All-Inside Arthroscopic Repair For Longitudinal Meniscal Tears: Clinical and Functional Results

Meniscal injuries are a common challenge in orthopaedic surgery. Depending on their location and the patient’s age and functional needs, they can be treated either conservatively or surgically. A surgical approach can consist of arthroscopic meniscectomy or meniscal suture. The latter is the treatment of choice in case of lesions involving the red-red or red-white areas of the meniscus, especially for young high-demanding patients. We report here our experience with the repair of longitudinal meniscal tears using the all-inside technique with the Fast-Fix™ 360 Meniscal Repair System (Smith & Nephew Endoscopy, Andover, MA). We retrospectively evaluated 20 consecutive cases of longitudinal meniscal tears. In 4 cases, concomitant ACL rupture was diagnosed and treated alongside the meniscal repair. All patients underwent periodic clinical evaluations. At the latest check-up, their functional outcomes were rated according to the Tegner-Lysholm Knee and KOOS scoring scales. The mean Tegner-Lysholm Knee score was 84.85 (44-100) and the mean KOOS score was 88.58. No failure or major complications were observed. Furthermore, a negative statistical association was observed between age at surgery and the post-operative Tegner-Lysholm Knee score (coef. = -1.01189 [-1.942073,-0.0817063], p = 0.035). This relation, independent of gender, meniscus involved, eventual associated ACL reconstruction, and chondral injury, suggests that functional outcomes worsen with increasing patient age. Our results suggest that the arthroscopic all-inside suture is both safe and effective in cases of longitudinal meniscal tear, considering the good post-operative functionality and low rates of local complications and surgical failures.

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Results of meniscal injuries repair using different arthroscopic techniques

SICOT-J ◽

10.1051/sicotj/2020030 ◽

2020 ◽

Vol 6 ◽

pp. 39

Author(s):

Mohamed Abdel Tawab Abdallah ◽

Hatem G. Said ◽

Eslam Karam Allah Ramadan ◽

Mohamed Abd El-Radi ◽

Maher A. El-Assal

Keyword(s):

Functional Outcomes ◽

Clinical Symptoms ◽

Meniscal Tear ◽

Corrective Osteotomy ◽

Meniscal Repair ◽

International Knee Documentation Committee ◽

Meniscal Tears ◽

Lysholm Knee Score ◽

Postoperative Symptoms ◽

A Prospective Study

Aim: Evaluation of clinical and radiological outcomes following meniscal repair using different arthroscopic techniques for all meniscal tears amenable for repair. Methods: Sixty-one patients were involved in a prospective study; all cases presented with meniscal tears underwent arthroscopic meniscal repair from December 2016 to December 2017. Outcomes involved the site of tear, the repair technique, and associated injuries. The International Knee Documentation Committee Score (IKDC) and Tegner Lysholm Knee Score were used to analyze the clinical and functional outcomes postoperatively. Results: Of the 61 patients, 50 patients (81.9%) had meniscal tear associated with isolated ligamentous ACL injury, 6 cases had corrective osteotomy with ACL reconstruction to correct concomitant genu varus, 2 cases (3.3%) had meniscal tear associated with isolated ligamentous PCL injury, and 9 patients (14.8%) presented with isolated meniscal tear; IKDC was preoperatively (44.52 ± 8.79), postoperatively at 6 months (90.97 ± 6.75) and at 12 months (92.27 ± 2.68) with P-value (0.001). Tegner Lysholm score was preoperatively (52.16 ± 12.22), postoperatively at 6 months (88.03 ± 6.84) and at 12 months (93.26 ± 2.95) with P-value (0.001). Fifty eight patients (95.1%) had no postoperative symptoms at 6 and 12 months’ follow-up. The remaining 3 cases (4.9%) underwent partial meniscectomy due to persistent postoperative clinical symptoms with no signs of healing in MRI. Conclusions: Our study concluded that arthroscopic meniscal repair is an effective way in the management of meniscal tears regarding clinical and functional outcomes.

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Mid-term evaluation of clinical and functional outcomes after arthroscopic medial longitudinal and bucket-handle meniscus repair

Joint Diseases and Related Surgery ◽

10.52312/jdrs.2021.46 ◽

2021 ◽

Vol 32 (2) ◽

pp. 363-370

Author(s):

Raşit Özcafer ◽

Ferdi Dırvar ◽

Abdülhamit Mısır ◽

Yaşar Maksut Dinçel ◽

Mehmet Özbey Büyükkuşçu ◽

...

