Horizontal Cleavage Tears Research Articles

Fish Mouth Closure of Horizontal Cleavage Tear of the Meniscus using Self-locking Modified Racking Hitch Knot (HitPat knot). - A Technical Note.

Horizontal cleavage tears (HCT) of the meniscus are treated with fish-mouth closure with sutures using different methods. Using a no. 0 fiber wire and taking bites through both the flaps using a suture passing device and tying multiple knots is a cost-effective technique. A racking hitch knot is an option for all inside repairs of HCT. It needs multiple half hitches for locking the knot. We used a modification of the racking hitch knot (HP knot), making it a self-locking knot, so it does not need half hitches. Loop of no. 0 fiber wire is passed across both the flaps of the meniscus and a modified racking hitch knot tied in one goes closing the fish mouth. This modification (HP knot) saves operative time, it is cost-effective and has the distinct advantage of a reduction in the size of the final knot construct.

Finite element analysis of the knee joint stress after partial meniscectomy for meniscus horizontal cleavage tears

ObjectiveTo establish a finite element model of meniscus horizontal cleavage and partial resection, to simulate the mechanical changes of knee joint under 4 flexion angles, and to explore what is the optimal surgical plan. MethodsWe used Mimics Research, Geomagic Wrap, and SolidWorks computer software to reconstruct the 3D model of the knee joint, and then produced the horizontal cleavage tears model of the internal and lateral meniscus, the suture model, and the partial meniscectomy model. These models were assembled into a complete knee joint in SolidWorks software, and corresponding loads and boundary constraints were added to these models in ANSYS software to simulate the changing trend of pressure and shear force on femoral condylar cartilage, meniscus, and tibial cartilage under the flexion angles of 0°, 10°, 20°, 30° and 40° of the knee joint. At the same time, the difference of force area between medial interventricular and lateral interventricular of knee joint under four states of bending the knee was compared, to explore the different effects of different surgical methods on knee joint after horizontal meniscus tear. ResultsWithin the four medial meniscus injury models, the lowest peak internal pressure and shear force of the knee joint was observed in the meniscal suture model; the highest values were found in the bilateral leaflet resection model and the inferior leaflet resection model; the changes of pressure, shear force and stress area in the superior leaflet resection model were the most similar to the changes of the knee model with the meniscal suture model. ConclusionSuture repair is the best way to maintain the force relationship in the knee joint. However, resection of the superior leaflet of the meniscus is also a reliable choice when suture repair is difficult.

Horizontal Cleavage Meniscus Tears: Biomechanics, Indications, Techniques, and Outcomes.

» Accounting for up to 24% of all meniscus tears, horizontal cleavage tears (HCTs) are a common pathology orthopaedic practitioners should be comfortable managing.» Historically, HCTs were treated with partial meniscectomy; however, recent studies have demonstrated that these procedures have an adverse biomechanical effect, while HCT repairs restore the knee's natural biomechanics.» Indications for the surgical repair of HCTs remain disputed, but surgery is generally considered for young, active patients and older patients without significant concomitant osteoarthritis.» Early clinical findings surrounding HCT repair are promising. They suggest that this treatment adequately restores meniscus mechanics, leads to good knee functional outcomes, and results in a high likelihood of return to preinjury activity levels.

Anterior Cruciate Ligament Ruptured Concomitant Meniscus Discoid in Young Patient: A Rare Case Report

