate ligament reconstruction: results from the New Zealand ACL Registry

PurposeThis study aimed to identify the risk factors for meniscal repair failure following concurrent primary anterior cruciate ligament (ACL) reconstruction.MethodsProspective data recorded by the New Zealand ACL Registry and the Accident Compensation Corporation were reviewed. Meniscal repairs performed during concurrent primary ACL reconstruction were included. Repair failure was defined as a subsequent reoperation involving meniscectomy of the repaired meniscus. Multivariate survival analysis was performed to identify the risk factors for failure.ResultsA total of 3,024 meniscal repairs were analysed with an overall failure rate of 6.6% (n = 201) at a mean follow-up of 2.9 years (SD 1.5). The risk of medial meniscal repair failure was higher with hamstring tendon autografts (adjusted HR [aHR] = 2.20, 95% CI 1.36–3.56, p = 0.001), patients aged 21–30 years (aHR = 1.60, 95% CI 1.30–2.48, p = 0.037) and in patients with cartilage injury in the medial compartment (aHR = 1.75, 95% CI 1.23–2.48, p = 0.002). The risk of lateral meniscal repair failure was higher in patients aged ≤ 20 years (aHR = 2.79, 95% CI 1.17–6.67, p = 0.021), when the procedure was performed by a low case volume surgeon (aHR = 1.84, 95% CI 1.08–3.13, p = 0.026) and when a transtibial technique was used to drill the femoral graft tunnel (aHR = 2.30, 95% CI 1.03–5.15, p = 0.042).ConclusionThe use of a hamstring tendon autograft, younger age and the presence of medial compartment cartilage injury are risk factors for medial meniscal repair failure, whereas younger age, low surgeon volume and a transtibial drilling technique are risk factors for lateral meniscal repair failure.Level of evidenceLevel II.

Revision Anterior Cruciate Ligament Reconstruction and Increased Tibial Slope: When to Perform a Slope-Altering High Tibial Osteotomy

Background: Slope-correcting high tibial osteotomy (HTO) is gaining popularity for mitigating the impact of posterior tibial slope (PTS) on graft failure in patients requiring revision anterior cruciate ligament (ACL) reconstruction surgery. Biomechanical and clinical studies have demonstrated that PTS reduction results in decreased graft forces and satisfactory patient outcomes, making it an important technique in the setting of complex revision ACL reconstruction (ACL-R). Indications: Slope-correcting HTO can be performed for the management of recurrent knee instability after ACL-R due to a high PTS of 12° or greater. Technique Description: A 3- to 4-inch incision is made along the tibia using an anteromedial approach, and the exposed patellar tendon is protected using a retractor. The anterior compartment is exposed by an incision in the tibialis anterior fascia, followed by elevation of the tibialis anterior and placement of a Hohmann retractor. Subperiosteal elevation of the medial collateral ligament (MCL) is performed on the medial side of the tibial tubercle. The position of eventual screw fixation is marked, and a straight tubercle osteotomy is performed without anteriorization, leaving a freely exposed proximal tibia. Two K-wires are used to mark the location of the osteotomy. Soft tissue structures are protected with Hohmann retractors on both sides while using an oscillating saw to perform the osteotomy. A few degrees (1°-3°) of overcorrection are preferred. The osteotomy is completed, retaining 1cm of posterior hinge. The wedge is removed and reduced by hyperextending the knee under gentle manual traction. Pre-contoured, low-profile plates with locking screws are placed, with 3 screws proximally and another 3 distally. During concurrent ACL-R, the screws should leave room for drilling of the ACL tibial tunnel. Results: Studies investigating the effects of slope-correcting HTO concurrent to revision ACL-R have reported reduced anterior tibial translation and rotatory knee instability, improved patient-reported outcomes, and a reduction in graft failure risk. Description/Conclusion: Slope-reducing HTO is an essential technique in the arsenal of complex ACL surgeons aiming to correct the detrimental effect of an increased PTS on ACL graft integrity in the setting of revision ACL-R.

