scholarly journals Comparison of Clinical Efficacy Between Arthroscopically Assisted Gracilis Autograft With Suture Reinforcement Technique and Transtibial Pull-out Technique in Treating Medial Meniscus Posterior Root Tears

2021 ◽  
Author(s):  
Si Si Nie ◽  
Hongbo Li ◽  
Jianyin He ◽  
Guanxiang Liao ◽  
Xuelei Ke ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Lysholm Score ◽  
Reconstruction Technique ◽  
Posterior Root ◽  
Vas Score ◽  
Pull Out ◽  
Meniscal Root ◽  
Meniscus Healing ◽  
Ikdc Score

Abstract Background: To compare the short-term efficacy of the transtibial pull-out technique and gracilis autograft with suture reinforcement technique in the treatment of medial meniscus posterior root tears. Methods: A total of 64 patients with medial meniscus posterior root tears received reconstruction of the posterior root of the meniscus attachment point through the tibial tunnel between June 2018 and April 2019 were included in this study, patients were divided into 2 groups (transtibial pull-out technique group: 35 cases; gracilis autograft with suture reinforcement technique group: 29 cases) according to the different posterior meniscus root tear repair methods. Clinical outcomes were evaluated by the visual analogue scale (VAS) and Lysholm score and IKDC score, and the demographics and functional recovery of the knee were compared between the two groups.Results: Intraoperative and postsurgical complications such as infection were not found in the two groups, and there was a statistically significant improvement in the Lysholm score，IKDC score and VAS score (P<0.001; respectively). All the patients were very satisfied with the function of their knee at the last follow-up. However, compared with the transtibial pull-out repair group, the reinforced medial meniscal root reconstruction technique with gracilis autograft group were significant improvement in the meniscus healing rates and Lysholm score, IKDC score and VAS score at the end of follow-up (P<0.05; respectively).Conclusions: Compared with the transtibial pull-out technique, the reinforced medial meniscal root reconstruction technique with gracilis autograft is advantageous for treating these patients because it is a minimally invasive procedure with superior clinical outcome and meniscus healing rates.Levels of Evidence: Ⅲ, Case-control study Retrospective comparative study

scholarly journals Improvement of clinical and radiological outcomes of root repair patients with advanced articular cartilage degeneration and osteoarthritis

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Nathan D. M. Hopkins ◽  
Steven Lawrie
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Medial Meniscus ◽  
Cartilage Degeneration ◽  
Bone Marrow Oedema ◽  
Posterior Root ◽  
Clinical Scores ◽  
Ikdc Score ◽  
Articular Cartilage Degeneration

Abstract Purpose The main purpose of this study was to investigate clinical and radiological outcomes of medial meniscus posterior root tear (MMPRT) repair in knees with advanced articular cartilage degeneration and osteoarthritis compared to those with minimal degenerative change. Methods Thirty-three knees underwent MMPRT repair using an arthroscopic pullout repair tibial tunnel technique. Clinical scores including Lysholm Score, International Knee Documentation Committee (IKDC) Score and Knee injury and Osteoarthritis Outcome (KOOS) Score were collected preoperatively and sequentially at 6 months, 12 months and mean final follow-up of 39.4 months. Kellgren-Lawrence (K-L) osteoarthritis grade, Outerbridge classification of cartilage degeneration and the presence of bone marrow oedema on MRI were also evaluated. Results All clinical scores improved at final follow-up for knees with K-L grade ≥ 2 osteoarthritis (p < 0.001), with no significant difference compared to K-L 0/1. Patients with Outerbridge class 3/4 cartilage degeneration also reported improvements in clinical scores, albeit lower than those with class 2 degeneration (p < 0.05). During recovery, the majority of patients reported clinical improvements by 6 months, and six patients further improved by at least 15 points in IKDC score between 6 and 12 months. Osteoarthritis progressed in 10 of 31 knees (32%), with an overall mean pre-operative K-L grade of 1.6 ± 0.9 compared to 2.0 ± 0.9 at final follow-up (n.s.). No knees progressed to K-L 4 or underwent re-operation. Pre-operative bone marrow oedema was present in 17 knees (52%), all of which had signal localised to the medial tibia or femur. Oedema had resolved in all but 5 knees post-operatively (p < 0.01). Conclusion Arthroscopic repair of medial meniscus posterior root tears is associated with improved outcomes in knees with advanced cartilage degeneration and osteoarthritis. Meaningful improvements in clinical outcomes can be achieved beyond 6 months, thus success of the operation is best determined at the 12-month mark. Oedema signal significantly improved post-operatively, however a relatively high proportion of knees had K-L progression. Level of evidence IV – Case Series.

