Meniscal Suture Research Articles

Natural biopolymer scaffold for meniscus tissue engineering.

Meniscal injuries caused by trauma, degeneration, osteoarthritis, or other diseases always result in severe joint pain and motor dysfunction. Due to the unique anatomy of the human meniscus, the damaged meniscus lacks the ability to repair itself. Moreover, current clinical treatments for meniscal injuries, including meniscal suturing or resection, have significant limitations and drawbacks. With developments in tissue engineering, biopolymer scaffolds have shown promise in meniscal injury repair. They act as templates for tissue repair and regeneration, interacting with surrounding cells and providing structural support for newly formed meniscal tissue. Biomaterials offer tremendous advantages in terms of biocompatibility, bioactivity, and modifiable mechanical and degradation kinetics. In this study, the preparation and composition of meniscal biopolymer scaffolds, as well as their properties, are summarized. The current status of research and future research prospects for meniscal biopolymer scaffolds are reviewed in terms of collagen, silk, hyaluronic acid, chitosan, and extracellular matrix (ECM) materials. Overall, such a comprehensive summary provides constructive suggestions for the development of meniscal biopolymer scaffolds in tissue engineering.

A comparative analysis of outcomes of surgical treatment of meniscus injuries in the knee joint in children after meniscectomy and meniscus suture repair

Introduction. The most common modalities of surgical treatment of meniscus injuries in children are meniscectomy and meniscal suture repair. However, indications and contraindications for both approaches in the pediatric practice is one of the most discussed problems. To more precisely define indications and contraindications for resection and meniscus suture repair will optimize management of meniscus injuries in children, thus improving outcomes and preventing early osteoarthritis of the knee joint.Purpose. To analyze outcomes after meniscectomy and meniscus suture repair in children after meniscus injuries.Material and methods. From 2015 till 2020, 120 children were treated in the department of traumatology and orthopedics (Morozovskaya Children's Clinical Hospital) for meniscus injuries. 88 patients (73.3%) from Group 1 had arthroscopic meniscus suture repair. 32 children (26.7%) from the comparison group had meniscectomy. All removed menisci were subjected to histological examination. Outcomes were assessed in 6 and 12 months after the surgery: clinical examination, MRI, radiography, and questionnaires with KOOS-Child and Pedi-IKDC scales.Results. In 6 months after the surgery, the following complaints were registered: after total meniscectomy pain was in 100% of patients; after partial resection of the meniscus pain was in 3.1% of patients. The basic complaint after meniscus suture repair was flexion restriction (10.2%). In 12 months after surgery, complaints were registered in 7 children after total meniscus resection (100% of all total meniscectomies), in 15 children after partial meniscus resection (60% of all partial meniscectomies), and in 14 children after meniscus suture repair (19.4% of all meniscus suture repairs). The assessment of clinical findings before and after meniscus suture repair in 6 and 12 months after the surgery has shown a statistically significant decrease in pain (p0.001), in swelling of the knee joint (p0.001) and relief of flexion restriction (p0.021), if to compare with partial meniscectomy.Conclusion. Unsatisfactory outcomes after total meniscectomy urge to exclude this type of intervention in the pediatric practice. Partial meniscectomy should be performed only if it is a case of multiple and multiplanar, multidirectional complex injury when meniscus repair is technically impossible. Marked cicatricial changes in the meniscus tissue which deform it and do not allow to make an anatomical reconstruction of the joint is also an indication for partial resection. If there are no marked degenerative changes and meniscus suture repair is technically possible, the damaged meniscus should be restored, regardless of the time of its injury and rupture location.

Function, Injury, and Treatment for Meniscus

The meniscus is considered a vital structure for maintaining normal functions and perennial health of the knee joint. This study focuses on the meniscus and discusses its function, injuries and the corresponding treatments. Results show that two menisci are located in the knee joint- medial and lateral meniscus, which are different in shape but work together to provide specific functions. The main functions of the meniscus include load sharing, shock absorption, stability, joint lubrication and nutrition. Meniscal injuries include vertical longitudinal, radial, horizontal (cleavage), degenerative (complex), and bucket-handle tears, all of which can cause serious knee morbidity. There are different symptoms of meniscus damage, and the severity of the damage can be identified from the symptoms. Once the meniscus injury is found, conservative or surgical treatment should be carried out immediately. Conservative treatments generally include massage, acupuncture, and slight movement, as well as drug treatment. Surgical treatments include meniscus suture, partial meniscectomy, and meniscectomy. If it is not treated in time, the meniscus could cause irreversible damage and a series of sequelae.

