scholarly journals The predictive factors that are associated with the number of sutures used during meniscal repair

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaoxiao Song ◽  
Dongyang Chen ◽  
Xinsheng Qi ◽  
Qing Jiang ◽  
Caiwei Xia
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Univariate Analysis ◽  
Meniscal Repair ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Chi Square ◽  
Level Of Evidence ◽  
Surgical Data

Abstract Purpose To investigate factors associated with the consumption of a large number of sutures during arthroscopic meniscus repair procedures. Methods All patients who received meniscal repair, with or without concomitant anterior cruciate ligament (ACL) reconstruction, in our hospital from January 2015 to December 2019 were included in the current study. Demographic data (sex, age, body mass index (BMI), and injury-to-surgery interval) and surgical data (the site of the tear, side of the meniscus, presence of an ACL rupture or not and the number of sutures) were retrospectively collected from our medical records. The number of sutures was divided into two groups (1–2 sutures versus > 2 sutures). The stitching process was implemented through an all-inside technique using a meniscal repair device (Fast-Fix; Smith & Nephew). According to the length and stability of the meniscal tear, one to seven sutures were used. Univariate analysis consisted of chi-square tests. Multivariate logistic regression was then performed to adjust for confounding factors. Results A total of 242 patients, including 168 males and 57 females, was finally included. In the univariate analysis, we found that those patients who underwent meniscus repair within one month after meniscus tear were more likely to need fewer sutures than those who underwent surgery more than one month after injury (70/110 versus 59/115, p=0.062). In total, 75/109 (68.8%) lateral meniscal tears were repaired with fewer sutures than medial (34/72, 47.2%) and bilateral meniscus injuries (20/44, 45.4%; p=0.003). In the multivariate analysis, we found that the duration of injury (OR, 2.06; 95% CI, 1.16–3.64, p=0.013), presence of an ACL injury (OR, 3.76; 95% CI, 1.97–7.21, p< 0.001) and the side of the meniscus (OR, 0.31; 95% CI, 0.14–0.65, p=0.002) were associated with the number of sutures used during meniscal repair procedures. Conclusions Patients who underwent meniscal repair within one month after meniscus tear, especially lateral menisci tears, were more likely to need fewer sutures. Study design Case-control study; level of evidence, 3.

scholarly journals The predictive factors that are associated with the number of sutures used during meniscal repair

2020 ◽  
Author(s):  
Xiaoxiao Song ◽  
Dongyang Chen ◽  
Qi Xinsheng ◽  
Qing Jiang ◽  
Caiwei Xia
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Univariate Analysis ◽  
Meniscal Repair ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Chi Square ◽  
Level Of Evidence ◽  
Surgical Data

Abstract PurposeTo investigate factors associated with the consumption of a large number of sutures during arthroscopic meniscus repair procedures.MethodsAll patients who received meniscal repair, with or without concomitant anterior cruciate ligament (ACL) reconstruction, in our hospital from January 2015 to December 2019 were included in the current study. Demographic data (sex, age, body mass index (BMI), and injury-to-surgery interval) and surgical data (the site of the tear, side of the meniscus, presence of an ACL rupture or not and the number of sutures) were retrospectively collected from our medical records. The number of sutures was divided into two groups (1–2 sutures versus > 2 sutures). The stitching process was implemented through an all-inside technique using a meniscal repair device (Fast-Fix; Smith & Nephew). According to the length and stability of the meniscal tear, one to seven sutures were used. Univariate analysis consisted of chi-square tests. Multivariate logistic regression was then performed to adjust for confounding factors.ResultsA total of 242 patients, including 168 males and 57 females, was finally included. In the univariate analysis, we found that those patients who underwent meniscus repair within one month after meniscus tear were more likely to need fewer sutures than those who underwent surgery more than one month after injury (70/110 versus 59/115, p = 0.062). In total, 75/109 (68.8%) lateral meniscal tears were repaired with fewer sutures than medial (34/72, 47.2%) and bilateral meniscus injuries (20/44, 45.4%; p = 0.003). In the multivariate analysis, we found that the duration of injury (OR, 2.06; 95% CI, 1.16–3.64, p = 0.013), presence of an ACL injury (OR, 3.76; 95% CI, 1.97–7.21, p < 0.001) and the side of the meniscus (OR, 0.31; 95% CI, 0.14–0.65, p = 0.002) were associated with the number of sutures used during meniscal repair procedures.ConclusionsPatients who underwent meniscal repair within one month after meniscus tear, especially lateral menisci tears, were more likely to need fewer sutures.Study DesignCase-control study; level of evidence, 3.

scholarly journals Which Factors Are Associated With the Prevalence of Meniscal Repair?

