Lateral Meniscus Repair Research Articles

A new scoring system for prediction of meniscal repair in traumatic meniscal tears.

Traditionally, MRI has not been used to predict meniscus tear reparability. An attempt has been made in this study to predict meniscal reparability using MRI, and a new scoring system to help with the same has been developed and tested. Thirty repaired menisci were compared with equal number of meniscectomy cases retrospectively. Various clinical and radiological (radiographs and MRI) characteristics like chronicity of tear, pattern of tear, etc, were tabulated. Based on their association with the outcome of repair or meniscectomy, odds ratio of each attribute were calculated. A scoring system-Ortho One PROMT Score (Prediction of Reparability of Meniscal Tears)-to predict meniscal repair was formulated. Using this score, meniscus surgery outcomes were prospectively predicted in 120 cases and results tabulated. The newly devised Ortho One PROMT score predicted medial meniscus repair with a sensitivity of 90.9% and a specificity of 93.2% and medial meniscectomy with a sensitivity of 93.2% and a specificity of 90.9%. It predicts lateral meniscus repair with a sensitivity of 69.2% of patients and lateral meniscectomy with a sensitivity of 78.8% of patients. Ortho One PROMT score is a useful scoring system to predict the outcomes of meniscus surgery preoperatively. It uses a combination of clinical and radiological (MRI and plain radiograph) characteristics. With this scoring system, both the surgeon and the patient are better prepared preoperatively regarding the outcome of a particular meniscus surgery. The scoring shall make day-to-day arthroscopic meniscus surgery less stressful. III.

Effect of meniscus repair on pivot-shift during anterior cruciate ligament reconstruction: Objective evaluation using triaxial accelerometer

BackgroundSome types of meniscus tear, especially lateral meniscus tear, have been reported to be associated with rotatory knee laxity. However, precise information regarding the effect of meniscus repair on rotatory laxity is limited. The purpose of this study was to investigate the effects of lateral and medial meniscus repair on rotatory laxity in anterior cruciate ligament (ACL) injured knees. MethodsForty-one patients who underwent ACL reconstruction were included in the study. The tibial acceleration during the pivot shift test was measured using a triaxial accelerometer preoperatively under anesthesia and intraoperatively before and after medial and lateral meniscus repair and ACL reconstruction during surgery. Effects of meniscus tear and its repair on rotatory laxity were analyzed. ResultsPreoperative measurements revealed that patients with lateral meniscus tear showed significantly higher tibial acceleration compared to the patients without meniscus tear (P = 0.006). Intraoperative measurements revealed that medial and lateral meniscus repair significantly reduced tibial acceleration by 1.46 m/s2 (P = 0.002) and 1.91 m/s2 (P < 0.001), respectively. ConclusionIn ACL injured knees, knees with lateral meniscus tear showed greater rotatory laxity compared to the knees without meniscus tear. In addition, lateral meniscus repair, and to a lesser degree medial meniscus repair, reduced rotatory laxity during ACL reconstruction surgery. Therefore, the meniscus should be repaired as much as possible for its role as a secondary stabilizer of rotatory laxity. Besides, the effect of meniscus repair on rotatory laxity should be considered when the indication of anterolateral augmentation is determined.

Proximity of the neurovascular structures during all-inside lateral meniscal repair in children: a cadaveric study

PurposeMeniscal repair has become increasingly common in a pediatric and adolescent population. All-inside repair techniques are utilized more often given their ease of insertion and decreased operative time required. However, there are possible risks including damage to adjacent neurovascular structures. The purpose of this study to was examine the proximity of the neurovascular structures during lateral meniscus repairs in pediatric specimens simulating a worst-case scenario.MethodsTen pediatric cadaveric knees (age 4–11) were utilized and simulated lateral meniscal repair through the posterior horn of the lateral meniscus and both medial and lateral to the popliteal hiatus through the body of the lateral meniscus was performed with an all-inside meniscal repair device. The distance to the popliteal artery or peroneal nerve was measured.ResultsDuring posterior horn repair, the average distance from the all-inside device to the popliteal artery was 1.9 mm ± 1.1 mm. There was penetration of the artery in one specimen. During repair on the medial side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 3.2 mm ± 2.0 mm. During repair on the lateral side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 12.4 mm ± 3.7 mm.ConclusionsThis study demonstrates that the proximity of the neurovascular structures to the lateral meniscus in children is extremely close and at high risk during meniscal repair with all-inside devices. This study gives important data for the proximity of these structures during these repair techniques.Level of evidenceLevel 5 Cadaveric Study.