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...

Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three-Year MRI Follow-Up.

ObjectiveTo describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations.MethodsA total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing.ResultsPreoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus.ConclusionsArthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.

Meniscal Tear Management Associated with ACL Reconstruction

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. “Masterly neglect” is a valuable option in selected cases.

Knee Meniscus Posterior Root Repair with FiberTak

Repair of medial meniscal root tear is nowadays a validated procedure in order to restore knee biomechanics and to prevent early development of arthritis. There are various techniques described, without any being considered superior. This article describes a technique with a knotless suture anchor design, using a high posteromedial portal to insert the anchor and a meniscal suture passer device from the anteromedial portal. The technique eliminates the need for transtibial drilling and knot tying, and it certifies a strong reproducible tension.

Pour une amélioration de la prise en charge du diabète des résidents en EHPAD

Postoperative stiffness is a feared complication after anterior cruciate ligament (ACL) reconstruction. In case of associated dislocated bucket-handle meniscal tear (BHMT), reduction is urgent, with ligament reconstruction in the same surgical step.Treatment of associated dislocated BHMT in ACL reconstruction incurs increased risk of arthrolysis for stiffness in flexion and/or extension.A retrospective exposure/non-exposure study included 208 patients undergoing ACL reconstruction between January 2009 and December 2018. Those showing dislocated medial or lateral BHMT at surgery (group A) were compared versus those free of meniscal lesions (group B). The main objective was to assess the risk of surgical revision for arthrolysis within 12 months. Group A included 69 patients: 40 male (58%), 29 female (42%); mean age, 29.0 ± 11.2 years. Group B included 139 patients: 68 male (49%), 71 female (51%); mean age, 30.0 ± 10.4 years. Patients were classified according to age of ACL tear, as acute (< 6 weeks), subacute (6 weeks to 6 months), or chronic (> 6 months).Risk of revision surgery for arthrolysis was greater in Group A than in Group B, with 7 (10.1%) and 4 (2.9%) cases respectively (p = 0.044), with 12-month arthrolysis-free survival of 89.7% (95% CI, 82.7–97.2) and 97.1% (95% CI, 94.3–99.9) respectively (p = 0.023). Stiffness in flexion and extension was more frequent in Group A at 6 weeks and at 6 months (p > 0.05). Risk of arthrolysis did not significantly differ according to accident-to-surgery time in the overall series (p = 0.421) or specifically in Group A (p = 0.887). The BHMT was sutured in 39 cases (56.5%), including 3 failures (7.7%) at 12 months’ follow-up. Arthrolysis was required in 6 patients treated by meniscal suture (15.4%) and just 1 patient treated by meniscectomy (3.3%) (p = 0.128).The present study confirmed increased risk of surgical revision for arthrolysis after ACL reconstruction in case of dislocated BHMT treated in the same surgical step. Age of ACL tear and type of BHMT treatment (suture or meniscectomy) showed no impact on postoperative stiffness.IV, retrospective exposure/non-exposure cohort study.

Significant risk of arthrolysis after simultaneous anterior cruciate ligament reconstruction and treatment of dislocated bucket-handle meniscal tear

IntroductionPostoperative stiffness is a feared complication after anterior cruciate ligament (ACL) reconstruction. In case of associated dislocated bucket-handle meniscal tear (BHMT), reduction is urgent, with ligament reconstruction in the same surgical step. HypothesisTreatment of associated dislocated BHMT in ACL reconstruction incurs increased risk of arthrolysis for stiffness in flexion and/or extension. Material and methodsA retrospective exposure/non-exposure study included 208 patients undergoing ACL reconstruction between January 2009 and December 2018. Those showing dislocated medial or lateral BHMT at surgery (group A) were compared versus those free of meniscal lesions (group B). The main objective was to assess the risk of surgical revision for arthrolysis within 12 months. Group A included 69 patients: 40 male (58%), 29 female (42%); mean age, 29.0±11.2 years. Group B included 139 patients: 68 male (49%), 71 female (51%); mean age, 30.0±10.4 years. Patients were classified according to age of ACL tear, as acute (<6 weeks), subacute (6 weeks to 6 months), or chronic (>6 months). ResultsRisk of revision surgery for arthrolysis was greater in Group A than in Group B, with 7 (10.1%) and 4 (2.9%) cases respectively (p=0.044), with 12-month arthrolysis-free survival of 89.7% (95% CI, 82.7–97.2) and 97.1% (95% CI, 94.3–99.9) respectively (p=0.023). Stiffness in flexion and extension was more frequent in Group A at 6 weeks and at 6 months (p>0.05). Risk of arthrolysis did not significantly differ according to accident-to-surgery time in the overall series (p=0.421) or specifically in Group A (p=0.887). The BHMT was sutured in 39 cases (56.5%), including 3 failures (7.7%) at 12 months’ follow-up. Arthrolysis was required in 6 patients treated by meniscal suture (15.4%) and just 1 patient treated by meniscectomy (3.3%) (p=0.128). ConclusionThe present study confirmed increased risk of surgical revision for arthrolysis after ACL reconstruction in case of dislocated BHMT treated in the same surgical step. Age of ACL tear and type of BHMT treatment (suture or meniscectomy) showed no impact on postoperative stiffness. Level of evidenceIV, retrospective exposure/non-exposure cohort study.

