scholarly journals Clinical Outcomes of Revision Meniscal Repair

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0046
Author(s):  
Muhammad Sakti
Keyword(s):  
Revision Surgery ◽  
Primary Repair ◽  
Meniscal Repair ◽  
Lysholm Score ◽  
Patient Demographics ◽  
Outcome Scores ◽  
The Mean ◽  
Location Type ◽  
Record Review

Background: The failure rate after arthroscopic primary meniscal repair ranges from 5% to 43.5% (mean 15%). Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported. Objective: This was a retrospective study aim to evaluate the outcome of revision meniscal repair in patients with re-tears in Makassar’s hospitals from 2010 – 2017. Methods: A medical record review was performed to identify all patients undergoing revision meniscal repair between 2010 and 2017 in Makassar’s hospitals. Only patients with re-tears of the primary repaired meniscus were included. Surgical technique of primary and revision meniscus repair was detailed. The records of all patients were reviewed to collect patient demographics, affected side of the re-teared meniscus, reasons for failed primary repair, combined disorder, location of the tear, and duration between the primary and revision surgery. Follow-up evaluation included clinical outcome scores (Lysholm Score). Results: A total 9 of 15 patients (5 male and 4 female) with a mean age of 25.3 years (range, 19 to 44) and a mean BMI of 24.48 kg/m2 (range, 19.6 to 32.9) were included. Three lateral menisci and six medial meniscal repairs were revised at mean 23.3 months (range, 19 to 32) after primary repair. Reasons for failed primary repairs were traumatic re-tears in 4 patients (44%) and non-traumatic re-tears in 5 patients (56%). Patients undergoing isolated meniscal repair were found in 6 patients, 2 patients with ACL concomitant disorder, and 1 patient with osteoarthritis. Two tears occurred in the red-red zone and 7 in the red-white zone. At final follow-up, the mean Lysholm score significantly improved from 79.8 points (range, 75-84 points) at pre-revision to 88.1 (range, 80 to 97). Conclusion: Meniscal repair should always be considered when the anatomic conditions are favorable (location, type of tear, ACL status).

scholarly journals Revision Meniscal Repair - Failure rates, clinical outcome and patient satisfaction

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0022
Author(s):  
Andreas Fuchs ◽  
Ferdinand Kloos ◽  
Gerrit Bode ◽  
Kaywan Izadpanah ◽  
Norbert Südkamp ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Revision Surgery ◽  
Meniscal Repair ◽  
Sports Participation ◽  
Lysholm Score ◽  
Failure Rates ◽  
The Mean ◽  
High Level

Aims and Objectives: Failure of isolated primary meniscal repair must be expected in 14% - 28%. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of revision meniscal repair remain unclear. The purpose of this study was therefore to evaluate the clinical outcome and failure rates of revision meniscal repair in patients with re-tears or failed healing after previous isolated meniscal repair in stable knee joints. Materials and Methods: A chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction. Results: A total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 with a range of 90-100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8 ± 1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either very satisfied or satisfied with the outcome. Conclusion: In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is comparable to isolated meniscal repair. Therefore, revision meniscal repair is worthwhile in order to save as much meniscal tissue as possible.

Examination of refractory discoid lateral meniscus injury

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110220
Author(s):  
Fumiyoshi Kawashima ◽  
Hiroshi Takagi
Keyword(s):  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Lysholm Score ◽  
The Body ◽  
Suture Repair ◽  
Discoid Lateral Meniscus ◽  
Short Term ◽  
Shift Type ◽  
The Mean