Lateral Meniscal Posterior Root Repair With Anterior Cruciate Ligament Reconstruction Better Restores Knee Stability

Background: The effect of lateral meniscal posterior root tear and repair—commonly seen in clinical practice in the setting of anterior cruciate ligament (ACL) reconstruction—is not known. Purpose/Hypothesis: This study evaluated the effect of tear and repair of the lateral meniscal posterior root on the biomechanics of the ACL-reconstructed knee. It was hypothesized that anterior tibial translation would increase under anterior loading and simulated pivot-shift loading with the root tear of the posterior lateral meniscus, while repair of the root tear would reduce it close to the noninjured state. Study Design: Controlled laboratory study. Methods: Thirteen fresh-frozen adult human knees were tested with a robotic testing system under 2 loading conditions: (1) an 89.0-N anterior tibial load applied at full extension and 15°, 30°, 60°, and 90° of knee flexion and (2) a combined 7.0-N·m valgus and 5.0-N·m internal tibial torque (simulated pivot-shift test) applied at full extension and 15° and 30° of knee flexion. The following knee states were tested: intact knee, ACL reconstruction and intact lateral meniscus, ACL reconstruction and lateral meniscal posterior root tear, and ACL reconstruction and lateral meniscal posterior root repair. Results: In the ACL-reconstructed knee, a tear of the lateral meniscal posterior root significantly increased knee laxity under anterior loading by as much as 1 mm. The transosseous pullout suture root repair improved knee stability under anterior tibial and simulated pivot-shift loading. Root repair improved the ACL graft force closer to that of the native ACL under anterior tibial loading. Conclusion: Lateral meniscal posterior root injury further destabilizes the ACL-reconstructed knee, and root repair improves knee stability. Clinical Relevance: This study suggests a rationale for surgical repair of the lateral meniscus, which can restore stability close to that of the premeniscal injury state.

Incidence and Treatment Trends of Symptomatic Discoid Lateral Menisci: An 18-Year Population-Based Study.

Background:A symptomatic discoid lateral meniscus is an uncommon orthopaedic abnormality, and the majority of information in the literature is limited to small case series.Purpose/Hypothesis:The purpose of this study was to determine the incidence of symptomatic discoid menisci in a geographically determined population and to describe treatment trends over time. The hypothesis was that the incidence of symptomatic discoid menisci would be highest among adolescent patients, and thus, the rate of surgical treatment would be high compared with nonoperative treatment.Study Design:Descriptive epidemiology study.Methods:The study population included 79 patients in Olmsted County, Minnesota, identified through a geographic database, who were diagnosed with a symptomatic discoid lateral meniscus between 1998 and 2015. The complete medical records were reviewed to confirm the diagnosis and evaluate the details of injury and treatment. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 United States population.Results:The overall annual incidence of symptomatic discoid lateral menisci was 3.2 (95% CI, 2.5-3.9) per 100,000 person-years; 12.6% of the patients in the cohort had bilateral symptomatic discoid lateral menisci. The overall annual incidence was similar between male (3.5 per 100,000 person-years) and female patients (2.8 per 100,000 person-years). The highest incidence of symptomatic discoid lateral menisci was noted in adolescent male patients aged 15-18 years (18.8 per 100,000 person-years). A majority (72.2%) of patients presented with a symptomatic tear of the discoid meniscus. The remaining patients presented with mechanical symptoms, including catching/locking or effusion, with no demonstrable meniscus tear on imaging or diagnostic arthroscopic surgery. Additionally, 20.0% of patients were observed to have peripheral instability of the meniscus at the time of diagnostic arthroscopic surgery. The mean age of those with peripheral instability was significantly younger than of those who did not have peripheral instability. Sixty patients (75.9%) received surgical treatment during the study period, including 49 (81.7%) patients who underwent partial lateral meniscectomy and 11 (18.3%) patients who underwent lateral meniscus repair in addition to saucerization.Conclusion:With an overall annual incidence of 3.2 per 100,000 person-years, a symptomatic discoid meniscus is an uncommonly encountered orthopaedic abnormality. However, the incidence of symptomatic discoid lateral menisci is highest in adolescent male patients. Because of the high rate of meniscus tears in patients presenting with symptoms, the majority are treated surgically.