How to Avoid Iatrogenic Saphenous Nerve Injury During Outside-In or Inside-Out Medial Meniscus Sutures

Medial meniscal sutures using outside-in or inside-out techniques are very popular. Nevertheless, a saphenous nerve entrapment may occur with these techniques. This Technical Note describes a modified outside-in medial meniscus suture without any additional skin incisions. By dissecting the space between the subcutaneous and the capsule, which is performed by grasping and knotting the sutures through the anteromedial portal, iatrogenic saphenous nerve injury is avoided.

Лечение пациентов с повреждениями менисков коленного сустава

The aim: to study the results of surgical treatment of patients with injuries of the meniscus of the knee joint, in whom arthroscopic suturing of the meniscus was used according to the developed technique.Methods. In this paper, we studied the results of surgical treatment of 134 patients with chronic injuries of the meniscus of the knee joint, who were treated at the City Clinical Hospital No. 7 in Almaty for the period from 2017 to 2021. 70 (52.3%) patients made up the control group, who underwent meniscus resection using arthroscopic technique. The main group included 64 (47.7%) patients with ruptures of the meniscus of the knee joint. He performed a meniscus suture under arthroscopic control according to the method developed by us (RK patent No. 35413 dated 12/10/2021). Results. Clinical application of a new method of arthroscopic meniscus suturing in patients of the main group allowed to increase the frequency of excellent results by 7.3% (p=0.012), good treatment results by 19.7% (p&lt;0.001) according to the Lysholm scale compared with the control group. The treatment outcomes of patients in the study groups, analyzed using the criteria of evidence-based medicine, indicate the effectiveness of a new method of arthroscopic meniscus suturing, which reduces the frequency of unsatisfactory outcomes in the long-term period of surgical treatment by 5.5% (p=0.184) compared with the control group.Сonclusions.The results of the research work support the arthroscopic repair of meniscal tears with good long-term results and a low risk of complications. Thus, a new method of arthroscopic suturing of the meniscus provides prevention of the development of contractures, gonarthrosis in the postoperative period in patients with injuries of the meniscus of the knee joint and allows for early functional treatment compared to traditional arthroscopic meniscectomy.Keywords: knee joint, menisci, meniscus injury, osteoarthritis, arthroscopy, meniscus suture, meniscus resection.

Treatment Outcomes of Meniscus Root Tear. Practical Results of Kazakh Republican Center of Arthroscopy and Sport Trauma Center of 2018-2020

Purpose of the study. To report experience of 30 months meniscus root tear treatment in Kazakhstan that was made by Kazakh center of arthroscopy and sport trauma.Methods. We analyzed work with meniscus root tear in period from 2018 to 2020. We find out the frequency of such injury among knee arthroscopies. Patients are classified by gender, age and anamnesis of injury.Results. In total of the 157 root tears, 22 were male patients (average age 49.2±11.9) and 135 female (55.5±12.6), mostly of them – degenerative etiology. Among 4 male cases identified in 2019, all lesions had degenerative etiology, the average age 54±12.5 (43.0-69.0), Me 57.0 (47.0-61.0 by 25/75 quartiles). Female - 50 detected cases, av. age 58±13.8 (36.0-70,0), Me 48,0 (39.0-64.0 according to 25/75 quartile). Only 6 injuries of them (12%) had acute, traumatic cause.In 2020, 12 cases of injuries were detected among men, av. age 44.4±11.4 years (from 15 to 68 years). Half of the tears were caused by acute trauma, including 2 combined injuries with ACL. In women, the number of identified cases increased to 73, av. age 53 years (range 39 to 72 years), and only 4 injuries were traumatic, including 1 case of combined injury with the posterior cruciate ligament tear.Conclusion. As a result of involve of the operation technique and effective detection of pathology among patients, the dynamics of meniscus root refixation increased by 2020. It is necessary to develop a protocol for the diagnosis and treatment of a meniscal root tear, given the increasing incidence of the problem.Keywords: arthroscopy and sports injury, meniscus root avulsion, meniscus suturing, Kazakhstan