Background: Lateral discoid meniscus (LDM) should be treated and preserved with saucerization and/or suture repair. However, repair of the meniscal hoop structure is sometimes difficult due to displacement or large defects. In this study, we aimed to examine tear patterns based on the Ahn classification in those requiring meniscal repair and those undergoing subtotal meniscectomy. Methods: Twenty-three patients were evaluated (mean age, 27.4 years; mean follow-up period, 2.5 years). The following were evaluated: displacement morphology based on the Ahn classification, site of tear under arthroscopy, morphology, surgical procedure, Lysholm score at final postoperative follow-up, and clinical outcome of meniscus using Barrett’s criteria. Result: There were 16 knees without displacement (saucerization with suture repair, 13 knees; subtotal meniscectomy, 3 knees) and 10 knees with displacement (reduction with suture repair, 3 knees; subtotal meniscectomy, 7 knees). Subtotal meniscectomy was performed more often in cases with dislocation, especially in the central shift type as defined by the Ahn classification. The mean Lysholm score was 65.0 points preoperatively and 95.3 points postoperatively. Twenty-three knees (88%) were postoperatively categorized under the Barrett’s criteria as healing and 3 knees (12%) were categorized as non-healing. The number of non-healing cases that underwent subtotal meniscectomy was relatively small (1 of 10 knees), and the short-term results were not poor. Conclusion: Localized peripheral longitudinal tears tended to be repairable even with displacement, while peripheral tears covering the entire meniscus or with severe defects/tears in the body of the meniscus tended to be difficult to repair, leading to subtotal meniscectomy.

scholarly journals How Consistent are the MRI Findings and the Clinical Outcomes after Meniscus Repair?

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0013
Author(s):  
Hasan Bombaci ◽  
Fatih Cetinkaya ◽  
Kaan Meric
Keyword(s):  
Clinical Outcomes ◽  
Meniscal Repair ◽  
Meniscus Repair ◽  
Lysholm Score ◽  
Activity Score ◽  
Meniscus Tear ◽  
Mri Findings ◽  
Mri Examination ◽  
The Mean

Objectives: The meniscal repair is a preferred treatment whenever possible after meniscus tear. There are reports in the literature that MRI assessment is not useful to evaluate healing of the meniscus after repair. However, we have not found any study which compares the clinical outcomes of meniscus repair according to the MRI findings. The purpose of this study was to compare the MRI features and the clinical outcomes after meniscus repair. Methods: 32 patients underwent meniscus repair between January 2011 and June 2013. Twenty three of them accepted a control MRI examination at last follow-up visit. One patient was more than 130 kg in weight so it was not possible to perform MRI examination in our institution. Therefore, twenty-two patients (17 male, 5 female) were included in this study. The mean age was 31.81 (18-48). Preoperative clinical and radiological findings were obtained from the hospital registry. At last follow-up, the clinical examination and MRI assessment were performed. The results were compared statistically with the ANOVA method. Results: MRI assessment, obtained at the last follow-up, was performed blindly by the radiology specialist and senior surgeon and any conflicts between the two assessments were settled by using the preoperative MRI findings. In 10 patients (45.45%), the MRI examination revealed normal/nearly normal meniscal signal alteration, in three (13.64%), incomplete tear and in nine (40.91%), a vertical/complex tear signal located in the previously torn meniscus area. Post-operatively the mean Lysholm score was 91.40±10.57 and Tegner activity score, 4.59±1.62. Also, the Lysholm score (91.5±12.44, 94.33±5.50 and 90.33±10.34, respectively) and Tegner activity score (4.2±1.87, 6±1.00 and 4.5±1.33, respectively) were evaluated in each group separately, however the difference was not statistically significant (p>0.05). Conclusion: In the present study, there was no correlation between the MRI signals and clinical outcomes. The Lysholm score was found to be over 90 in 20 of the 22 knees in this series. In conclusion, the findings reveal that the meniscus fulfills its function as normal or nearly normal even though the MRI findings fail to prove healing, in the mean 19. 5 months’ period postoperatively.

Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

scholarly journals Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098187
Author(s):  
Justus Gille ◽  
Ellen Reiss ◽  
Moritz Freitag ◽  
Jan Schagemann ◽  
Matthias Steinwachs ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Demographic Data ◽  
Case Series ◽  
Defect Size ◽  
Lysholm Score ◽  
Outcome Analysis ◽  
Cartilage Defects ◽  
Chondral Defects ◽  
The Mean

Background: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. Purpose: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. Results: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement ( P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. Conclusion: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.