Pseudomonas Aeruginosa Joint and Graft Infection following Anterior Cruciate Ligament Reconstruction Surgery

A 15-year-old male presented to our clinic with right knee pain sustained after a football injury. He was diagnosed with a right knee complete ACL tear and lateral meniscus injury based on Magnetic Resonance Imaging (MRI) findings. He was taken to the operating room four weeks later for a right ACL reconstruction with quadriceps patellar autograft and a lateral meniscus repair.

Particulated Juvenile Articular Cartilage (PJAC) Allograft for Treatment of Lateral Femoral Condyle defect in High-Performance Athletes

Background: A relatively new technology for the treatment of high grade articular cartilage lesions is the implantation of particulated articular cartilage obtained from a juvenile allograft donor (PJAC).1-2 Previous studies have reported the ability of juvenile chondrocytes to migrate from cartilage explants after being secured in a cartilage defect.3 There is little in the literature to use as a reference with respect to the use of PJAC for high grade articular cartilage lesion of the lateral femoral condyle after a failure of treatment with a microfracture in the high level athlete. Objective: The aim of this report is to describe the technique of PJAC transplantation for the treatment of chondral lesions of the lateral femoral condyle and to report the short term outcomes in the high performance athlete. Methods: We present a case report of two patients who were treated in our clinic in December 2014. Case 1: 16 year old female Division 1 university soccer player, who one year prior to our index surgery underwent microfractures of a symptomatic lateral femoral condyle articular cartilage lesion without relief. Cae 2: 29 year old male professional tennis player (case 2) with a recurrent, symptomatic chondral defect on the lateral femoral condyle. The player had undergone multiple arthroscopic procedures on the same knee following an injury sustained while playing in the Australian Open, including a surgery 8 months prior to our index operation that had included lateral meniscal tear repair and microfractures. PJAC procedure consists of a minimal debridement and chondroplasty, performed arthroscopically. For these central lateral femoral condyle lesions, a mini-arthrotomy is created along the lateral parapatellar longitudinal axis over a length of about 3 cm. With the chondral defect localized and prepared, a thin fresh layer of fibrin glue is then applied. The PJAC graft is equally distributed in the defect with space in between the fragments so as not over-fill the defect. Then, a new fibrin glue layer is placed to cover the graft. The overall construct remains just below the level of the normal articular surface. The knee is cycled through the range of motion to ensure that the tissue construct is stable. We present images of the cartilage defect after debridement and the allograft implantation procedure. In addition we will submit an instructional video performed on a knee specimen. Results: Outcomes measured were: IKDC, Lysholm, and Tegner knee scores together with arc of motion of the joint. After 28 months follow up, patients had gained complete range of motion and significantly decreased pain. Improvement for each outcome measure used is reported. Conclusions: PJAC transplantation offers pain relief and improved short term outcomes in high level performance athletes. Both of our patients are back to practicing their sport with notable improvement in symptoms. No complications have been noted. Long-term data is not yet available.