2020 ◽  
Author(s):  
Xiaoxiao Song ◽  
Dongyang Chen ◽  
Xinsheng Qi ◽  
Qing Jiang ◽  
Caiwei Xia
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Chi Square ◽  
Level Of Evidence ◽  
Aged Patients

Abstract PurposeTo investigate the potential factors associated with the prevalence of meniscal repairMethodsPatients who received partial menisectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscetomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscetomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors.Results592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p=0.002), patients aged 40 years or younger (p<0.001), increased weight (p=0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p<0.001), lateral meniscus (p=0.039)and early surgery (p<0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p=0.002), ACL injury (OR, 3.76; 95% CI, 1.97 – 7.21, p<0.001), side of menisci (OR, 3.29; 95% CI, 1.43 – 7.55, p=0.005), site of tear (OR, 0.15; 95% CI, 0.07 – 0.32, p<0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 – 0.82, p=0.008) were associated with the prevalence of meniscus repair. ConclusionsMeniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior.Study DesignCase-control study; level of evidence, 3.

scholarly journals Which factors are associated with the prevalence of meniscal repair?

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaoxiao Song ◽  
Dongyang Chen ◽  
Xinsheng Qi ◽  
Qing Jiang ◽  
Caiwei Xia
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Univariate Analysis ◽  
Lateral Meniscus ◽  
Meniscal Repair ◽  
Acl Injury ◽  
Partial Meniscectomy ◽  
Meniscus Tear ◽  
Confounding Factors

Abstract Purpose To investigate the potential factors associated with the prevalence of meniscal repair Methods Patients who received partial meniscectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscectomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscectomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors. Results 592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p = 0.002), patients aged 40 years or younger (p < 0.001), increased weight (p = 0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p < 0.001), lateral meniscus (p = 0.039) and early surgery (p < 0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p = 0.002), ACL injury (OR, 3.76; 95% CI, 1.97 – 7.21, p < 0.001), side of menisci (OR, 3.29; 95% CI, 1.43 – 7.55, p = 0.005), site of tear (OR, 0.15; 95% CI, 0.07 – 0.32, p < 0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 – 0.82, p = 0.008) were associated with the prevalence of meniscus repair. Conclusions Meniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior. Study design Case-control study; level of evidence, 3.

scholarly journals CONCOMITANT MENISCECTOMY RESULTS IN REDUCED RETURN TO SPORT COMPARED TO MENISCUS REPAIR IN PRIMARY PEDIATRIC ACL RECONSTRUCTION

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0007
Author(s):  
Brendan A. Williams ◽  
Maggie L. Wright ◽  
Joshua T. Bram ◽  
Kathleen J. Maguire ◽  
Neeraj M. Patel ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pediatric Patients ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Return To Sport ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Initial Contact ◽  
Severity Of Injury ◽  
The Impact

Background: Meniscus repair has demonstrated favorable outcomes when performed with ACL reconstruction (ACLR). However, literature comparing meniscal tear patterns, treatments, and outcomes among pediatric patients remains limited. Purpose: The aim of this study is to evaluate the impact of surgical technique on patient outcomes, in primary pediatric ACLR with associated meniscal pathology. We secondarily examined patient factors and tear characteristics on these outcomes. Methods: This is a retrospective cohort study from 2014-2016 of pediatric ACL reconstruction patients who underwent concurrent surgical management of a meniscus tear. Predictors included patient demographics, injury mechanism, meniscal tear characteristics and surgical treatments. Clinical outcomes including return to sport (RTS), meniscus or ACL graft re-tear, and return to surgery were assessed via patient cross-sectional survey. Criteria for RTS were based on standardized postoperative rehabilitation protocols. Univariate and multivariate analyses were used to examine the relationship between studied predictors with the likelihood of RTS and other outcomes. Results: Inclusion criteria were met by 123 patients with an average follow-up time of 2.5 ± 0.7 years. RTS was achieved by 80.8% of patients while 17.1% of patients had a subsequent knee surgery within the studied timeframe. Univariate analysis of factors associated with successful RTS are shown in Table 1. While patients failing to RTS were shown to have delayed surgical intervention in univariate testing, multivariate analysis identified that patients who underwent meniscectomy were less likely to RTS than those who underwent meniscal repair (OR=2.690, 95% CI 1.044-6.930, p=0.040). Patients with an initial contact mechanism of injury were also demonstrated to be more likely to return to the OR for any reason (OR=13.443, CI 1.736-104.108, p=0.013) in multivariate modeling. Conclusion: In one of the few large cohorts of pediatric ACL reconstructions with concomitant meniscus surgery, this study adds to our understanding of a potentially modifiable factor (meniscus repair) in the surgical treatment of ACL injury with concaminant meniscus tear. Although no differences were seen in rates of meniscus or graft re-tear when comparing treatments, patients who underwent meniscal repair were more likely to return to sport than patients treated with meniscectomy. While these findings may reflect the quality of the torn meniscal tissue and severity of injury, it further emphasizes the importance of meniscal preservation not just for long term joint quality, but also for short term function in active pediatric patients. [Table: see text]