Outcomes of Inside-out Meniscal Repair in the Setting of Multiligament Reconstruction in the Knee

2017 ◽  
Vol 45 (9) ◽  
pp. 2098-2104 ◽  
Author(s):  
Jorge Chahla ◽  
Chase S. Dean ◽  
Lauren M. Matheny ◽  
Justin J. Mitchell ◽  
Mark E. Cinque ◽  
...  
Keyword(s):  
Failure Rate ◽  
Meniscal Repair ◽  
Postoperative Outcome ◽  
Control Group ◽  
Failure Rates ◽  
Significant Difference ◽  
Outcome Scores ◽  
Inside Out ◽  
Repair Group

Background: Limited evidence exists for meniscal repair outcomes in a multiligament reconstruction setting. Purpose/Hypothesis: The purpose of this study was to assess outcomes and failure rates of meniscal repair in patients who underwent multiligament reconstruction compared with patients who underwent multiligament reconstruction but lacked meniscal tears. The authors hypothesized that the outcomes of meniscal repair associated with concomitant multiligament reconstruction would significantly improve from preoperatively to postoperatively at a minimum of 2 years after the index surgery. Secondarily, they hypothesized that this cohort would demonstrate similar outcomes and failure rates compared with the cohort that did not have meniscal lesions at the time of multiligament reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Inclusion criteria for the study included radiographically confirmed skeletally mature patients of at least 16 years of age who underwent multiligamentous reconstruction of the knee without previous ipsilateral osteotomy, intra-articular infections, or intra-articular fractures. Patients were included in the experimental group if they underwent inside-out meniscal suture repair with concurrent multiligament reconstruction. Those included in the control group (multiligament reconstruction without a meniscal tear) underwent multiligament reconstruction but did not undergo any type of meniscal surgery. Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index, Short Form–12 physical component summary and mental component summary, Tegner activity scale, and patient satisfaction scores were recorded preoperatively and postoperatively. The failure of meniscal repair was defined as a retear of the meniscus that was confirmed arthroscopically. Results: There were 43 patients (16 female, 27 male) in the meniscal repair group and 62 patients (25 female, 37 male) in the control group. Follow-up was obtained in 93% of patients with a mean of 3.0 years (range, 2.0-4.7 years). There was a significant improvement between all preoperative and postoperative outcome scores ( P < .05) for both groups. The meniscal repair group had significantly lower preoperative Lysholm and Tegner scores ( P = .009 and P = .02, respectively). There were no significant differences between any other outcome scores preoperatively. The failure rate of the meniscal repair group was 2.7%, consisting of 1 symptomatic meniscal retear. There was no significant difference in any postoperative outcome score at a minimum 2-year follow-up between the 2 groups. Conclusion: Good to excellent patient-reported outcomes were reported for both groups with no significant differences in outcomes between the cohorts. Additionally, the failure rate for inside-out meniscal repair with concomitant multiligament reconstruction was low, regardless of meniscus laterality and tear characteristics. The use of multiple vertical mattress sutures and the biological augmentation resulting from intra-articular cruciate ligament reconstruction tunnel reaming may be partially responsible for the stability of the meniscal repair construct and thereby contribute to the overall improved outcomes and the low failure rate of meniscal repair, despite lower preoperative Lysholm and Tegner scores in the meniscal repair group.