Keyword(s):

Functional Outcomes ◽

Meniscal Repair ◽

Control Group ◽

Meniscal Tears ◽

Significant Difference ◽

Ikdc Score ◽

The Mean ◽

Bucket Handle Tear ◽

Bucket Handle

Objectives: The aim of this study was to evaluate clinical and functional outcomes following the arthroscopic medial meniscal repair. Patients and methods: A total of 50 patients (42 males, 8 females; mean age: 32.9±7.6 years; range, 17 to 48 years) who underwent arthroscopic repair for longitudinal and bucket-handle medial meniscal tears between March 2005 and October 2011 were retrospectively evaluated. The patients were divided into two groups as those having a longitudinal tear (patient group, n=31) and having a bucket-handle tear (control group, n=19). Preoperative and final follow-up functional outcomes were evaluated using the Lysholm Knee Score (LKS), International Knee Documentation Committee (IKDC) score, Tegner Activity Scale (TAS) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: The mean follow-up was 61.7±22.8 (range, 36 to 110) months. The mean preoperative LKS, IKDC score, TAS, and KOOS scores were significantly improved at the final postoperative follow-up (p<0.05). There was no significant difference in functional outcome scores between longitudinal and bucket-handle repairs (p>0.05), and isolated repairs and concomitant meniscal repair and anterior cruciate ligament reconstruction (p>0.05). Conclusion: Arthroscopic meniscal repair provides similar mid-term functional and clinical outcomes for longitudinal and bucket-handle medial meniscal tears. Concomitant meniscal repair does not seem to affect meniscal healing.

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Assessment of Meniscal Healing Status by Magnetic Resonance Imaging T2 Mapping After Meniscal Repair

The American Journal of Sports Medicine ◽

10.1177/0363546520904680 ◽

2020 ◽

Vol 48 (4) ◽

pp. 853-860

Author(s):

Shinya Yamasaki ◽

Yusuke Hashimoto ◽

Yohei Nishida ◽

Takanori Teraoka ◽

Shozaburo Terai ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

T2 Mapping ◽

Meniscal Tear ◽

Meniscal Repair ◽

T2 Relaxation Time ◽

Resonance Imaging ◽

T2 Relaxation ◽

Conventional Mri ◽

Meniscal Healing ◽

The Mean

Background: Although the sensitivity and specificity of magnetic resonance imaging (MRI) for the diagnosis of primary meniscal tears are high, these values are lower for the assessment of healing status of repaired menisci. Purpose: To compare the accuracy of MRI T2 mapping and conventional MRI in assessing meniscal healing after repair. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients who underwent meniscal repair with concurrent anterior cruciate ligament reconstruction between 2012 and 2016 and had a follow-up second-look arthroscopy were enrolled. The patients were divided into healed and incompletely/not healed groups based on the second-look arthroscopy findings. For the repaired menisci, the following were compared between the groups, (1) Stoller and Crues classification on conventional MRI with a proton density-weighted fat-saturated sequence and (2) the remaining colored meniscal tear line on T2 mapping coincident with the high signal line showing the primary tear on conventional MRI were compared. The change of T2 relaxation time (ΔT2) of the colored meniscal tear line pre- to postoperatively was compared between the groups. The mean T2 relaxation time of the whole area of the postoperative meniscus at each slice was also compared with that of control menisci to assess the whole quality of the repaired meniscus. Results: A total of 26 menisci from 24 knees were assessed (16 healed menisci, 10 incompletely/not healed menisci). According to the Crues classification on conventional MRI, 8 of 16 healed menisci and 3 of 10 incompletely/not healed menisci improved from grade 3 to 2, with there being no significant difference between the groups ( P = .43). However, the colored meniscal tear line remained in only 3 of the 16 healed menisci as compared with 9 of the 10 incompletely/not healed menisci, and the presence of this colored line allowed differentiation between healed menisci and incompletely/not healed menisci (sensitivity, 81.3%; specificity, 90.0%; odds ratio, 39.0; P = .001). The mean (SD) ΔT2 was −31.1 ± 3.2 and −19.9 ± 4.4 ms in the healed and incompletely/not healed groups, respectively ( P < .001). Receiver operating characteristic curve analysis showed a cutoff ΔT2 value of −22.3 ms for separation of meniscal healing ( P < .001). The T2 relaxation times of the whole area of the repaired menisci were 31.7 ± 3.4 and 32.8 ± 3.8 ms in the healed and incompletely/unhealed groups, respectively ( P = .69), with these values being significantly longer than the 26.9 ± 2.2 ms in the controls ( P < .001). Conclusion: MRI T2 mapping allowed the differentiation of healing status after meniscal repair, with high sensitivity and specificity as compared with conventional MRI.