Background: Abnormalities of the human meniscus, including discoid meniscus, double-layered meniscus, and ring-shaped meniscus, have been reported. The prevalence of discoid meniscus is extremely rare, with an incidence of 0.9%－2.4% in the Asian population. Traditionally, discoid meniscus concomitant anterior cruciate ligament (ACL) ruptures are extremely rare cases. The aim of this study is to discuss a rare case to provide diagnosis and management properly by using arthroscopy.Case Presentation: A 21-year-old male Balinese, complained of pain in his right knee after fast walking for two months and an unstable knee in the past 1 year ago. On physical examination, the range of motion was limited due to the pain for flexion of more than 90°. Special tests such as Lachman test positive, and Anterior drawer test positive. The patient had medial joint line tenderness, and a McMurray test elicited pain on the medial joint line. Meanwhile, an MRI examination of the right knee showed a discoid medial meniscus with a horizontal cleavage tear and a discoid lateral meniscus with an incomplete tear. We performed a partial meniscectomy of the incomplete discoid medial meniscus and resection of the pathologic medial patellar plica. We performed surgical reconstruction of the ACL ruptured after the meniscus was repaired.Results: We presented a 21-year-old male with discoid meniscus concomitant ACL rupture to his right knee. After the patient was performed with partial meniscectomy of the incomplete discoid medial meniscus and resection of pathologic medial patellar plica following surgical reconstruction of the ACL ruptured. The patient had no limitation of motion or pain 1 year after the operation and he had no complaints and was satisfied with the result by radiograph.Conclusion: We concluded that This rare case of medial discoid meniscus concomitant with the ACL rupture must be reconstructed. The treatment of discoid meniscus should consider its tear pattern and whether it is symptomatic. With the development of arthroscopic techniques, the treatment of discoid meniscus has gradually changed from total meniscectomy or partial meniscectomy.Keywords: anterior cruciate ligament, meniscus, discoid, knee, arthroscopy.Correspondence: I Gusti Ngurah Wien Aryana. Department of Orthopaedic & Traumatology, General Central Hospital of I.G.N.G Ngoerah Central Hospital/ Faculty of Medicine, Udayana University, Bali, Indonesia. Email: wienaryanaortho@gmail.com. Mobile: +62811-385-263.Indonesian Journal of Medicine (2023), 08(03): 317-324https://doi.org/10.26911/theijmed.2023.08.03.09

Horizontal Cleavage Tear Meniscal Repair Using All-Inside Circumferential Compression Sutures

Horizontal cleavage meniscus tears occur more frequently in older patient populations with degenerative changes within the meniscus. Traditionally, they have been managed with nonsurgical interventions or with partial meniscectomy. As increasing evidence demonstrates the link between partial meniscectomy and progressive osteoarthritis with these types of tears, as well as worse long-term outcomes and reduced cost savings, surgical repair of horizontal cleavage meniscal tears has increased in appropriate patients. This technique article highlights the evaluation, indications, and preferred repair technique for horizontal cleavage tears in appropriately selected patients.

Treatment of Degenerative Meniscus Tears

Degenerative meniscus tears are generally atraumatic and a normal part of aging. They are typically observed in middle-aged or older people. Tears are often associated with knee osteoarthritis and degenerative changes. The medial meniscus is most commonly torn. The tear pattern is normally complex with significant fraying but other tear patterns, such as horizontal cleavage, vertical, longitudinal, and flap tears, as well as free-edge fraying are also observed. The onset of symptoms is usually insidious although the majority of tears are not symptomatic. Initial treatment should always be conservative and include physical therapy, NSAIDs, topical treatment, and supervised exercise. In overweight patients, weight loss can decrease pain and improve function. Injections, including viscosupplemenation and the use of orthobiologics, can be considered in the presence of osteoarthritis. Several international orthopaedic societies have issued guidelines for progression to operative management. Mechanical symptoms of locking and catching, acute tears with clear evidence of trauma and persistent pain with failure of nonoperative treatment are considered for operative management. Arthroscopic partial meniscectomy is the most commonly performed treatment for most degenerative tears. However, repair is considered for appropriately selected tears, with special emphasis on surgical technique and patient selection. Treatment of chondral pathology at the time of surgery for meniscus tears is controversial, although a recent Delphi Consensus statement concluded that debridement of loose cartilage fragments may be considered.

A Comparative Study on Outcomes of Partial Meniscectomy for Horizontal Cleavage Tear of Medial Meniscus: Complete versus Partial Resection of Inferior Leaf.

The extent to which resection of unstable leaf should be performed in horizontal cleavage meniscus tear has not yet been elucidated. The purpose of this study was to compare the clinical outcomes of partial meniscectomy for horizontal cleavage tear of medial meniscus between complete resection of inferior leaf including the periphery up to the joint capsule and partial resection leaving stable peripheral torn meniscal tissue. A total of 126 patients who underwent partial meniscectomy for horizontal cleavage tear of medial meniscus were divided into two groups: group C (n = 34), treated with the complete resection of the inferior leaf; and group P (n = 92), treated with partial resection of the inferior leaf. The minimum follow-up duration was 3 years. Functional outcomes were evaluated using the Lysholm knee scoring scale, International Knee Documentation Committee (IKDC) subjective knee evaluation form, and knee injury and osteoarthritis outcome score (KOOS). Radiologic assessments were performed using the IKDC radiographic assessment scale and measurement of the height of the joint space in the medial compartment of the tibiofemoral joint. The functional outcomes including the Lysholm knee, IKDC subjective score, activities of daily living and sport and recreation subscale of KOOS were worse in group C than in group P (p < 0.001). The radiologic outcomes including postoperative IKDC radiographic scale (p = 0.003) and the postoperative joint space on the affected side (p < 0.001) were also worse in group C than in group P. In the horizontal cleavage tear of medial meniscus, complete resection of the inferior leaf including the periphery up to the joint capsule showed inferior clinical outcomes compared with partial resection leaving stable peripheral rim of torn meniscus at minimum 3-year follow-up. If the peripheral part of the inferior leaf is stable in horizontal cleavage tear of medial meniscus, partial resection of the inferior leaf preserving peripheral rim can be recommended.