Schatzker II tibial plateau fractures: Anatomically precontoured 3.5 mm locking compression plates allow for improved patient outcome

Aims and Objectives: In the operative treatment of split depression factures to the lateral tibial plateau, the reconstruction of the depressed joint surface is eagerly sought after. The subchondral bony defect often requires bone grafting or bone graft substitutes. At least equally important is the achievement of an internal fixation that provides the greatest possible support for the fragile joint surface fragments. The design of the anatomically precontoured locking compression plates features a higher number of locking screws underneath the joint surface and permits the screw placement closer to the subchondral zone compared to conventional plates. Whether the altered design results in better patient outcome is analysed in this study. Materials and Methods: Our databank was searched for Schatzker II fractures from 2012 until 2015. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm locking compression plates (A) or conventional 4,5 mm L-shaped locking compression plates and screws (B) were included and retrospectively evaluated. CT-scans, radiographs in two planes and in full length standing mode, if available, were analysed. Details of the operative procedures and secondary events were determined. Objective outcome parameters were collected from the patient records, subjective outcome parameters were assessed in a survey and WOMAC as well as Rasmussen functional knee scores were calculated. Results: A total of 36 patients were included (A=20, B=16). The mean patient age, the ratio male to female and the mean follow up were comparable. CT-scans revealed an equal mean size of the depressed joint surface (A: 23.7 x 25.3 mm; B: 23.9 x 24.0 mm) and maximal depression depth (11.2 and 11.8 mm). The duration of the operation, the frequency of utilizing bone grafts or bone graft substitutes and of lateral meniscus repair as well as the rate of subsequent implant removal were also comparable. In the early postoperative controls, the radiological assessment according to Rasmussen revealed a mean score of 9.1 (A) and of 8.5 (B). During follow up, the mean score decreased to 8.1 and 6.7 for A and B, respectively. This difference was statistically significant (p<0.05). A valgus deviation was more often observed in group B. Both, the WOMAC and the Rasmussen functional knee score revealed lower mean values for group B in the final evaluation. Conclusion: The progressive decrease of the Rasmussen radiological score for the conventional 4,5 mm L-shaped locking compression plates and screws was predominantly due to a secondary loss of reduction and an increasing valgus deviation. The altered design of the anatomically precontoured 3.5 mm locking compression plate seems to prevent more sufficiently the reduced joint surface fragments from sintering over time. The anatomically precontoured 3.5 mm locking compression plate allows for improved patient outcome and should closely be considered for internal fixation of split depression fractures to the lateral tibial plateau.

The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement.

Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. Two hundred patients (mean age 28.6 ± 10.2years) with a mean follow-up of 45.5 ± 12.8months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1year was 0.6 ± 1.0mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears using a suture placed in the popliteus tendon is a safe technique. It is associated with a very low failure rate with no specific complications. Level IV.

Root avulsion and para-root tear of the posterolateral meniscus: repair versus untreated

Background: This study aimed to assess the outcomes of repairing posterolateral meniscal (PLM) root avulsion and para-root tear in association with anterior cruciate ligament (ACL) reconstruction and compare with those whose PLM tear was left untreated. Methods: Patients with PLM root avulsion or para-root tear accompanying ACL tear were evaluated for eligibility. Group A was composed of patients whose ACL tears were reconstructed without any lateral meniscal repair (33 patients) from 2006-2009. From 2009-2012, patients had ACL reconstruction and additional PLM repair (group B: 40 patients). Both groups were evaluated for knee stability (Lachman test), return to previous level of sports activity, subjective International Knee Documentation Committee form (S-IKDC) and Lysholm knee scores (LKS). Results: Functional results (IKDS and LKS) at 12 and 24-month follow-up were similar between the two groups (all P&gt;0.05). Eight patients (24%) in group A, and two patients (5%) in group B were unable to achieve the previous sports activity level (P=0.036). Return to previous sports activity level was significantly better in group B. Short-term (34.5 mo) and mid-term (73.5 mo) functional results of group A patients were compared, and it was demonstrated that IKDC (84.5±4) and LKS (87.7±3) scores were decreased significantly (P&lt;0.0001). Conclusions: Functional outcomes of repairing PLM root avulsion and para-root tear with those whose PLM tear was left untreated are similar in short-term follow-up; however, as the time passes, the sports activity level and mid-term subjective outcomes may worsen in patients whose PLM tear was left untreated.