Patient’s subjective knee function 3-5 years following partial meniscectomy or meniscus repair compared to a normal population: a retrospective cohort study

PurposeEvaluate patient-reported knee function after arthroscopic partial meniscectomy (APM) and meniscus suture repair in two different age cohorts compared with a normal population.MethodArthroscopic meniscus surgery was performed on 421 patients...

Treatment Trends in Meniscal Pathology in the Setting of Concomitant ACL Injuries in Pediatric and Young Adult Patients: An Insurance Database Study

Background: Meniscal pathology is commonly encountered in the setting of anterior cruciate ligament (ACL) rupture and is increasingly common in the pediatric and adolescent population. Studies have shown that over half of individuals presenting with ACL rupture will have concurrent meniscal pathology. Purpose: To define trends in the utilization of meniscal procedures (ie, meniscus repair vs partial meniscectomy) and short-term complications in pediatric and young adult patients with meniscal pathology in the setting of a concurrent ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: The IBM MarketScan Commercial Database was utilized to identify ACL reconstruction procedures performed between 2006 and 2018 for individuals aged 5 to 30 years. Annual proportions of meniscectomy and meniscal repair were analyzed, and short-term complications were compared between pediatric/adolescent patients (aged 5-17 years) and young adults (aged 18-30 years). Results: An overall 40,736 records of individuals <18 years old with ACL tears were included. The pediatric/adolescent population had a significantly lower proportion of concomitant meniscal procedures (56.8%; 23,149/40,736) than the young adult population (59.7%; 33,764/56,515; P < .01). From 2006 to 2018, utilization of meniscal repair in the setting of ACL reconstruction steadily increased (20.1% to 35.1% [+15 percentage points], P < .01), while the proportion with meniscectomy decreased (34.4% to 21.3% [–13.1 percentage points], P < .01). There was no difference in rate of reoperation for repeat meniscal repair or meniscectomy in the pediatric/adolescent population for those undergoing meniscal repair versus meniscectomy within 180 days of primary surgery (1.7% [188/10,766] vs 1.5% [186/12,383]; P = .14). Conclusion: From 2006 to 2018, the proportion of patients receiving ACL reconstruction with concomitant meniscal repair increased (20.1% to 35.1%) while the proportion with meniscectomy decreased (34.4% to 21.3%) in the pediatric/adolescent population. Meniscal repair was not associated with a higher 180-day rate of reoperation for repeat meniscal repair or meniscectomy than meniscectomy in the setting of ACL reconstruction.

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

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

Posterior Slope Reducing Osteotomy With Concomitant Anterior Cruciate Ligament Reconstruction

Background: Modern techniques for graft choice, preparation, and fixation for anterior cruciate ligament (ACL) reconstruction demonstrate excellent longevity and return-to-play rates; however, up to 10% to 18% of cases continue to suffer reruptures, with even higher rates in specific subsets of patients. Indications: Normally, the posterior tibial slope is measured between 7° and 10°, with biomechanical and observational studies showing that posterior slope greater than 12° increases the risk of graft failure by 5× by allowing for increased anterior tibial translation, putting increased stress on the graft. The primary indication for a slope correction osteotomy with a revision ACL reconstruction is a patient with tibial slope greater than 12° who has failed prior ACL reconstruction. Technique Description: In our preferred technique, we illustrate a slope reducing anterior closing wedge proximal tibial osteotomy with concurrent revision ACL reconstruction rather than a staged ACL reconstruction. Results: The primary benefit of this technique is the ability to correct the tibial slope and reconstruct the ACL in one setting, which decreases recovery time, costs, and risks to the patients by eliminating an additional procedure. Discussion/Conclusion: In cases of ACL reconstruction failure, particularly in patients with multiple failures, an increased posterior tibial slope may be a contributing factor. Anterior closing wedge osteotomy has been shown to be an effective treatment, in patients with a native slope greater than 12°. A slope reducing anterior closing wedge proximal tibial osteotomy with concurrent revision ACL reconstruction rather than a staged ACL reconstruction has a wide array of benefits.