scholarly journals Incidence and Risk Factors for Residual High-Grade Pivot Shift After ACL Reconstruction With or Without a Lateral Extra-articular Tenodesis

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110035
Author(s):  
Christophe Jacquet ◽  
Charles Pioger ◽  
Romain Seil ◽  
Raghbir Khakha ◽  
Sebastien Parratte ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Knee Laxity ◽  
High Grade ◽  
Level Of Evidence ◽  
Rotatory Knee Laxity

Background: Residual rotatory knee laxity at midterm follow-up after isolated anterior cruciate ligament reconstruction (ACLR) versus ACLR with lateral extra-articular tenodesis (LET) remains an issue. Purpose/Hypothesis: To evaluate the outcomes of ACLR with or without additional LET at a minimum 2-year follow-up in patients with preoperative high-grade pivot shift (PS). Our hypothesis was that the addition of LET would decrease the risk of secondary meniscal injury and the presence of residual high-grade PS at follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis performed at 3 sports medicine centers identified 266 study patients; all had a high-grade PS (grade 2 or 3) preoperatively and underwent isolated ACLR with or without LET. Four different ACLR techniques were used: single-strand quadrupled semitendinosus (ST4) ACLR without LET (ST4 group; n = 55), ST4 with anatomic LET (ST4+LET group; n = 77), bone–patellar tendon and modified Lemaire LET (BTB+LET group; n = 43), and quadriceps tendon and modified Lemaire LET (QT+LET group; n = 91). At follow-up, we evaluated for the presence of high-grade (grade ≥2) PS. Preoperative meniscal tears and their treatment were recorded. Results: Overall, 185 (69.5%) patients had at least 1 meniscal tear at index surgery. The mean follow-up period was 44.3 months; 47 (17.7%) patients had a new meniscal tear and 64 (24%) patients had a high-grade PS at follow-up. Compared with meniscal repair, significant predictors for high-grade PS at follow-up were meniscectomy (odds ratio [OR] = 2.65 [95% CI, 1.19-5.63]; P = .02) and nonrepair of preoperative meniscal tear (OR = 3.26 [95% CI, 1.27-9.43]; P = .007). The appearance of a new symptomatic meniscal tear was the strongest significant predictor of high-grade PS at follow-up (OR = 4.31 [95% CI, 2.31-8.06]; P < .001). No significant correlation was observed between the addition of LET and the presence of high-grade PS at follow-up. Conclusion: In the current study, 1 in 4 patients with high-grade PS before ACLR with or without LET was at risk of residual rotatory knee laxity at mean 44-month follow-up, regardless of the technique used. Repairing a pre-existing meniscal lesion was more effective than performing LET to decrease the presence of a high-grade PS at follow-up.

scholarly journals Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket-Handle Meniscal Tears: A Propensity-Matched Analysis

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877904 ◽  
Author(s):  
Brian T. Samuelsen ◽  
Nicholas R. Johnson ◽  
Mario Hevesi ◽  
Bruce A. Levy ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Meniscal Tears ◽  
Level Of Evidence ◽  
Inside Out ◽  
Bucket Handle ◽  
Repair Techniques