Meniscus repair with simultaneous ACL reconstruction demonstrated similar clinical outcomes as isolated ACL repair: a result not seen with meniscus resection.

To compare Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol-5D (EQ-5D) subscale scores at 2-year follow-up for patients with primary isolated ACL reconstruction with patients undergoing ACL reconstruction and simultaneous meniscal treatment in terms of either resection or repair in the Swedish National Knee Ligament Register (SNKLR). All ACL reconstruction patients within the SNKLR at 2-year follow-up were reviewed. The KOOS and EQ-5D subscales were assessed in four distinct patient groups: isolated ACL reconstruction, ACL reconstruction + medial meniscus resection, ACL reconstruction + lateral meniscus resection, ACL reconstruction + medial meniscus repair, and ACL reconstruction + lateral meniscus repair. The primary analysis was conducted using linear regression with isolated ACL reconstruction designated as the reference group, and was adjusted for patient age, gender, and time from injury to surgery. The included patients consisted of 10,001 (65.0%) individuals with an isolated ACL injury, 588 (3.8%) with ACL injury plus treated with medial meniscus repair, 2307 (15.0%) with ACL injury plus treated with medial meniscus resection, 323 (2.1%) with ACL injury plus treated with lateral meniscus repair, and 2173 (14.1%) with ACL injury plus treated with lateral meniscus resection. Meniscus resection demonstrated significantly worse results with respect to the KOOS Symptoms subscale for both the medial and lateral meniscus resection groups. Medial meniscus resection also demonstrated worse results for the KOOS quality of life (QoL) subscale, while lateral meniscus resection only approached significance. Outcomes were not different between the isolated ACL reconstruction group and the meniscus repair groups. Meniscus resection in addition to ACL reconstruction resulted in worse clinical outcomes than isolated ACL reconstruction patients; a result not seen within the meniscus repair group. This suggests that, when possible, meniscus repair may provide greater clinical outcomes over resection when treating a reparable meniscal tear that presents along with an ACL tear. Clinicians should consider and implement these findings for the management of future meniscus tear patients within their clinical practice. Level III.

Meniscal repair results in inferior short-term outcomes compared with meniscal resection: a cohort study of 6398 patients with primary anterior cruciate ligament reconstruction

PurposeTo compare patient reported outcome measures (PROMs) during the first postoperative year between isolated anterior cruciate ligament (ACL) reconstruction and ACL reconstruction with concomitant meniscal intervention.MethodsPatients who underwent primary ACL reconstruction at Capio Artro Clinic, Stockholm, Sweden, between 1st Jan 2001 and 31st Dec 2014 without concomitant injuries others than meniscal and/or cartilage lesions were included. Five groups of meniscal treatment simultaneously to ACL reconstruction were established; medial meniscal (MM) resection, MM repair, lateral meniscal (LM) resection, LM repair, and MM + LM resection. Patients treated with isolated ACL reconstruction formed a separate group. Preoperative, 6-month and 1-year Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm knee score and Tegner Activity scale were collected. Differences in the change over time were analyzed with an ANOVA for repeated measurements with age at surgery, gender, and cartilage injury as covariates. A univariate ANOVA was applied to analyze PROMs between groups at the final follow-up.ResultsA total of 6398 patients were included (56.8% males, mean age 28.5 ± 10.2 years). The KOOS improved across all subscales for all treatment groups. The mean change over time differed significantly between groups for the subscales symptoms (p = 0.017) and activities in daily living (ADL) (p < 0.001). Symptoms was least improved in the MM repair group, while the MM + LM resection group showed the largest improvement. For the ADL subscale, the isolated ACL reconstruction group showed the least improvement and the MM + LM resection group showed the major improvement. At 1-year follow-up, a significant difference between the groups was found for the subscale symptoms (p = 0.019), where the MM repair group reported the lowest score [mean 78.4 (95% CI 76.3–80.5)]. No significant differences were found between groups in change of the Lysholm score over time; however, at 6 months, the difference between groups was significant (p = 0.006) with the meniscal repair groups reporting the lowest scores.ConclusionPatients with concomitant meniscal resection are able to reach the same subjective knee function as isolated ACL reconstructions as early as 6 months postoperatively. However, patients with meniscal repair may have slightly worse subjective knee function at both 6- and 12-month follow-up. These findings could help clinicians to set realistic short-term expectations for patients undergoing ACL reconstruction with simultaneous meniscal intervention.Level of evidence3.