Arthroscopic Intrameniscal Decompression for the Treatment of Lateral Meniscal Cysts

The meniscal cyst is a common complication associated with complex degenerative meniscal tears such as degenerative flaps and horizontal cleavage tears. The current gold standard treatment for this condition is arthroscopic decompression with partial meniscectomy; however, there are three concerns regarding this treatment. First, cases of meniscal cysts commonly involve an intrameniscal location of the degenerative lesion. Second, when there is difficulty in finding the lesion, a so-called “check-valve” is required, and a large-scale meniscectomy is necessary. Thus, postoperative osteoarthritis is a well-known sequela. Third, treatment of a meniscal cyst from the inner edge of the meniscus is indirect and inadequate for reaching the pathological region, as most meniscal cysts are located at the peripheral portion of the meniscus. Therefore, this report describes direct decompression of a large lateral meniscal cyst and repair of the meniscus using decompression with an intrameniscal approach. This technique is simple and reasonable for the purpose of meniscal preservation.

Techniques to treat challenging meniscus tears

IntroductionMeniscus tears are one of the most common knee pathologies encountered. Although meniscus tears were initially treated with meniscectomy, numerous studies have described the effect of meniscectomy on accelerating degenerative changes of the knee. In addition, certain tear patterns that may have been traditionally underrecognized are now the subject of recent investigation on the merits of repair. ObjectivesWe review the existing literature on the biomechanical and clinical outcomes following treatment of radial, horizontal cleavage, and ramp meniscus tears. This article will also highlight meniscus repair strategies for these tear patterns. MethodsPubMed was searched. All levels of evidence (I-IV) pertaining to meniscus tears were analyzed and presented. ResultsFor radial tears, all-inside techniques are gaining popularity, with 2 emerging strategies: “tie-grip” sutures and transtibial approaches. For horizontal tears, circumferential sutures allow even compression of the superior and inferior leaflets of the tear. Multiple techniques have been described for repair of ramp lesions, which are best recognized with a systematic exploration of the posteromedial aspect of the knee. ConclusionsIncreased awareness of certain meniscus tear types and their effect on knee kinematics and stability has led to investigation and evolution of repair techniques, with an increased emphasis on all-inside repairs.

Horizontal Cleavage Meniscus Tear Repaired Using a Cerclage Technique

Background: Horizontal meniscal cleavage tears often occur in older individuals and have a degenerative component. Commonly, these are managed with partial meniscectomy. However, this results in significantly decreased contact area and increased peek contact forces. Arthroscopic repair has shown comparable results with repairs of other tear types. Indications: Cerclage repair is performed for a horizontal cleavage tear in individuals without significant arthritis and in whom partial meniscectomy would remove an unacceptably large portion of meniscal tissue. Technique Description: Using standard arthroscopy portals, a self-retrieving suture passing device is used to pass a #0 high-strength suture through the periphery of the meniscus. Arthroscopic knots are tied on the superior surface of the meniscus and pushed as far posteriorly as possible. A small 1-cm incision is made just through skin on the proximal, posteromedial border of the tibia. Through this a spinal needle is placed percutaneously to pass a Chia into the joint just posterior to the knot. A curved spinal needle from an outside-in meniscal repair kit may be used as this provides a better trajectory to tears closer to the root attachment. The Chia and suture limbs are retrieved out the front of the knee, and then the suture tails are shuttled out the back of the knee. This is repeated until the repair is complete. The suture limbs are then cut below skin. Results: After arthroscopic all-inside repair of horizontal cleavage tears, patients do well. Outcomes are similar to repairs of other meniscal tear types. In all, 80% of patients are satisfied with their results, and there is an 11% to 12% failure rate which is comparable to other types of tear repairs. Discussion: All-inside cerclage repair should be considered for individuals sustaining a horizontal cleavage tear. This preserves meniscal tissue compared to partial meniscectomy and yields good healing rates and outcomes. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Repair of a Horizontal Cleavage Tear of the Lateral Meniscus with Circumferential Compression Stitches and Marrow Venting Augmentation