A Technique for Anterior Cruciate Ligament Reconstruction in the Setting of Unicompartmental Knee Arthroplasty

Unicompartmental knee arthroplasty (UKA) is becoming a more prevalent treatment for medial-compartment arthritis. Traditionally, a competent anterior cruciate ligament (ACL) is required to achieve satisfactory results. This leads to the question of treatment for medial-compartment arthritis in the setting of an incompetent ACL. A treatment option for this subset of patients is concurrent UKA and ACL reconstruction; however, this technique addresses the cohort of patients with a previously stable UKA who sustain an injury to the ACL, leading to symptomatic instability. The purpose of this article is to detail a technique for ACL reconstruction in the setting of a previous UKA.

Outcomes at 20 Years After Meniscectomy in Patients Aged 50 to 70 Years

To report the outcomes of arthroscopic meniscectomy (AM) at 20 years of follow-up through timing/rate of conversion to total knee replacement (TKR) and Knee Injury and Osteoarthritis Outcome Score (KOOS), focusing on detection of specific predictor variables for these outcomes, in patients 50 to 70 years old. We performed a retrospective study of 289 patients, ages at surgery 50 to 70 years, with diagnosis of degenerative meniscal tear who underwent arthroscopic meniscectomy. We collected the following baseline data: age, sex, injured meniscus (medial, lateral, or both), knee alignment, osteoarthritis (OA), associated lesion identified during arthroscopy, and associated procedure performed during arthroscopy. At 20 years of follow-up, we collected rate and timing of TKR conversion, and we evaluated clinical outcomes with KOOS. Female sex (P < .01), older age (P < .01), lateral meniscectomy (P= .02), malalignment (P= .03), and advanced chondral lesion (P < .01) were found to be significantly related to subsequent TKR. No significant correlation was found between amount of resection and subsequent TKR (P= .26). Negative predictor factors to obtain equal or superior to age- and sex-adjusted KOOS scores were age 60 to 70 years at time of AM (P= .03) and lateral meniscectomy (P= .02). We report a 15.7% conversion rate at 20 years from AM to TKR and a mean time between surgeries of 7 years. Subsequent TKR in the 20 years after AM for degenerative meniscus tears were significantly associated with preoperative OA and chondral lesion (Kellgren Lawrence 2; Outerbridge >2), lateral meniscectomy, age at surgery, female sex, and malalignment. Furthermore, age >60 years, lateral meniscectomy, and concurrent anterior cruciate ligament reconstruction were negative predictors for poor clinical outcomes at 20 years. Therefore, if patients present with negative predictor factors, the AM should not be proposed as second-line treatment, and nonoperative management should be continued until TKR is unavoidable. IV, case series.

Risk factors for all-inside meniscal repair failure in isolation and in conjunction with anterior cruciate ligament reconstruction

BackgroundThis study examines the relationship between meniscus tear presentations and failure rates following all-inside repair in isolation and in conjunction with an anterior cruciate ligament (ACL) reconstruction. MethodsEighty seven consecutive patients undergoing all-inside meniscal repair at a single institution from July 2016 to June 2018 were retrospectively reviewed. Details of patient presentation, tear type and location, the presence or absence of simultaneous ACL reconstruction, and surgical repair details were recorded to evaluate the relationship between patient characteristics and the primary endpoint of repair failure. ResultsPatients were followed for an average of 2.7 ± 0.8 years. Three patients (3.4%) experienced 30-day complications including 1 deep vein thrombosis and 2 joint aspirations. Within the study time frame, 15 repairs (17.2%) failed, with 10 (11.5%) failing within one year of the initial procedure; the average time to failure was 12.3 ± 9.0 months. Patients undergoing concurrent ACL reconstruction were less likely to experience repair failure (9.7% vs. 36.0%, p = .009), while bucket-handle repairs were more likely to fail during the study period (45.0% vs. 9.0%, p = .001). These trends remained after controlling for tear location, body mass index, and number of sutures (ACL reconstruction Odds Ratio [OR]: 0.229, p = .029; Bucket-handle OR: 9.400, p = .003). ConclusionOur findings suggest concurrent ACL reconstruction at the time of meniscal repair is associated with increased repair survival. The all-inside technique may be successfully used across a variety of tear types and locations, although further study of its efficacy in repairing bucket-handle tears is warranted.