Medial Meniscus Resection Increases and Medial Meniscus Repair Preserves Anterior Knee Laxity: A Cohort Study of 4497 Patients With Primary Anterior Cruciate Ligament Reconstruction

Background: There are still controversies regarding the effects on knee laxity of additional meniscus resection or repair in the setting of anterior cruciate ligament reconstruction (ACLR). Hypothesis/Purpose: The purpose was to determine the effects on knee laxity of resection or repair of medial meniscus (MM) or lateral meniscus (LM) injuries in the ACLR knee. The hypothesis was that patients with an additional meniscus resection would have significantly increased postoperative knee laxity versus that of an isolated ACLR, whereas patients with meniscus repair would have laxity comparable to that of an isolated ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: The KT-1000 arthrometer, with an anterior tibial load of 134 N, was used to evaluate knee laxity preoperatively and at 6-month postoperative follow-up for a total of 4497 patients with primary hamstring tendon ACLR. Patients with isolated ACLR or ACLR with additional MM resection, MM repair, LM resection, LM repair, or MM plus LM resection were compared, with the isolated ACLR group as a control. Results: All patients showed a significant reduction of knee laxity preoperatively (3.6 ± 3.1 mm) to postoperatively (1.9 ± 2.2 mm) (P < 0.0001). Patients who had an ACLR with either an MM resection (2.2 ± 2.55 mm) or MM + LM resection (2.35 ± 2.30 mm) showed significant increased postoperative knee laxity versus isolated ACLR (1.74 mm ± 2.11 mm) (P < 0.05), whereas patients with MM repair (1.69 ± 2.37 mm) did not show significantly different knee laxity when compared with the control group (P > 0.05). LM resection or repair did not significantly affect knee laxity. Significantly more surgical failures, defined as side-to-side difference >5 mm, were found in the ACLR + MM resection group and the ACLR + MM + LM resection group. Conclusion: In ACLR, additional MM resection increased whereas MM repair preserved knee laxity in comparison with the ACLR knee with intact menisci. Neither LM resection or LM repair showed a significant effect on knee laxity. Surgeons should make every effort to repair the meniscus whenever possible to avoid the residual postoperative laxity present in the meniscus-deficient knee.

Meniscal Sutures are Superior to Bioabsorbable Arrows: Results After 918 Consecutive Meniscal Repairs in a Dual Center Analysis