Application of exposure enhancement technique combined with femoral condyle pushing technique in repairing the posterior horn of the medial meniscus under knee arthroscopy.

Objectives:To investigate the clinical efficacy of exposure enhancement technique and femoral condyle pushing technique applying in the posterior horn of the medial meniscus of the knee.Methods:From January 2016 to June 2019, 52 patients with injury in the medial meniscus treated in our department were selected. The horizontal tear of the posterior horn of the medial meniscus was repaired by exposure enhancement technique and femoral condyle pushing technique using the meniscus suture system. Postoperatively, the efficacy was evaluated using the Lysholm scoring system.Results:These 52 patients were all followed up for 3~18 months, with an average of 12.5 ± 7.3 months. The pain and activity of all patients were significantly improved compared with those before surgery.Conclusion:Exposure enhancement technique and femoral condyle pushing technique in the repair of the posterior horn of the medial meniscus presents satisfactory efficacy. It can improve the pain and activity of the knee, and enhance the stability of residual meniscus. Therefore, it is worth promoting.

The Clinical Efficacy and Risk Factors after Revision and Reconstruction of Anterior Cruciate Ligament.

The aim of this study was to study the clinical efficacy and prognostic factors after revision and reconstruction of anterior cruciate ligament. All the patients who underwent the first revision of anterior cruciate ligament (ACL) reconstruction in the department of sports medicine from January 2001 to December 2015 were collected. The demographic information, the first revision and reconstruction information of ACL, and the information during the first ACL reconstruction were collected. A total of 335 cases were included. Lysholm score, Tegner activity score, and IKDC subjective score at the last follow-up were significantly higher than those before operation. Compared with graft failure caused by sports injury, the postoperative scores of patients with revision due to life accidents or initial reconstruction techniques were significantly lower (P < 0.05). The postoperative Lysholm score of patients with femoral canal drilling through the tibial canal was lower than that of patients with anterior internal approach. The postoperative IKDC score of patients who underwent medial meniscus suture at the same time was higher than that of patients without meniscus combined injury. ACL revision can improve the stability and function of knee joint. Compared with the revision caused by life accident or technical reasons of primary reconstruction surgery, the patients with graft failure caused by sports injury have better postoperative recovery. Medial meniscus suture and anterior internal approach drilling of the femoral bone canal have a statistically protective effect on the clinical function after ACL revision.

Microinvasive Meniscal Suture with Disposable Needle.

The first meniscal suture was performed in 1885 and took about a century to become popular. Currently, all-inside meniscal repair devices are widely used. However, this technique presents the disadvantage of being a method dependent on specific devices, presenting a higher cost than other techniques. This high cost limits the use of such a technique in many locations. The objective of the present technical note is to describe a microinvasive meniscal suture technique as a modification of the all-inside technique, using a disposable 40 × 12 mm procedure needle. The authors believe that the proposed modification to the technique can make it more popular, enabling the use of the microinvasive technique in places with limited resources.

Tibial slope correction combined with second revision ACLR grants good clinical outcomes and prevents graft rupture at 7-15-year follow-up.