scholarly journals Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Tarun Goyal ◽  
Souvik Paul ◽  
Sushovan Banerjee ◽  
Lakshmana Das
Keyword(s):  
Cruciate Ligament ◽  
Lysholm Score ◽  
Activity Level ◽  
Type Ii ◽  
Hamstring Tendons ◽  
Peroneus Longus ◽  
Type Iii ◽  
Type Iv ◽  
Ikdc Score

Abstract Purpose This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts. Methods All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up. Results A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Conclusion Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes. Level of evidence Level IV, case series.

scholarly journals Different Suture Materials for Arthroscopic Transtibial Pull-out Repair of Medial Meniscal Posterior Root Tears: A Human Biomechanical Study

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987327
Author(s):  
Gilberto Y. Nakama ◽  
Zachary S. Aman ◽  
Hunter W. Storaci ◽  
Alexander S. Kuczmarski ◽  
Joseph J. Krob ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Failure Load ◽  
Clinical Care ◽  
Posterior Root ◽  
Clinical Failure ◽  
Postoperative Rehabilitation ◽  
Pull Out ◽  
Ultimate Failure Load ◽  
Ultimate Failure ◽  
Suture Tape

Background: Transtibial pull-out repair of the medial meniscal posterior root (MMPR) has been largely assessed through biomechanical studies. Biomechanically comparing different suture types would further optimize MMPR fixation and affect clinical care. Purpose/Hypothesis: The purpose of this study was to determine the optimal suture material for MMPR fixation. It was hypothesized that ultra high–molecular weight polyethylene (UHMWPE) suture tape would be biomechanically superior to UHMWPE suture and standard suture. Study Design: Controlled laboratory study. Methods: The MMPR attachment was divided in 24 human cadaveric knees and randomly assigned to 3 repair groups: UHMWPE suture tape, UHMWPE suture, and standard suture. Specimens were dissected down to the medial meniscus, and the posterior root attachments were sectioned off the tibia. Two-tunnel transtibial pull-out repair with 2 sutures, as determined by the testing group, was performed. The repair constructs were cyclically loaded between 10 and 30 N at 0.5 Hz for 1000 cycles to mimic the forces experienced on the medial meniscus during postoperative rehabilitation. Displacement was recorded at 1, 50, 100, 500, and 1000 cycles. Ultimate failure load, displacement at failure, and load at 3 mm of displacement (clinical failure) were also recorded. Results: UHMWPE suture tape had significantly less displacement of the medial meniscus when compared with standard suture at 1 (–0.22 mm [95% CI, –0.41 to –0.02]; P = .025) and 50 (–0.35 mm [95% CI, –0.67 to –0.03]; P = .029) cycles. There were no other significant differences observed in displacement between groups at any number of cycles. UHMWPE suture tape had significantly less displacement at the time of failure than standard suture (–3.71 mm [95% CI, –7.17 to –0.24]; P = .034). UHMWPE suture tape had a significantly higher load to reach the clinical failure displacement of 3 mm than UHMWPE suture (15.64 N [95% CI, 0.02 to 31.26]; P = .05). There were no significant differences in ultimate failure load between groups. Conclusion: The meniscal root repair construct with UHMWPE suture tape may be stronger and less prone to displacement than that with standard suture or UHMWPE suture. Clinical Relevance: UHMWPE suture tape may provide better clinical results compared with UHMWPE suture and standard suture.

scholarly journals Arthroscopic Transphyseal Anterior Cruciate Ligament Reconstruction in Adolescent Athletes

2016 ◽  
Vol 24 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Luca Dei Giudici ◽  
Roberto Fabbrini ◽  
Luca Garro ◽  
Serena Arima ◽  
Antonio Gigante ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Leg Length ◽  
Adolescent Athletes ◽  
Ikdc Score ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tegner Activity Scale

Purpose To evaluate the 5-year outcome of arthroscopic transphyseal anterior cruciate ligament (ACL) reconstruction in 19 adolescent athletes. Methods 14 male and 5 female adolescent athletes aged 12 to 16 (mean, 13.9) years with Tanner stage 2 or 3 open physes underwent arthroscopic transphyseal ACL reconstruction by a single surgeon and were followed up for 5 years. Patients were evaluated using the numerical rating score (NRS) for pain, knee osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lysholm Score, as well as the leg length discrepancy, femorotibial alignment, varus or valgus deformities, active and passive knee range of motion. Results At 5-year follow-up, physes were closed in all patients. The mean NRS for pain improved from 7.2 to 1.6; the KOOS improved from 55.3 to 88; the mean IKDC score improved from 34.5 to 84; the mean Tegner Activity Scale improved from 2.7 to 8.2 and was comparable with that before injury (8.4); and the mean Lysholm score improved from 36.3 to 84.6. All except 2 patients returned to their pre-injury level of sports activity after a mean of 25 weeks. The 2 exceptions had a 2+ Jerk test and a 3+ Lachman test; one of them also had positive signs for a lateral meniscal lesion. Both had sustained a second trauma not long before the 5-year follow-up. Two patients had reduced sensitivity in the anteromedial aspect of the proximal third of the tibia. One patient had leg length discrepancy of +1.5 cm owing to overgrowth response of the physis. Conclusion Transphyseal ACL reconstruction is a viable option for skeletally immature patients, with high reproducibility, a high rate of return to sport, and a low incidence of growth disturbance. Early surgery can prevent the onset of meniscal lesions and early osteoarthritis.