Objectives:It has been long known that removal of the meniscus can lead to degenerative changes, and preserving surgery rather than meniscal resection is likely to have better long-term outcomes. Success rates after meniscal repair ranges from 60- 95%, but with most studies having small number of patients. The purpose of this study was to review all meniscal repairs, and potential predictors for failure, during a 12-year period.Methods:A dual center retrospective analysis was performed on two consecutive cohorts of meniscal repairs, during the period 1999-2011 and 1999-2010 respectively. Data from surgical protocols and follow up charts were reviewed including type of tear, location, associated injury to the knee, and surgery. Study endpoint was failure of repair, which was defined as a need for reoperation and secondary partial or total meniscal resection, within 3 years. Kaplan-Meier was used to assess repair device survival. Results were expressed as hazard ratios (HR) with 95% confidence intervals (CI) and were adjusted for confounding factors using cox regression.results:954 meniscal repairs were performed on 918 patients (n = 536 males [58%] and 382 females [42%]) with a mean age of 23 years (12-60). 64% underwent medial meniscal repair and 36% underwent lateral meniscal repair. 4% were repaired both medially and laterally. 75% of the repairs were performed using meniscal sutures (predominantly Fast-Fix), and 25% of the meniscal tears were repaired using bioabsorbable arrows (Biofix). The median time from injury to surgery was 23 days (0-360). The reoperation rate in the whole cohort was 29%. 35% of the medial meniscal repairs failed and 17% failures were noted on the lateral side. Repair with bioabsorbable arrows on the medial meniscus resulted in reoperation in 44% of the cases, whereas the reoperation rate for meniscal sutures was 32% on the medial side. On the lateral side 18% failures were noticed when using arrows, and 17% when sutures were used. 62% of the patients had a simultaneous anterior cruciate ligament (ACL) injury. When medial meniscal repair was preformed with simultaneous ACL-reconstruction 26% of the meniscal repairs failed, when no simultaneous ACL- reconstruction was performed 37% of the meniscal repairs failed and with no associated ACL-injury 41% of the meniscal repairs failed. Analyzing failure in a multivariate cox regression, adjusted according to age, gender, meniscus, ACL-pathology and days- to-surgery, revealed a higher failure rate for medial meniscal repairs (HR 3.006 [2.074-4.355; p = 0.000). Bioabsorbable arrows had significantly more failures than meniscal sutures (HR 1.656 [1.207-2.273]; p = 0.002). With reference to no ACL injury, meniscal repairs performed with a simultaneous ACL-reconstruction resulted in less failure than when no simultaneous ACL-reconstruction was performed (HR 0.605 [0.413-0.885]; p = 0.010).Conclusion:The failure rate was significantly higher on the medial side, especially when using Biofix-arrows. Patients who underwent a simultaneous ACL-reconstruction had a significantly better healing than conservatively treated ACL-ruptures, and patients with no ACL-injury. Age and days-to-surgery were not significant factors for failure.

Simplified Arthroscopic Lateral Meniscal Root Repair Involving the Use of 2 Cinch-Loop Sutures

The meniscal root attachments are critical for meniscal function by securing the menisci in place and allowing optimal shock absorption in the knee. Successful meniscal root repair has been shown to restore the knee's tibiofemoral contact pressure to the same state as an intact meniscus. Although there have been multiple different repair techniques described, there is no report in the literature regarding the use of 2 simple cinch-loop sutures for a meniscal root repair. This article presents an arthroscopic lateral meniscal root repair technique involving the use of 2 simple cinch-loop configuration sutures and tibial suture anchor fixation.

Concurrent Lateral Meniscal Repair with Anterior Cruciate Ligament Reconstruction Induces the Extrusion of the Lateral Meniscus: Assessments of Magnetic Resonance Images.

Concurrent meniscal repair with anterior cruciate ligament (ACL) reconstruction has shown good clinical outcomes, but it has a considerable risk of progressing to post-traumatic osteoarthritis of the knee. Here we investigated postoperative changes in the position of the lateral meniscus (LM) and assessed the short-term clinical results after concurrent LM repair with ACL reconstruction. Twentyseven patients underwent LM repair of a peripheral longitudinal tear concomitant with ACL reconstruction. We evaluated the preoperative and postoperative values of the Lysholm score and anteroposterior instability. The length and width of the lateral tibial plateau were determined by radiographic images. The length, width, body width, extrusion, and height of the LM were measured in magnetic resonance images and compared between the preoperative and postoperative measurements. Our analysis revealed that concurrent LM repair with ACL reconstruction improved the shortterm clinical outcomes. Although the body width and height of the LM did not change, the postoperative LM extrusion and LM width were significantly increased after the surgery. The post-traumatic transposition of the LM may not be completely prevented by LM repair concomitant with ACL reconstruction.