To update previously published outcomes (at 2-8years) of second revision anterior cruciate ligament reconstruction (ACLR) combined with tibial deflexion osteotomy (TDO), after an interval of 5 more years (at 7-15years), and monitor evolution of clinical scores and progression of osteoarthritis. The initial retrospective consecutive series included nine patients that underwent one-stage second revision ACLR with TDO, all of whom were contacted for second follow-up at minimum 7years. An independent observer collected IKDC-SKF, the Lysholm score, and assessed radiographs for signs of osteoarthritis. Of the nine original patients, seven were assessed at the clinic, one could only be assessed by telephone, and one was lost to follow-up. At final follow-up of 9.9 ± 3.0years, the eight patients assessed maintained or improved clinical scores, compared to the previous follow-up at 4.0 ± 2.9years. The mean Lysholm score improved from 73.8 ± 5.8 (65-82) to 84.5 ± 11.9 (59-95), and IKDC improved from 71.6 ± 6.2 (62-79) to 82.9 ± 12.1 (61-98). Of the three patients that had signs of arthritis at the previous follow-up, the stage of osteoarthritis increased in one (from grade 2 to grade 3), remained unchanged in one, and could not be assessed in one. At 7-15years following second revision ACLR with TDO, patients maintained or improved clinical scores compared to the previous follow-up at 2-8years, without retears or reoperations. Although eight of the nine knees had meniscectomies or meniscal sutures, osteoarthritis progressed in only one of the six knees that had signs of arthritis at the previous follow-up. These results confirm that TDO can protect the ACL graft from retear, with minimal progression of osteoarthritis and/or risks of meniscal tears, suggesting that correction of excessive tibial slope should be considered when performing ACLR, whether a revision or primary procedure.

Biomaterials and Meniscal Lesions: Current Concepts and Future Perspective.

Menisci are crucial structures for knee homeostasis. After a meniscal lesion, the golden rule, now, is to save as much meniscus as possible; only the meniscus tissue that is identified as unrepairable should be excised, and meniscal sutures find more and more indications. Several different methods have been proposed to improve meniscal healing. They include very basic techniques, such as needling, abrasion, trephination and gluing, or more complex methods, such as synovial flaps, meniscal wrapping or the application of fibrin clots. Basic research of meniscal substitutes has also become very active in the last decades. The aim of this literature review is to analyze possible therapeutic and surgical options that go beyond traditional meniscal surgery: from scaffolds, which are made of different kind of polymers, such as natural, synthetic or hydrogel components, to new technologies, such as 3-D printing construct or hybrid biomaterials made of scaffolds and specific cells. These recent advances show that there is great interest in the development of new materials for meniscal reconstruction and that, with the development of new biomaterials, there will be the possibility of better management of meniscal injuries

АНАЛИЗ ОСОБЕННОСТЕЙ ПРИМЕНЕНИЯ ФИЗИОТЕРАПЕВТИЧЕСКИХ МЕТОДОВ ЛЕЧЕНИЯ БОЛЬНЫХ В КЛИНИЧЕСКОМ ГОСПИТАЛЕ ФКУЗ «МЕДИКО-САНИТАРНАЯ ЧАСТЬ МВД РОССИИ ПО РТ», ПЕРЕНЕСШИХ АРТРОСКОПИЧЕСКИЕ ОПЕРАЦИИ НА КОЛЕННОМ СУСТАВЕ В 2018–2019 ГОДАХ

Background. Diseases of the musculoskeletal system are the most common cause of disability in the modern world, and the prevalence of these diseases is increasing at an alarming rate. Currently, various types of arthroscopic operations on the knee joint are performed – for meniscus damage (including meniscus suture), instability of the knee joint, damage to the cruciate complex, articular cartilage, patellar instability, free joint bodies, pathological folds, synovitis, knee arthrosis, and rheumatoid arthritis. Medical rehabilitation after arthroscopic surgery traditionally includes administration of nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, therapeutic exercise using isometric active exercises, hydrokinesis therapy, and various physical therapy methods. Aim. Study of the use of physiotherapeutic methods in the treatment of patients who underwent atroscopic surgery on the knee joint in the physiotherapy department at the Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019. Material and methods. The frequency of prescription of therapeutic physical factors for patients who underwent arthroscopic surgeries on the knee joint at the physiotherapy department at the Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019 was investigated. The patients were accordingly divided into two groups: in 2018, 37 patients were prescribed physiotherapeutic procedures, in 2019 there were 48 patients. The age of the patients in 2018 was (33,9±9,4) years, in 2019 it was (34,2±9,1) years. Statistica 6 software package by StatSoft was used for statistical processing. Differences were considered statistically significant at p&lt;0,05. Results and discussion. Paraffin therapy, treatment using Nuga-Best bed, amplipulse therapy, UHF therapy, cryotherapy, oxygen cocktails containing medicinal herbs were prescribed with less frequency in the treatment of patients operated for knee joint injuries in 2018 than in 2019. Despite the proven effectiveness of whirlpool baths and darsonvalization in treating musculoskeletal disorders were not prescribed for the rehabilitation of patients who underwent atroscopic surgeries at the physiotherapy department of Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2019. Conclusion. When rehabilitating patients who have undergone arthroscopic intervention on the knee joint, it is advisable to thoroughly consider the use of therapeutic physical factors to improve the operation of the physiotherapy department.