Horizontal cleavage tears (HCTs) are challenging meniscal tear patterns, as they split the meniscus into inferior and superior leaflets, while also involving the central, less vascular portions of the meniscus. Circumferential compression sutures using an all-inside self-retrieving suture passing device like the Novostitch Pro (Smith & Nephew, Andover, MA) have demonstrated the ability to create stable repair constructs with uniform compression across both leaflets in the setting of HCTs. Additionally, biological augmentation of meniscal repairs using a marrow venting procedure (MVP) has demonstrated superior clinical outcomes relative to isolated meniscal repairs. Thus, the purpose of this technical note is to outline our procedure for implementing circumferential compression sutures and biologic augmentation using an MVP for repairing an HCT of the lateral meniscus.

In-Office Needle Arthroscopy Can Evaluate Meniscus Tear Repair Healing as an Alternative to Magnetic Resonance Imaging

PurposeTo assess the healing of horizontal cleavage tears of the meniscus 1 year after surgical repair and to determine what modality is best to determine healing.MethodsPatients were prospectively followed for 12 months after surgical meniscus repair using a circumferential compression stitch. Inclusion criteria were preoperative magnetic resonance imaging (MRI) evidence of horizontal cleavage tear, age between 18 and 50 years, and no concomitant anterior cruciate ligament reconstruction. Patients were excluded if they were >50 years old, had a meniscus tear pattern other than horizontal cleavage tear, and underwent concomitant ligament reconstruction. MRIs were performed 1-year postoperatively for evaluation of repair healing. Preoperative and postoperative MRIs of tears were evaluated blindly by a musculoskeletal radiologist. In-office needle arthroscopy was performed at 6 months post-operatively.ResultsEight patients were included and had surgery between March 2016 and November 2017. There were 4 medial and 4 lateral meniscus tears. No patients had recurrence of preoperative symptoms or evidence of retear. Six repairs evaluated by in-office needle (at 5.9 months postsurgery) arthroscopy demonstrated complete healing. Seven of the 8 patients had grade III changes on preoperative MRI, and 1 patient had grade IIc changes. On postoperative MRI, 5 of 7 patients had grade III changes, 1 patient had IIc changes, and 1 had IIb changes. There was no significant difference in the proportion of patients with grade III changes preoperatively compared with postoperatively (P = .57). One of 8 patients with preoperative MRIs demonstrated extrusion where no patients demonstrate postoperative MRI evidence of extrusion (P = .47).ConclusionsHorizontal cleavage meniscal tears repaired with a circumferential compression stitch demonstrate healing on in-office needle arthroscopy 6 months after surgery. No evidence of incomplete or failed healing was found. MRI at 1 year after surgery demonstrated residual tear evidence for all patients.Level of EvidenceIV, therapeutic case series.

Surgical Management of Medial Discoid Meniscus in Pediatric and Adolescent Patients.

Medial discoid meniscus (MDM) is an exceedingly rare anatomic abnormality that presents similarly to other meniscal pathologies. Symptomatic MDM is typically managed arthroscopically with mixed short-term and long-term outcomes, although the existing knowledge about MDM is limited. The purpose of this study was to describe the presentation and surgical treatment of MDM in pediatric and adolescent patients. Medical records of 12 knees with MDM in 8 pediatric and adolescent patients treated between 1991 and 2016 were reviewed retrospectively for patient characteristics, clinical manifestations, radiographic findings, operative techniques, and surgical outcomes. Of the 446 knees diagnosed arthroscopically with discoid menisci, lateral discoid meniscus was noted in 434 knees (97.3%) and MDM was present in 12 knees (2.7%). The MDM series included 8 patients of mean age 13.8 years (range: 7.8 to 19.8), of which 5 were males (63%), and 4 (50%) had bilateral involvement. Of the 11 knees with available clinical records, all cases presented symptomatically (pain, mechanical symptoms); 10 (91%) had concurrent physical exam findings. On intraoperative examination, discoid morphologies were described as complete in 4/8 knees (50%) or incomplete in 4/8 (50%), with associated instability in 6/12 (50%). Meniscal tears were reported in 9 cases (75%)-primarily, horizontal cleavage tears. Saucerization was performed in 11 knees (92%), with medial meniscal repair in 7 (58%), when indicated. Retear of the medial meniscus occurred in 4/11 knees (36%) at a mean of 25.8 months postoperation; 2 knees required revisions. One knee developed arthrofibrosis and underwent arthroscopic lysis of adhesions. MDM is a rare diagnosis, representing 3% of all discoid menisci, with a nonspecific clinical manifestation. Operative management of symptomatic MDM typically involves saucerization and meniscal repair, when indicated, for concurrent tears. Symptom resolution is common short-term, but long-term outcomes include recurrent meniscal tears. Subsequent observational studies are important to evaluate long-term outcomes, such as arthritic changes, with the advancement of arthroscopic techniques for meniscal preservation. Level IV-retrospective case series.