Internal Fixation of Lateral Trochlear Groove Osteochondritis Dissecans With Simultaneous Lateral Retinacular Lengthening in Adolescent Athletes

2021 ◽  
pp. 036354652110478
Author(s):  
Dhong Won Lee ◽  
Joon Kyu Lee ◽  
Young Chang Cho ◽  
Sang Jin Yang ◽  
Seung Ik Cho ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Vertical Jump ◽  
Lysholm Score ◽  
Trochlear Groove ◽  
Adolescent Athletes ◽  
Isokinetic Muscle Strength ◽  
Subjective Score ◽  
The Mean ◽  
Tegner Activity Scale

Background: The goals of operative treatment for the adolescent athlete with unstable osteochondritis dissecans (OCD) lesion are rigid fixation and prevention of recurrence. Purpose: To evaluate clinical and radiological outcomes of internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening. Study Design: Case series; Level of evidence, 4. Methods: Adolescent athletes who had undergone internal fixation and simultaneous lateral retinacular lengthening for an unstable OCD lesion of the lateral trochlear groove were retrospectively reviewed. Subjective assessments included the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Tegner activity scale, and an athletic questionnaire. Functional tests included isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance. Pre- and postoperative radiographs and magnetic resonance images were reviewed. Results: The mean ± SD age of the 17 patients included in this study was 15.9 ± 0.9 years; last clinical follow-up duration was 37.7 ± 8.1 months. At the last follow-up, the Lysholm score improved from 68.7 ± 15.3 to 93.4 ± 12.4 and the IKDC subjective score from 60.2 ± 14.7 to 88.7 ± 12.7 ( P < .001). The mean Tegner activity scale score was 9.4 ± 0.5 before injury and 8.9 ± 1.2 at the last follow-up ( P = .059). The limb symmetry indices of isokinetic muscle strength, single-leg hop for distance, single-leg vertical jump, and Y-balance improved at the last follow-up; the mean limb symmetry index was ≥85% in each functional test. Regarding the athletic questionnaire, 16 (94.1%) patients were satisfied with the surgery. At the last follow-up, 2 patients had higher ability after returning to sports, 11 had the same ability, and 3 had lower ability than the preinjury level. Postoperative magnetic resonance imaging at 12-month follow-up showed that the OCD lesion appeared healed in 7 (41.2%) patients and partially healed in 9 (52.9%). Conclusion: Internal fixation of lateral trochlear groove OCD with simultaneous lateral retinacular lengthening in adolescent athletes achieved satisfactory clinical and radiological outcomes. Therefore, this combined surgical technique could be considered an effective treatment for lateral trochlear groove OCD, with a high rate of return to sport.

Time to achieve best postoperative visual acuity following Boston keratoprosthesis surgery

2021 ◽  
pp. bjophthalmol-2020-317483
Author(s):  
Jonathan El-Khoury ◽  
Majd Mustafa ◽  
Roy Daoud ◽  
Mona Harissi-Dagher
Keyword(s):  
Visual Acuity ◽  
Contributing Factors ◽  
Time Duration ◽  
Patient Demographics ◽  
Snellen Visual Acuity ◽  
Boston Type 1 Keratoprosthesis ◽  
The Mean ◽  
Retroprosthetic Membrane

Background/aimsTo evaluate the time needed for patients with Boston type 1 keratoprosthesis (KPro) to reach their best-corrected visual acuity (BCVA) and all contributing factors.MethodsWe retrospectively reviewed 137 consecutive eyes from 118 patients, measured how long they needed to reach their BCVA and looked at factors that might affect this time duration including patient demographics, ocular comorbidities and postoperative complications.ResultsThe mean follow-up was 5.49 years. The median time to BCVA postoperatively was 6 months, with 47% of patients achieving their BCVA by 3 months. The mean best achieved logMAR visual acuity was 0.71, representing a gain of 6 lines on the Snellen visual acuity chart. Postoperative glaucoma, retroprosthetic membrane (RPM) and endophthalmitis prolonged this duration. We found no correlation between the following factors and time to BCVA: gender, age, indication for KPro surgery, primary versus secondary KPro, number of previous penetrating keratoplasties, previous retinal surgery, intraoperative anterior vitrectomy and preoperative glaucoma.ConclusionIn our retrospective cohort, the majority of subjects reached their BCVA between 3 and 6 months after KPro implantation. This duration was significantly prolonged by the development of postoperative glaucoma, RPM and endophthalmitis.

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