Concurrent Anterior Cruciate Ligament and Medial Patellofemoral Ligament Reconstruction: A Case Report and Literature Review

Anterior cruciate ligament (ACL) insufficiency in combination with patellar instability are rare occurrences and are difficult to treat. Failure to address patellar instability in such cases may place excessive strain on ACL graft leading to graft rupture. We present three such cases treated by concurrent ACL and medial patellofemoral ligament (MPFL) reconstruction with hamstring tendon autografts. Two patients had MRI evidence of MPFL injury and one patient had intact MPFL on MRI. All patients had good outcome without any residual instability at final follow-up.

All-Inside Repair of Bucket-Handle Meniscal Tears: Clinical Outcomes and Prognostic Factors

Background: There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs). Purpose: To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs. Study Design: Systematic review. Methods: A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. All English-language literature from 1993 to 2019 describing clinical outcomes for patients undergoing all-inside BHMT repair with ≥12-month follow-up was reviewed by 2 independent reviewers. Patient characteristics (patient sex, age), intraoperative factors (laterality, concomitant procedures, surgical technique, implants utilized), and postoperative outcomes (failure rates) were analyzed. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS). Results: Fifteen studies (1 level 1, 4 level 3, 10 level 4) with 763 total patients (64% male; average age, 26.4 years [range, 9-58 years]; average follow-up, 39.8 months [range, 12-120 months]) including 396 all-inside BHMT repairs were included. Six devices were used for repair including the Meniscal Repair System, FasT-Fix, Meniscus Arrow, Biofix Arrow, RapidLoc device, and PDS II suture, with failure rates of 13.5%, 22.4%, 27.1%, 42.9%, 45.2%, and 0%, respectively. The overall repair failure rate was 29.3% at an average of 13.0 months (range, 5.0-32.4 months), but 19.0% for devices still in use. The RapidLoc and Biofix Arrow had higher failure rates than other devices (P = .0003). Women (31%) were less likely to experience a failure than were men (69%) (P = .03). Longer follow-up duration resulted in higher failure rates (>30 months, 34.4%; <30 months, 23.4%; P = .016). In 4 studies reporting on both all-inside and inside-out repairs, no significant differences in failure rates were observed. No significant differences in failure rates were found between medial and lateral repairs nor repair with and without concurrent anterior cruciate ligament reconstruction (P > .05 for all). The overall average MCMS was 54.4 ± 12. Conclusion: The overall failure rate after all-inside repair of BHMTs is 29.3% at an average of 13.0 months, with no difference in failure rates between medial and lateral meniscal repairs. The variables shown to negatively affect the failure rates were the RapidLoc and Biofix Arrow, male sex, and longer follow-up duration.

Delayed or neglected meniscus tear repair and meniscectomy in addition to ACL reconstruction have similar clinical outcome.