Symptomatic Discoid Meniscus in Children and Adolescents: A Review of 470 Cases.

Discoid meniscus is a congenital variant, typically involving the lateral meniscus, that comprises a spectrum of meniscal shapes and degrees of instability in an estimated 1% to 15% of the population. The purpose of this study was to describe the clinical and operative course of a large cohort of children and adolescents patients with symptomatic lateral discoid meniscus. Medical records of 470 knees with symptomatic lateral discoid meniscus in 401 patients ages 18 years or younger diagnosed at a single institution between 1991 and 2016 were reviewed retrospectively for patient characteristics, treatment course (nonoperative and/or operative), and complications. Surgical reports were reviewed in the operative group. The series included 401 patients of mean age 11.6 years (range: 1 mo-18.9 y), of which 222 (55%) were female, and 69 (17%) had bilateral involvement. Of 470 knees, 83 (18%) were initially managed nonoperatively. Of these, 32 knees (39%) failed nonoperative management and were converted to surgical treatment at a median of 7.9 months (interquartile range: 4.0-15.1). In total, 419 knees were managed surgically with saucerization (partial meniscectomy) with or without meniscal repair/stabilization; 84 knees (20%) required at least one concurrent nonmeniscal procedure. Discoid meniscus tears were reported in 264/419 knees (63%) intraoperatively; horizontal cleavage tears were most common. Reoperation was required for 66/379 cases (17%) with clinical follow-up, at a median of 19.6 months (range: 9.2-34.9) after index saucerization; 60/379 cases (16%) had ongoing pain and/or mechanical symptoms at final follow-up. With a failure rate of 39% (32/83 knees), nonoperative management for discoid lateral meniscus frequently convert to surgical treatment. During surgery, meniscus tearing and instability are common and should be anticipated. Postoperatively, 33% (126/379) of knees with clinical follow-up underwent either reoperation, or had ongoing symptoms of the knee at final follow-up. Discoid mensical retear is the most common complication (94%, 62/66) prompting repeat surgery, and should be discussed with families before the index operation. Level IV-descriptive case series.

Experimental and Finite Element Investigations on the Biomechanical Effects of Meniscal Tears in the Knee Joint: A Review

The knowledge of the complex biomechanical behaviour of the injured knee joints is of paramount importance in various clinical situations. A review of the biomechanical effects of meniscal tears based on experimental and finite element analysis has not been reported in the literature. The objective of this study is to present a review of experimental and finite element investigations on the consequences of meniscal tears such as longitudinal, radial, horizontal cleavage and root tears in the medial and lateral menisci. It is found that larger longitudinal tear in the medial meniscus has a significant impact on the magnitude of strain in the meniscus associated with a dramatic increase in CP in the tibial cartilage. Also, the untreated fragment of the torn meniscus leads to a significant rise in contact pressure in the cartilage resulting in the progressive degeneration of the cartilage surface. The radial tears in the lateral meniscus of more than 66% width and those in the medial meniscus of more than 75% width result in a substantial increase in the contact pressure in the cartilage compared to that in the intact knee joint. The root tears in the menisci demonstrate a significant influence on the biomechanical response of the knee joint. The results of finite element analysis studies are compared with experimental findings. Finally, some recommendations for future work are proposed to predict the realistic biomechanical response of the knee joints with meniscal tears. The results of this study present a rationale that could help surgeons in making clinical decisions when managing patients with meniscal tears.