Effects of suture site or penetration depth on anchor location in all-inside meniscal repair

BackgroundTo evaluate the effects of suture site or penetration depth on anchor location in all-inside meniscal repair. MethodsEight fresh-frozen cadaveric knees were evaluated after meniscal repair using eight FasT-Fix360 (FF360) devices (Smith & Nephew Endoscopy, Andover, MA) (16 anchors) for each knee. The penetration depth was 14mm, the distance same from the periphery to insertion point, in four knees (Group A) and that in the remaining four knees (Group B) was 18mm. The anchor location in two groups was evaluated after attentive dissection. ResultsOf 32 anchors for the medial meniscus, 94% were on the capsule, including the superficial medial collateral ligament (sMCL) in both groups. For the lateral meniscus, 47% anchors in Group A and 44% anchors in Group B were on the capsule. Total three anchors were over the lateral collateral ligament (LCL), whereas 15 anchors were behind the popliteus tendon (POP). Although all three anchors settled in the subcutaneous fat were in Group B, no significant difference was observed in anchor location between two groups. ConclusionsSecure fixation to thin membranous tissue can be achieved for the medial meniscal repair using FF360, while some were located in/on bunchy LCL or POP in lateral meniscal repair. Only anchors with additional four-millimeter penetration depth were in the subcutaneous fat, although there was no effect of the penetration depth to anchor location.Clinically, for lateral meniscal repair, penetrating toward POP/LCL should be avoided and four-millimeter deeper penetration depth might be a risk for the subcutaneous irritation.

Medial and Lateral Meniscal Inside-Out Repairs.

Meniscal tears differ in terms of pattern and location. If left untreated, a meniscal tear can lead to the development of osteoarthritis and increased pain, swelling, and functional limitations. Tears in the vascularized outer two-thirds of the meniscus can often be successfully repaired with use of an inside-out technique. Vertical mattress sutures stabilize the meniscal tear in place, allowing for proper healing. The principal steps in the procedure include (1) assessing the location and pattern of the tear arthroscopically, (2) performing a medial or lateral meniscal repair incision in the proper anatomic location, (3) passing the sutures in a vertical mattress pattern through the torn meniscus, and (4) tying the sutures while verifying sufficient reduction of the tear arthroscopically. Postoperatively, patients remain non-weight-bearing for the course of six weeks. Passive knee flexion from 0° to 90° is allowed for the first two weeks. After two weeks, motion is increased as tolerated. At six weeks postoperatively, patients are allowed to progress to weight-bearing as tolerated and initiate the use of a stationary bicycle. They should avoid squatting, sitting cross-legged, and squatting and lifting for four months postoperatively to avoid substantial stress on the healing meniscus. After four months, sports-specific activities are initiated. Patients are expected to return to normal physical activity within four to six months postoperatively.

Influence of lateral meniscal posterior root avulsions and the meniscofemoral ligaments on tibiofemoral contact mechanics.

The purpose of this study was to investigate the effect of lateral meniscal posterior root avulsions combined with intact meniscofemoral ligaments (MFLs), deficient MFLs, anterior cruciate ligament (ACL) tears and reconstructions, and root repairs using an established tibiofemoral contact mechanics testing protocol. Ten fresh-frozen cadaveric knees were tested with six knee conditions (1: intact; 2: lateral meniscal posterior root avulsion; 3: root avulsion and deficient MFLs; 4: condition3 with ACL tear; 5: condition4 with ACL reconstruction; 6: ACL reconstruction with root repair) at five flexion angles (0°, 30°, 45°, 60°, and 90°), under a 1000-N axial load. Contact area and pressure were measured with Tekscan sensors. Compared to the intact state, condition2 did not significantly change lateral compartment contact area or pressure. Changes in contact mechanics were greater at increased flexion angles; for condition3 at 0° and 90°, contact area decreased 37 and 52% [95% CI (21-53) and (39-66), respectively] and mean contact pressure increased 55 and 87% [95% CI (33-76) and (59-114), respectively]. Root repair with ACL reconstruction was not significantly different from the intact state. The MFLs protect the lateral compartment from changes in contact mechanics in the setting of a lateral meniscal posterior root avulsion, whereas a combination of lateral meniscal root avulsion and deficient MFLs leads to significant changes. Concurrent ACL reconstruction and lateral meniscal root repair restore mean contact pressure and area to the intact state and are recommended in this combined injury to prevent or slow the development of lateral compartment arthritis.

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

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