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Characterization of Synovial Cytokine Patterns in Bucket-Handle and Posterior Horn Meniscal Tears

Mediators of Inflammation ◽

10.1155/2020/5071934 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Marco Turati ◽

Davide Maggioni ◽

Nicolò Zanchi ◽

Marta Gandolla ◽

Massimo Gorla ◽

...

Keyword(s):

Inflammatory Cytokines ◽

Meniscal Tear ◽

Meniscal Repair ◽

Posterior Horn ◽

Meniscal Tears ◽

Tnf Α ◽

Cytokine Levels ◽

Tear Pattern ◽

Cytokine Responsiveness ◽

Bucket Handle

The specific etiology of meniscal tears, including the mechanism of lesion, location, and orientation, is considered for its contribution to subsequent joint cytokine responsiveness, healing outcomes, and by extension, appropriate lesion-specific surgical remediation. Meniscal repair is desirable to reduce the probability of development of posttraumatic osteoarthritis (PTOA) which is strongly influenced by the coordinate generation of pro- and anti-inflammatory cytokines by the injured cartilage. We now present biochemical data on variation in cytokine levels arising from two particular meniscal tears: bucket-handle (BH) and posterior horn (PH) isolated meniscal tears. We selected these two groups due to the different clinical presentations. We measured the concentrations of TNF-α, IL-1β, IL-6, IL-8, and IL-10 in knee synovial fluid of 45 patients with isolated meniscal lesions (BH tear, n = 12 ; PH tear, n = 33 ). TNF-α levels were significantly ( p < 0.05 ) greater in the BH group compared with the PH group, whereas IL-1β levels were significantly greater ( p < 0.05 ) in the PH group compared with the BH group. Both BH and PH groups were consistent in presenting a positive correlation between concentrations of IL-6 and IL-1β. A fundamental difference in IL-10 responsiveness between the two groups was noted; specifically, levels of IL-10 were positively correlated with IL-6 in the BH group, whereas in the PH group, levels of IL-10 were positively correlated with IL-1β. Collectively, our data suggest a possible influence of the meniscal tear pattern to the articular cytokine responsiveness. This differential expression of inflammatory cytokines may influence the risk of developing PTOA in the long term.

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ACCURACY OF SPECT IMAGING FOR ARTHROSCOPICALLY CONFIRMED MENISCAL TEARS IN PATIENTS WITH ACUTE KNEE PAIN AND NO RADIOGRAPHIC ARTHRITIS

Journal of Musculoskeletal Research ◽

10.1142/s0218957714500067 ◽

2014 ◽

Vol 17 (01) ◽

pp. 1450006

Author(s):

Barak Haviv ◽

Shlomo Bronak ◽

Rafael Thein

Keyword(s):

Knee Pain ◽

Tibial Plateau ◽

Meniscal Tear ◽

Arthroscopic Surgery ◽

Emission Computed Tomography ◽

Meniscal Tears ◽

Plain Radiographs ◽

The Mean ◽

Spect Scan ◽

Acute Knee

Purpose: To evaluate the accuracy of single photon emission computed tomography (SPECT) compared with arthroscopy in the diagnosis of acute knee pain due to meniscal tear. Methods: Patients with knee pain that persisted for less than six months with normal plain radiographs that had arthroscopic surgery following SPECT scan were included. The main scintigraphic criterion for diagnosing a tear of the meniscus was tibial plateau activity on the planar image with at least a half crescent of peripheral tibial plateau uptake. The accuracy of SPECT in detecting meniscal tears was calculated according to the arthroscopic findings as the gold standard. Results: There were 68 patients in the study (46 males and 22 females). The mean age was 45.3 (17–72) years and the mean time between SPECT scan and surgery was 3.5 (1–6) months. The overall sensitivity of SPECT was 90%, specificity 70%, NPV 54%, PPV 95% and accuracy 87%. Conclusion: SPECT was found to be an accurate imaging technique in the diagnosis of symptomatic meniscal tears in patients with acute knee pain and unremarkable plain radiographs. Thus, SPECT may be helpful in selecting candidates for arthroscopy.