To compare the clinical outcomes of meniscus repair and meniscus resection with concurrent anterior cruciate ligament (ACL) reconstruction in patients with ACL rupture and neglected or delayed medial meniscus tears. Thirty patients with ACL ruptures and unstable vertical longitudinal medial meniscus tears were included. Patients were divided into two groups. Group I included 15 patients who underwent meniscal repair and Group II included 15 patients who underwent meniscectomy. The knee range of motion, McMurray test, Lachman test, pivot shift test, Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) Questionnaire, Hospital for Special Surgery (HSS) Knee score, and Tegner activity (TA) scale were used to assess all patients. The median follow-up time was 3.6 (0.5-6.5) years. Median age was 28 (16-36) years. Fourteen patients (93.3%) in Group I and six patients (40%) in Group II returned to their preinjury sport activity level (P = .007). Median maximum knee flexion was 132° (121°-140°) in Group I and 134° (121°-139°) in Group II (n.s.). All patients had full knee extension and negative McMurray test results. Lachman and pivot shift test results were similar between groups. The median IKDC Questionnaire score was 99 (86-100) in Group I and 93 (70-100) in Group II (P = .016). The difference in Lysholm Knee Scoring Scale, HSS knee, and TA scale score between groups were not significant. Clinical outcomes of patients that underwent meniscus repair were better than those that underwent meniscus resection with concurrent ACL reconstruction. The technically complicated and costly meniscus repair may achieve better clinical outcomes than meniscectomy when treating a neglected or delayed meniscal tear with a concurrent ACL tear. III.

Assessment of Meniscal Healing Status by Magnetic Resonance Imaging T2 Mapping After Meniscal Repair

Background: Although the sensitivity and specificity of magnetic resonance imaging (MRI) for the diagnosis of primary meniscal tears are high, these values are lower for the assessment of healing status of repaired menisci. Purpose: To compare the accuracy of MRI T2 mapping and conventional MRI in assessing meniscal healing after repair. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients who underwent meniscal repair with concurrent anterior cruciate ligament reconstruction between 2012 and 2016 and had a follow-up second-look arthroscopy were enrolled. The patients were divided into healed and incompletely/not healed groups based on the second-look arthroscopy findings. For the repaired menisci, the following were compared between the groups, (1) Stoller and Crues classification on conventional MRI with a proton density-weighted fat-saturated sequence and (2) the remaining colored meniscal tear line on T2 mapping coincident with the high signal line showing the primary tear on conventional MRI were compared. The change of T2 relaxation time (ΔT2) of the colored meniscal tear line pre- to postoperatively was compared between the groups. The mean T2 relaxation time of the whole area of the postoperative meniscus at each slice was also compared with that of control menisci to assess the whole quality of the repaired meniscus. Results: A total of 26 menisci from 24 knees were assessed (16 healed menisci, 10 incompletely/not healed menisci). According to the Crues classification on conventional MRI, 8 of 16 healed menisci and 3 of 10 incompletely/not healed menisci improved from grade 3 to 2, with there being no significant difference between the groups (P = .43). However, the colored meniscal tear line remained in only 3 of the 16 healed menisci as compared with 9 of the 10 incompletely/not healed menisci, and the presence of this colored line allowed differentiation between healed menisci and incompletely/not healed menisci (sensitivity, 81.3%; specificity, 90.0%; odds ratio, 39.0; P = .001). The mean (SD) ΔT2 was −31.1 ± 3.2 and −19.9 ± 4.4 ms in the healed and incompletely/not healed groups, respectively (P < .001). Receiver operating characteristic curve analysis showed a cutoff ΔT2 value of −22.3 ms for separation of meniscal healing (P < .001). The T2 relaxation times of the whole area of the repaired menisci were 31.7 ± 3.4 and 32.8 ± 3.8 ms in the healed and incompletely/unhealed groups, respectively (P = .69), with these values being significantly longer than the 26.9 ± 2.2 ms in the controls (P < .001). Conclusion: MRI T2 mapping allowed the differentiation of healing status after meniscal repair, with high sensitivity and specificity as compared with conventional MRI.