Background: There are limited data comparing the outcomes of all-inside versus inside-out meniscal repair techniques. Purpose: To assess failure rates and clinical outcomes after the surgical repair of bucket-handle meniscal tears utilizing either an all-inside or inside-out technique. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with bucket-handle meniscal tears undergoing all-inside or inside-out repair at a single institution between 2003 and 2013 were analyzed. A total of 28 mensici repaired utilizing second-generation all-inside suturing devices and 42 menisci repaired using an inside-out technique were eligible for inclusion. Rigorous propensity matching was performed on the basis of age, sex, tear laterality, rim width, and concomitant anterior cruciate ligament reconstruction (ACLR), resulting in a total of 40 patients equally distributed between the 2 repair techniques for comparison. Retear-free survival as well as preoperative and postoperative International Knee Documentation Committee (IKDC) and Tegner scores and physical examination findings were subsequently analyzed. Results: Twenty patients who underwent all-inside repair (14 male; mean age, 23.7 ± 6.7 years) were successfully propensity matched to 20 patients who underwent inside-out meniscal repair (15 male; mean age, 22.5 ± 7.6 years), with a mean retear-free follow-up of 4.4 years (range, 2.5-7.4 years). Four (20%) all-inside repairs and 4 (20%) inside-out repairs failed over the course of follow-up ( P > .999), with a mean time to failure of 2.7 years (range, 1.3-4.4 years) and 5.0 years (range, 0.8-7.5 years), respectively ( P = .25). Increasing patient age trended toward a decreased clinical retear rate, independent of the repair technique (hazard ratio, 0.86; P = .056). There were no significant differences in the Tegner scores, IKDC scores, or range of motion between the groups as a whole or when subcategorizing by age, sex, body mass index, tear complexity, rim width, isolated versus concomitant ACLR, or medial- versus lateral-sided repair. There were no complications in the all-inside group, while there was a 10% rate of minor complications in the inside-out group ( P = .49). Conclusion: Overall, satisfactory clinical outcomes are achievable at short-term to midterm follow-up with both inside-out and all-inside repair techniques of bucket-handle meniscal tears in rigorously matched patients with similar meniscal tear patterns.

scholarly journals Meniscal Repair in Pediatric Populations: A Systematic Review of Outcomes

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984335 ◽  
Author(s):  
Daniel J. Liechti ◽  
David S. Constantinescu ◽  
Taylor J. Ridley ◽  
Jorge Chahla ◽  
Justin J. Mitchell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pediatric Population ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Cochrane Central Register ◽  
Complication Rates ◽  
Meniscal Tears ◽  
Effective Treatment Option ◽  
Level Of Evidence

Background: Loss of meniscal tissue in the pediatric population can have long-term consequences on joint health, highlighting the importance of meniscal preservation in this group. Purpose: To systematically review reported knee outcome measures and complication rates after repair of meniscal tears in children and adolescents. Study Design: Systematic review; Level of evidence, 4. Methods: A review of the literature regarding the existing evidence for pediatric meniscal tear outcomes was performed through use of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-present), and MEDLINE (1980-present). Included were articles in English that reported the outcomes of meniscal tears in the pediatric population (<18 years old) with a follow-up of more than 12 months. Clinical outcome scores were reviewed. Results: A total of 1003 total studies were initially retrieved, with 8 meeting the inclusion criteria. The review included 287 patients (165 male, 122 female), mean age 15.1 years (range, 4-18 years), with 301 meniscal tears (reported: 134 medial, 127 lateral, and 32 both medial and lateral, 8 location unspecified). Concomitant anterior cruciate ligament reconstruction was performed in 52% (158/301) of meniscal repairs. The average reported postoperative Lysholm scores ranged from 85.4 to 96.3, and the average reported postoperative Tegner activity scores ranged from 6.2 to 8. Conclusion: Arthroscopic repair of a meniscal tear in the pediatric and adolescent population is an effective treatment option that has a low failure rate, enhances postoperative clinical outcomes, and preserves meniscal tissues.

scholarly journals EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Brett Heldt ◽  
Elsayed Attia ◽  
Raymond Guo ◽  
Indranil Kushare ◽  
Theodore Shybut
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Skeletal Maturity ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscus Tears ◽  
Anterior Cruciate

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.

scholarly journals Predicting Reparability of Meniscal Tears Pre-Operatively Using 3-Tesla MRI (111)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0026
Author(s):  
Thomas Kremen ◽  
Ignacio Garcia-Mansilla ◽  
Jason Strawbridge ◽  
Grant Schroeder ◽  
Kambiz Motamedi ◽  
...  
Keyword(s):  
Predictive Accuracy ◽  
Statistical Significance ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Partial Meniscectomy ◽  
3 Tesla ◽  
Meniscus Tear ◽  
Predictive Values ◽  
3T Mri ◽  
Mri Characteristics