Favorable Reoperation Rate at 2 Years Following Repair of Horizontal Cleavage Tears Using an All Suture-Based Technique: A Prospective, Multicenter Trial

PurposeThis prospective, multicenter trial evaluates the clinical success (as measured by reoperation rates and improvements in patient-reported outcome measures) of using circumferential compression stitches with all-suture techniques for horizontal cleavage tears (HCTs) of the meniscus.MethodsInvestigators enrolled 30 patients (mean age, 38.2 years; standard deviation, 11.1 years) aged 18 to 60 years with HCTs in the symptomatic compartment at 8 centers in the United States who underwent HCT repair with all-suture circumferential stitches using a self-retrieving all-inside suture passing device. Postoperative follow-up visits were conducted at 6 months, 1 year, and 2 years. Study outcomes included freedom from reoperation of the index meniscus repair site; knee pain and function, as measured by International Knee Documentation Committee Knee evaluation (IKDC), Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, and Tegner Activity Scale; and serious complications observed during the study. Minimal clinically important difference at 1 year was assessed for IKDC and Lysholm.ResultsTwenty-three patients had 2-year follow-up data available. Freedom from reoperation was 96.0% at 6 months (26/27, 91.7% at 1 year [23/25], and 82.6% at 2 years [19/23]). Significant improvement was observed in over baseline at 2 years for IKDC (36.7-82.5; P < .001), Knee injury and Osteoarthritis Outcome Score (52.2-89.3; P < .001), Lysholm (50.2-87.4; P < .001), and Tegner scores (3.3-5.3; P = .007). Minimal clinically important difference was met or exceeded for IKDC and Lysholm scores at 1 year 69.2% and 65.4% of patients, respectively. Four patients (6.7%) experienced serious complications, of which 2 were assessed as being related to the procedure.ConclusionsRepair of HCTs using all-suture circumferential stitches placed with a self-retrieving all-inside suture passing device leads to a favorable reoperation rate (17.4%), significant improvements in clinical outcomes, and an acceptable rate of serious complications (6.7%) at 2 years, supporting the viability of this treatment approach in this indication.Level of EvidenceLevel IV, therapeutic case series.

Intrasubstance degeneration of medial meniscus horizontal cleavage tear in young patients is associated with increased joint line obliquity in the coronal plane of the knee.

To evaluate the effect of joint line obliquity of the knee on intrasubstance degeneration of isolated medial meniscus horizontal cleavage tear (HCT) in young patients. Sixty knees of 50 patients aged < 40years (mean age, 33.3 ± 5.5years old), who underwent arthroscopic partial meniscectomy (APM) for HCT, were retrospectively reviewed. The radiologic parameters of alignment, including mechanical hip-knee-ankle (mHKA) angle, posterior tibial slope, and joint line obliquity, were measured on preoperative long-standing whole-leg radiographs. The patients were classified into two groups, simple horizontal type (type 1) and complicated type (type 2), according to the presence of diffuse intrasubstance degeneration of the meniscus on preoperative magnetic resonance imaging. The risk factors for intrasubstance degeneration of HCT were analyzed using multiple logistic regression analysis. Medial joint space width (JSW) on weight-bearing 45° flexion posteroanterior radiographs and the mHKA were measured to evaluate the radiographic outcomes. The clinical outcomes were evaluated using the modified Lysholm score. Among patients followed-up for > 5years, the clinical and radiologic outcomes were compared between the two groups. The joint line obliquity was significantly greater in the type 2 group than in the type 1 group (2.9 ± 1.3 vs. 0.9 ± 1.4, P < 0.001), and a significant risk factor for diffuse intrasubstance degeneration (P < 0.001; odds ratio, 2.88; 95% confidence interval, 1.27-6.54). The relative changes in the JSW in the type 2 group were greater than those in the type 1 group during the mean follow-up period of 7.9 ± 2.5years (26% vs 10%, P = 0.045). The modified Lysholm score was not significantly different between the two groups (n.s). The diffuse intrasubstance degeneration of medial meniscus HCTs in young patients is associated with increased joint line obliquity of the knee joints. The radiologic outcomes after APM were inferior in the patients with diffuse intrasubstance degeneration. However, the clinical outcomes were not different during the mid-term follow-up. Level III.

Is radiofrequency use in arthroscopic treatment of isolated medial meniscus horizontal cleavage tears more effective than mechanical debridement in young adults?