Evaluation of clinical results after arthroscopic meniscus repair and partial meniscectomy

Aim: The aim of our study was to evaluate the clinical results of arthroscopic repair and partial meniscectomy in the patients who had with meniscal tear.Material and Method: A total of 113 patients who were admitted to our clinic for meniscal tear between 2009 and 2017 were included in our study. Sixty one patients who underwent arthroscopic meniscal repair and 52 underwent partial meniscectomy. All inside meniscal repair technique was used for all meniscal repairs. Clinical assessments included physical examination findings, Lysholm score, the IKDC score and visual analog score(VAS). Barret criteria were used for the clinical assessment of healing status.Results: The patients who underwent meniscal repair, 54 (88.5%) were male 7 (11.5%) were female. The mean age was 32 (19- 45) years. Our mean follow-up period was 47 (range; 24-109) months. Number of patients underwent only meniscal repair was 29 and concurrent anterior cruciate ligament reconstruction was 32. According to the Barret’s criteria’s patients had 18% surgical failure. The patients who underwent partial meniscectomy33 were male 19 were female. Our mean follow-up period was 29.5 (range; 24-101) months. Eight patients (15.4%) had surgical failure. IKDC, Lysholm and VAS scores were statistically significantly improved postoperatively both in repair and partial meniscectomy groupConclusion: Meniscus repair should be performed whenever possible independent from age of patient. When repair is not possible, partial meniscectomy also have good results at least in short term follow-up.

Meniscal Repair with Concurrent Anterior Cruciate Ligament Reconstruction: Is ACL Graft Choice Predictive of Meniscal Repair Success?

Objectives: The success rate of meniscal repair is known to increase with concurrent anterior cruciate ligament (ACL) reconstruction. However, the influence of ACL graft choice has not been described. The current study examines the effect of ACL graft choice on the outcome of meniscal repair performed in conjunction with ACL reconstruction (ACLR). Methods: Patients who underwent meniscal repair with concurrent primary ACLR were identified from a longitudinal, prospective cohort. Patient demographics and subjective outcome measures including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale were collected preoperatively. Arthroscopic assessment of meniscal tear characteristics and associated repair technique were recorded intraoperatively. Patients with subsequent repair failure, defined as any subsequent surgical procedure addressing the meniscus repaired at index surgery, were identified and operative notes were obtained in order to accurately classify pathology and treatment. A logistic regression model was built to assess the association of patient specific factors, ACL graft, baseline Marx activity level and meniscal tear laterality with the occurrence of repair failure at 6-year follow-up. Results: A total of 646 patients underwent ACLR with concurrent meniscal repair. Bone-patellar tendon-bone (BTB) and soft tissue (ST) autograft were used in 55.7% and 33.9% of cases, respectively, while allografts were utilized in the remaining cases. Table 1 summarizes the univariate analysis of each baseline variable. A total of 101 patients (15.6%) required subsequent surgery on the meniscus repaired at index surgery, including 89 meniscectomies (87 partial, 2 subtotal), 11 revision meniscal repairs, and 1 meniscus allograft transplantation. No statistically significant difference in meniscal repair failure rate was observed based on patient age, sex, BMI or smoking status. The odds of meniscal repair failure within 6 years of surgery for patients with only a lateral meniscal repair are 68% less than those with only a medial meniscal repair (CI: 41%, 83%; p&lt;0.001). There is a statistically significant relationship between baseline Marx activity and the risk of subsequent meniscal repair, though it is nonlinear—patients with low or high baseline activity are at the highest risk of meniscal repair failure (CI: 1.05,1.31; p=0.004, Figure 1). The estimated odds of meniscal repair failure for BTB allograft, ST allograft, and ST autograft were 2.78 (CI: 0.84,9.19; p=0.09), 2.29 (CI: 0.97,5.45; p=0.06), and 1.42 (CI:0.87,2.32; p=0.16) times that of BTB autograft, respectively, although none proved statistically significant. Meniscal repair failure is associated with significantly lower 6-year scores for all KOOS components and the IKDC (p&lt;0.001). However, there was no significant difference in MARX activity at 6-years (p=0.27). Conclusion: In the setting of primary ACLR, the risk of meniscal repair failure is increased with medial versus lateral meniscal repair. Patients with low or high baseline activity levels are also at an increased risk. ACL graft choice seems to have an effect on meniscal repair failure that approaches but does not reach statistical significance. A larger sample size may be required to accept the null hypothesis. [Table: see text][Figure: see text]