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Evaluation of the Results of Arthroscopic Release in Limits of Movement in Knees

Journal of Shahid Sadoughi University of Medical Sciences ◽

10.18502/ssu.v27i9.2308 ◽

2020 ◽

Author(s):

Mohammad Reza Sobhan ◽

Seyed Hossein Saeed Banadaky ◽

Mohammad Shafiee ◽

Mohammad Gheisari

Keyword(s):

Statistical Tests ◽

Cross Sectional Study ◽

Knee Score ◽

Cross Sectional ◽

Mean Values ◽

Arthroscopic Release ◽

Lysholm Knee Score ◽

Significant Difference ◽

Before And After ◽

The Mean

Introduction: Limits of movement in knees is one of the most common complications following trauma and surgery. With early diagnosis and appropriate treatment choices, knee replacement and performance improvement are expected in many patients. However, limits of movement in knees is unpleasant and should be corrected as soon as possible. In this study, we decided to evaluate the results of arthroscopic release in motion limits of knees. Methods: This was a descriptive cross-sectional study.14 patients who referred to the Shahid Sadoughi Hospital of Yazd from 2014 to 2016 and diagnosed with knee limitation (flexion or extension restriction of more than 10 degrees) were selected. Patients were undergone arthroscopic release and followed-up for 6 months. Lysholm knee score, degrees of flexion and extension, and patient satisfaction were evaluated. The results were analyzed by SPSS-18 and statistical tests Paired T-test as well as Spearman correlation. Results: The mean age of the patients was 28.92±10.99 years. The most common type of trauma in the patients was femoral distal fracture (46.7%). The frequency of the patients' satisfaction with arthroscopy was as followed: 50% (7 patients), had moderate satisfaction, 28.6% (4 ones), high satisfaction, and 21.4% (3 ones) had low satisfaction.The mean difference in Lysholm Knee Score, improvement in degree of extension, improvement in degree of flexion and pain score before and after arthroscopy were 26.21±14.11,64.78±26.13,3.57±2.92 and 4.13±1.65,respectively.There was a significant difference between the mean values of these factors before and after arthroscopy. Conclusion: According to the results obtained, we can conclude that arthroscopic release is an effective and low-complication method in motion limits of knees.

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

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200225076k ◽

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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Tension Band Wiring for Fracture Patella Outcome with 3 K Wire versus 2 K Wire

RECENT ADVANCES IN PATHOLOGY AND LABORATORY MEDICINE ◽

10.24321/2454.8642.202103 ◽

2021 ◽

Vol 07 (1&2) ◽

pp. 7-10

Author(s):

Sudip Deb ◽

Keyword(s):

Kirschner Wire ◽

Small Sample ◽

Tension Band ◽

Tension Band Wiring ◽

Knee Score ◽

Kirschner Wires ◽

Pain Status ◽

Lysholm Knee Score ◽

The Mean ◽

Working Status

Introduction: Fractures of the patella constitute almost 1% of all skeletal injuries, resulting from either direct or indirect trauma. Many forms of internal fixation for patellar fractures have been described in the literature but perfect anatomical reduction during surgery has an excellent outcome irrespective of the method of fixation used. The conventional method of patellar tension band wiring is always done with the help of two parallel Kirschner wires. Here, in our study, we intended to see whether the use of 3 parallel Kirschner wires in comparison to conventional one results in a superior functional outcome. Methods: A prospective observational study was carried out in ANIIMS and GB Pant hospital Port Blair from November 2016 to November 2019 on 44 patients of patellar fracture operated by tension band wiring with 22 patients in 2 parallel Kirschner wires and 3 parallel Kirschner wires groups respectively. Results: 44 patients were followed up postoperatively for 1 year and assessed by Lysholm knee score for pain status and working status and other variables. The mean age of the participants was 40.27 years (41.86 in two Kirschner wire group and 38.68 in three Kirschner wire group) in our study. Lysholm knee score, pain status, or working status was not significant throughout the mean follow-up periods for both groups. Conclusions: We found no significant difference between patellar TBW in 3 Kirschner wire and 2 Kirschner wire groups. However small sample size limits our study.

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Comparative Outcomes of Radial and Bucket-Handle Meniscal Tear Repair: A Propensity-Matched Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546518786035 ◽

2018 ◽

Vol 46 (11) ◽

pp. 2653-2660 ◽

Cited By ~ 9

Author(s):

Isabella T. Wu ◽

Mario Hevesi ◽

Vishal S. Desai ◽

Christopher L. Camp ◽

Diane L. Dahm ◽

...