Introduction/Objective Arthroscopic mechanical hand tools, motorized shavers, and bipolar radiofrequency are used in arthroscopic partial meniscectomy. The aim of this study is to evaluate efficacy of radiofrequency on early clinical outcomes in patients who underwent arthroscopic partial meniscectomy with horizontal cleavage tear and without additional intraarticular knee pathology. Methods A total of 37 patients complied with the study criteria. Patients were divided into two groups according to usage of bipolar radiofrequency. Patients were evaluated by using visual analog scale (VAS) and Tegner Lysholm knee scores at the end of the first year follow-up. Results Twenty-two patients comprised the shaver-using group. Preoperative mean VAS score was 7.9 ? 0.8, and the Tegner Lysholm knee score was 49.6 ? 9.6. Fifteen patients comprised the bipolar radiofrequency-using group. Preoperative VAS score was 7.8 ? 0.9, and the Tegner Lysholm knee score was 52.2 ? 10.7. The mean VAS score was 1.2 ? 0.9, and the mean Tegner Lysholm knee score was 89.5 ? 8.1 in shaver used group at last follow-up. At the last postoperative follow-up, the mean VAS score was 1.1 ? 1, and the Tegner Lysholm knee score was 88.8 ? 7.3 in the bipolar radiofrequency-using group. No statistically significant differences between the VAS and Tegner Lysholm knee scores of the preoperative and postoperative controls of the two groups were observed (p?0.05). Conclusion Radiofrequency use has no effect on early clinical outcomes in the arthroscopic treatment of isolated medial meniscus posterior horn horizontal cleavage tears; we do not recommend its use.

Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing.

The purpose of this study was to evaluate the clinical outcomes and meniscus healing after arthroscopic repair of horizontal-cleavage meniscus tears, compared with vertical-longitudinal meniscus tears. This was a retrospective review of a consecutive series of 52 meniscal repairs for horizontal-cleavage tears (n = 27) or vertical-longitudinal tears (n = 25); the groups were compared with respect to clinical symptoms and meniscal healing. Arthroscopic meniscal repair was performed using the inside-out technique with a marrow-stimulating technique. Clinical symptoms were evaluated using the Lysholm score and Knee injury and osteoarthritis outcome score (KOOS). Meniscus healing was evaluated by MRI. The mean follow-up periods were 35.4 ± 8.9months in the horizontal-cleavage tear group and 39.8 ± 8.3months in the vertical-longitudinal tear group. There were no significant differences in Lysholm score and KOOS, including each subscale, between the horizontal-cleavage tear- and vertical-longitudinal tear-groups at the final follow-up. At the final follow-up, MRI meniscus grades 0 and 1 were significantly more frequent in the vertical-longitudinal tear-group than in the horizontal-cleavage tear-group, while grade 3 was significantly more frequent in the horizontal-cleavage tear group than in the vertical-longitudinal tear group (p < 0.0001). Although meniscus healing of horizontal-cleavage tears may be poor, arthroscopic repair should be considered for horizontal-cleavage tears because it does provide good clinical outcomes. IV.

Meniscus Tear Management: Indications, Technique, and Outcomes

Meniscus tears are commonly encountered in the clinical and operative setting and vary in presentation, including bucket-handle, radial, and horizontal cleavage tears. Historically, tears were treated with benign neglect or partial meniscectomy. However, a great deal of subsequent research has highlighted the biomechanical consequences of tears and meniscectomy, including increased peak local contact forces, progressive postmeniscectomy arthritis, and subsequent arthroplasty. With the advent and evolution of repair devices, increasing attention is being turned to the ideal restorative treatment of meniscus tears. Successful meniscus repair is centered about the ABCs of repair: Anatomic reduction, Biologic preparation and augmentation, and Circumferential compression. Recent advances in repair techniques have included microfracture of the intercondylar notch to provide healing factors and marrow cells for augmented healing, all-inside suture devices enabling the reduction and fixation tears without the need for additional assistants and the morbidity of inside-out exposure, and circumferential compression combined with clot augmentation to reduce and fix horizontal cleavage tears and recreate biomechanics to within 15% of baseline contact forces. Clinical outcomes of meniscus repair using modern techniques have been promising, with reapproximation of native joint biomechanics, substantial improvements in patient subjective outcome scores, and satisfactory reoperation rates. With implementation of the ABCs of meniscus repair as well as the continued expansion of the orthopedic surgeons' meniscus repair toolbox, restoration and preservation of the meniscus are increasingly possible across the spectrum of tear types.