Clinical oberservation on rotator cuff suture threader and strapping suture in meniscus tear under arthroscopy

To explore clinical effect of arthroscopic meniscus tear strapping suture by rotator cuff suture threader. Forty patients with meniscus tear injury admitted from July 2015 to May 2019, including 27 males and 13 females, aged from 20 to 55 years old with an average of (36.0±1.4) years old. Menisci laceration was sutured with rotator cuff suture thread under arthroscopy. Postoperative complication was observed, Lysholm knee joint score before and after operation at 12 months were used to evaluate clinical effects, visual analogue scale (VAS) and range of knee flexion and extension were applied to evaluate recovery of pain and function. All patients were followed up from 12 to 15 months with an average of (12.6±0.7) months.No complication such as joint effusion, suture failure occurred. Two patients occurred mild pain after activity without clinical physical abnormality, and 1 patient manifested moderate pain with joint space tenderness, the other rest without abnormal. Lysholm knee joint score was increased from (49.55±1.21) preoperatively to (98.95±0.42) at 12 months after operation, VAS score decreased from (5.18±0.78)preoperatively to (1.03±0.77) at 12 months after operation, and range of knee joint flexion and extension activity increased from (50.63±9.20)°preoperatively to (130.38±4.99)°after operation, and there were statistical differences in Lysholm knee joint score, VAS and range of knee joint flexion and extension activity (P< 0.05). Arthroscopic strapping suture by rotator cuff suture threading device applies to most meniscus injuries, including medial meniscus posterior horn tears, lateral meniscus body tears and lateral meniscus posterior horn tears. This technique meets the need of full-internal meniscus suture without specialmeniscus suture, and has advantages of convenient operation, less complications and good postoperative function.

Application of pie-crusting technique of deep medial collateral ligament under arthroscopy in repairing posterior horn of medial meniscus tears

To explore effectiveness and safety of an inside-out, arthroscopic deep medial collateral ligament pie-crusting release in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint. From January 2016 to December 2017, 61 patients (61 knees) were underwent arthroscopic partial meniscectomies for PHMM tear in tight medial tibiofemoral compartment of knee joint, who were divided into valgus group and pie-crusting group according to exposure of PHMM region . There were 28 patients in valgus group, including 12 males and 16 females aged from 27 to 60 years old with an average age of (35.75±7.57) years old;who were performed conventional valgused knee to exporsure PHMM region. There were 33 patients in pie-crusting group, including 15 males and 18 females aged from 26 to 58 years old with an average age of (36.06±7.93) years old;who were treated with inside-out, arthroscopic deep MCL pie crusting release technique with MM-Ⅱ meniscus suture package (Smith & Nephew). Operation time, preoperative and postopertaive Lysholm score of knee joint, injury of MCL between two groups were recorded and compared. All patients were followed up from 12 to 18 months with an average of (15.19±2.22) months. The incisions were healed at stageⅠ. There were no statistical difference in anatomical classification of PHMM between two groups(P>0.05). There was difference in opertaion time between valgus group (83.32±5.01) min and pie-crusting group (50.06±3.67) min (P<0.05). Postopertaive Lysholm score of knee joint at 3 months in two groups were higher than that of before operation (P<0.05), and Lysholm total score of knee joint in pie-crusting group was higher than that of valgus group (P<0.05). Acocording to Lysholm score of knee joint, 7 patients got excellent results, 12 good, 7 moderate and 2 poor in valgus group;19 patients got excellent results, 10 good, 4 moderate in pie-crusting group;and had difference between two groups (P<0.05). MCL injury of valgus group (15 patients with degree 0, 10 patients with degreeⅠ, 3 patients with degreeⅡ, 0 patient with degree Ⅲ) was higher than pie-crusting group(28 patients with degree 0, 5 patients with degreeⅠ, 0 patient with degreeⅡ, 0 patient with degreeⅢ)(P<0.05), while there was no differnce between two groups in MCL injury at 1 month after opertaion (P>0.05) . The inside-out, arthroscopic deep MCL pie-crusting release for the treatment of posterior horn of medial meniscus tear in tight medial tibiofemoral could expand working apace, shorten operation time, reduce injury to MCL and obtain good clinical efficacy.