Objectives: The ability to predict meniscus tear reparability based on pre-operative MRI is desirable for pre-operative patient counseling. However, the accuracy of MRI-based predictive methods varies widely within the orthopedic and radiology literature. We hypothesized that modern higher resolution 3-Tesla (T) MRI improves the accuracy of predicting reparability compared to prior investigations using 1.5T MRI assessments. Methods: We identified 44 patients (age 16 to 40 years) who were known to have undergone arthroscopic meniscal repair at our institution between the dates of January 1, 2013 and June 1, 2019. The MRI characteristics of this meniscus repair group were then compared to 43 age- and sex-matched patients who underwent arthroscopic partial meniscectomy during the same time period. 3T MRI images from the repair (Figure 1A) and the partial meniscectomy (Figure 1B) groups were all obtained pre-operatively at the author’s institution. Images from all 87 patients were independently reviewed by two fellowship-trained musculoskeletal radiologists and one orthopedic surgery fellow specializing in sports medicine. Each examiner was blinded with regard to meniscus tear treatment (repair versus partial meniscectomy). Meniscal tear MRI characteristics were evaluated based on established arthroscopic criteria including tear length greater than 10 mm, tear location within 3 mm of the menisco-synovial junction, tear greater than 50% thickness, and the presence of an intact inner meniscal fragment. We then analyzed the predictive accuracy and interrater reliability of this method. Results: With regards to accurately predicting meniscal reparability using the established criteria, the three MRI examiners accurately predicted repair 58% (orthopedist), 60% (radiologist 1), and 63% (radiologist 2) of the time, with respective positive predictive values of 60%, 62%, and 70%. The three examiners agreed upon tear reparability (i.e., a score of 4 versus not 4) only 41% of the time (κ = 0.173, p = .005). For 2 of the examiners (orthopedist and radiologist), none of the individual criteria were significantly predictive of tear reparability. For the 3rd examiner (radiologist), tear location within 3mm of the meniscosynovial junction was the most predictive individual criterion and the only criteria that reached statistical significance (OR = 9.83, p = .04). Conclusions: Although 3T MRI is higher resolution than 1.5T MRI, 3T MR imaging assessments performed by experienced examiners demonstrated a poor ability to predict the reparability of meniscus tears based on the application of previously established arthroscopic criteria. In addition, inter-observer reliability in this setting was also poor. Arthroscopic inspection remains the gold standard for the determination of meniscus tear reparability.

scholarly journals Return to Play After Isolated Meniscal Repairs in Athletes: A Systematic Review

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096209
Author(s):  
Erica R. Blanchard ◽  
Christopher J. Hadley ◽  
Eric D. Wicks ◽  
William Emper ◽  
Steven B. Cohen
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Return To Play ◽  
Meniscal Tears ◽  
Arthroscopic Technique ◽  
Level Of Evidence ◽  
Study Results ◽  
Anterior Cruciate

Background: Meniscal tears are a common knee injury. Isolated meniscal tears are less common; however, unaddressed tears can be troublesome, particularly for athletes. There is currently a lack of data in the literature on athletes returning to play after isolated meniscal repair. Purpose: To evaluate the return to play rate and time to return to play for athletes with isolated meniscal injuries. Study Design: Systematic review; Level of evidence, 4. Methods: A search of the PubMed, EMBASE, and Cochrane electronic databases was conducted to identify studies that reported the time and the rate of return to play in athletes after repair of isolated meniscal tears. Studies were excluded if there was a concomitant anterior cruciate ligament reconstruction, if there was a meniscectomy instead of a meniscal repair, or if the study was a systematic review. Quality assessment and data extraction were performed by 2 examiners. Results: Overall, 21 studies were included in this review. There were 355 athletes (358 knees) with a mean age of 22.5 years (range, 9-68 years). A sex breakdown was noted in 16 of the 21 (76.2%) studies with 224 men and 71 women. The specific repair technique was described in 259 (72.3%) knees. Of the total knees, 109 (30.4%) had an open repair, 128 (35.8%) had an inside-out arthroscopic technique repair, and 22 (6.1%) had an all-inside arthroscopic technique repair. Complications were addressed in 11 studies, with 13 out of 155 (8.4%) patients across the 11 articles having a postoperative complication. Of the total 355 patients, 295 (83.1%) returned to play, and 17 of these 21 (81.0%) articles reported the time it took for athletes to return to play, with a mean return of 8.7 months. Conclusion: The study results indicate that return to play rates after isolated meniscal repair are high, with an overall return to play rate of 83.1% and a mean return to play time of 8.7 months. However, the limited number of studies, particularly ones with larger patient numbers, highlights the need for further investigation regarding isolated meniscal repair in athletes.

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