Prognostic Factors of Arthroscopic Pull-out Repair for a Posterior Root Tear of the Medial Meniscus

2012 ◽  
Vol 40 (5) ◽  
pp. 1138-1143 ◽  
Author(s):  
Hong-Kyo Moon ◽  
Yong-Gon Koh ◽  
Yong-Chan Kim ◽  
Young-Sik Park ◽  
Seung-Bae Jo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Medial Meniscus ◽  
Posterior Root ◽  
Root Tear ◽  
Posterior Root Tear ◽  
Pull Out

scholarly journals Prospective Short-term MRI controlled investigation of the healing properties of the Meniscus

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0014
Author(s):  
Lukas Willinger ◽  
Felix Förschner ◽  
Andreas Imhoff ◽  
Elmar Herbst
Keyword(s):  
Classification System ◽  
Statistical Significance ◽  
Lateral Meniscus ◽  
Meniscus Repair ◽  
Lysholm Score ◽  
Joint Fluid ◽  
Short Term ◽  
Meniscus Tears ◽  
Meniscus Healing

Aims and Objectives: The purpose of the study was to prospectively investigate signal alterations in short-term follow-up after acute meniscus repair on specific magnetic resonance imaging (MRI) scan sequences. It was hypothesized that 1) there are different meniscus healing properties depending on lesion configuration and size, and 2) the tear zone has an influence on the healing properties of the meniscus. Materials and Methods: We conducted this prospective short-term clinical and radiological study to investigate the healing properties of acute meniscus tears. Inclusion criteria were patients (age 18-45 years) with traumatic meniscus lesion, subsequent arthroscopic meniscus repair within 6 weeks and preoperative MRI. Exclusion criteria were age < 18 or >45 years, arthrosis > grade III and multiligamentous knee injuries. Clinical examination and outcome scores (IKDC, KOOS, Lysholm Score) were surveyed preoperatively and 12 weeks after surgery. Meniscus tears were classified according to the ISAKOS meniscus classification system on MRI scans. Radiological assessment using a 3T-MRI was performed preoperatively and 2, 4, 6 and 12 weeks after operation. Meniscus healing were classified according to Henning’s criteria in A) healed, B) partially healed (> 50%) and C) not healed. Data were analyzed using SPSS statistics software version 21 (IBM, New York, USA). Statistical significance was set at a p value of < 0.05. Results: These are preliminary results of 14 patients (13 m, 1w) with a total of 16 meniscus tears. According to the ISAKOS meniscus classification system 9 medial and 7 lateral meniscus tears were included and average tear length was 21.5 mm (6 - 40 mm). 12 tears were located in the rim zone 1 and 4 tears were more medially in zone 2. In 8 (57%) patients an additional anterior cruciate ligament (ACL) reconstruction was performed. Six weeks postoperatively 8 menisci (50%) were deemed healed, 6 menisci (37%) partially healed whereas 2 menisci were not healed (13%). After 12 weeks 9 menisci (56%) were considered healed, 4 menisci (25%) partially healed and 3 menisci (19%) showed intrameniscal joint fluid in more than 50% of meniscus thickness. Two bucket handle tears of the medial meniscus and one radial tear of the lateral meniscus, all located in the red-red zone sized 35 mm, 25 mm and 12 mm, were not healed after 12 weeks. Clinical scores improved significantly 12 weeks after surgery: IKDC Score (preOP: 46.7, postOP: 67.8), KOOS (preOP: 49.7, postOP: 79.1) and Lysholm Score (preOP: 49.5, postOP: 77.7) (p < 0.05). Conclusion: Clinical and radiological follow-up showed good short-term results after meniscus repair. MRI revealed signal alteration in all menisci after 12 weeks, in most instances considered as scar tissue without intrameniscal joint fluid. In this cohohrt tear size and location was not correlated with non-healing. Arthroscopic meniscus repair achieves a high healing response of the meniscus and good clinical outcomes.

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

2020 ◽  
pp. 76-76
Author(s):  
Özgür Korkmaz ◽  
Uğur Kasman ◽  
Sıtkı Çeçen
Keyword(s):  
Clinical Outcomes ◽  
Medial Meniscus ◽  
Knee Score ◽  
Arthroscopic Partial Meniscectomy ◽  
Vas Score ◽  
Bipolar Radiofrequency ◽  
Lysholm Knee Score ◽  
The Mean ◽  
Early Clinical Outcomes

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

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