Keyword(s):

Clinical Outcomes ◽

Cruciate Ligament ◽

Meniscal Tear ◽

Survival Rates ◽

Meniscal Repair ◽

Full Thickness ◽

Meniscal Tears ◽

Free Survival ◽

Reoperation Rates ◽

Bucket Handle

Background: Full-thickness radial meniscal tears render the meniscus nonfunctional and have historically been treated with partial meniscectomy. As preservative techniques evolve for radial repair, comparisons with other tear patterns are necessary to evaluate repair efficacy and prognosis. Purpose: To assess clinical outcomes and reoperation rates of radial meniscal repair and to compare them to bucket-handle meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: Radial and bucket-handle meniscal tears without concurrent root injuries undergoing surgical repair at a single institution between 2007 and 2015 were analyzed, including both all-inside and inside-out suturing techniques. Propensity matching was performed on the basis of age at surgery, sex, meniscus laterality, body mass index (BMI), and concomitant anterior cruciate ligament reconstruction (ACLR) using a comparison pool of 70 bucket-handle repairs. Reoperation-free survival rates and Tegner, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were analyzed. Results: Twenty-four patients (18 male, 6 female; mean age, 22.8 ± 11.9 years) who underwent repair of a radial meniscal tear were followed for a mean of 3.5 years (range, 2.0-6.3 years). Significant postoperative improvements in VAS scores at rest and with use and IKDC scores were noted postoperatively ( P < .001). Five patients (20.8%) required a reoperation. Subsequently, 18 patients with radial tears (mean age, 19.1 ± 9.1 years; 12 male; mean BMI, 27.0 ± 6.2 kg/m2; 3 medial; 11 ACLR) were propensity matched to 18 patients with bucket-handle tears (mean age, 20.8 ± 5.1 years; 13 male; mean BMI, 25.0 ± 3.5 kg/m2; 3 medial; 11 ACLR). The matched radial and bucket-handle groups demonstrated similar ( P = .17) reoperation-free survival rates at 2 years (88.9% and 94.4%, respectively) and 5 years (77.8% and 87.7%, respectively). VAS and IKDC scores improved significantly after surgery ( P < .001), with no difference noted between the groups ( P ≥ .17). Patients with radial and bucket-handle meniscal repairs achieved mean postoperative Tegner scores (6.6 and 6.6, respectively) not significantly different from their preinjury levels (6.9 and 6.7, respectively) ( P ≥ .32). Conclusion: Satisfactory clinical outcomes are achievable for radial meniscal tear repair at short-term follow-up. In a robustly matched comparison, radial and bucket-handle meniscal tears demonstrate similar improvements in VAS and IKDC scores, restoration of preoperative Tegner scores, and acceptable reoperation rates. Full-thickness radial meniscal tears should be considered for repair.

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An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2984-3 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Zhiqiang Wang ◽

Yan Xiong ◽

Xin Tang ◽

Qi Li ◽

Zhong Zhang ◽

...

Keyword(s):

Subcutaneous Tissue ◽

Meniscal Tear ◽

Lateral Meniscus ◽

Meniscal Repair ◽

Arthroscopic Repair ◽

Normal Anatomy ◽

Meniscal Tears ◽

Repair Technique ◽

Meniscus Tissue ◽

Repair Techniques

Abstract Background At present, most repair techniques for meniscal tears fix the meniscus directly over the capsule. This changes the normal anatomy and biomechanics and limits the activity of the meniscus during motion. We introduce an arthroscopic repair technique by suturing the true meniscus tissue without the capsule and subcutaneous tissue. Methods After confirmation of a tear, a custom-designed meniscal repair needle first penetrates percutaneously, crossing the capsular portion and the torn meniscus, and exits from the femoral surface of one side of the torn meniscus. Then a No. 2 PDS suture is passed through the needle and retrieved through the arthroscopy portal. Next, the needle is withdrawn to the synovial margin of the meniscus and is reinserted, exiting the femoral surface of the other side of the torn meniscus. The suture is pulled out through the same portal with a grasper. Finally, arthroscopic knotting is performed. Results We had 149 cases of meniscal tears repaired with this outside-in transfer all-inside technique since July 2016. Conclusions It is a simple, minimally invasive, and economical procedure that is appropriate for most parts of the meniscus except the posterior horn of the lateral meniscus, and it can be used to fix torn meniscus tissue firmly while also preserving the inherent activity of the meniscus.

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