Knee meniscus suturing techniques in children and indications for their use

Relevance The problem of meniscus injuries in children has acquired a particular relevance. The growth in their incidence has been caused not only by an active sports- and lifestyle of pediatric patients but also by improved diagnosis due to magnetic resonance and arthroscopic techniques. Aim To formulate indications for the use of various methods of meniscus suturing in children and to evaluate the results of treatment of meniscus injuries in children, depending on the location of the tears. Materials and methods Our study included 74 patients who underwent meniscus suturing from March 2018 to December 2020. The age of the children ranged from 10 to 17 years. Time since the injury ranged from one day to 3 years. Before surgery, they underwent instrumental examination; knee joint radiography was performed in all patients, knee MRI was performed in 66 patients. Results Meniscus sutures were evaluated clinically and instrumentally at 6 months after the operation (MRI). One year after the meniscus repair, X-rays of the knee were taken to assess osteoarthritis. There was no pain after surgery in 68 children (91.9 %). There were no blocks of the knee joint after surgery in all children. Full recovery of the range of motion in the knee joint was observed in 69 children (93.2 %). Complications were noted in five children. Conclusion Poor results after meniscectomy has led to the emergence of several methods that allow meniscus repair and avoid meniscectomy that impairs knee functions. In children, the potential for restoration of menisci after their reconstruction is higher than in adults. It is possible to repair lesions not only in the white zone but after periods of more than three months since the injury. The choice of the meniscus suture technique used is determined by the location of the tear, taking into account possible complications. The use of a combination of methods allows reconstruction of the damaged meniscus regardless of the location of the tear and the complexity of the injury. Good clinical results, absence of complaints and return to usual physical activities in the immediate postoperative period should be regarded as positive outcomes subjected to further study.

Current Approaches and Problems Faced by Orthopedic Surgeons in All-Inside Arthroscopic Meniscus Repairs

BACKGROUNDAll-inside meniscal sutures are frequently the treatment of choice in arthroscopic practice. However, the literature contains limited evidence of the technical issues experienced during the procedure. We aimed to evaluate the technical difficulties encountered during the placement of all-inside meniscal repair sutures according to the surgeon’s experience and the success rate of the suture placement. METHODSThrough an online platform, we invited orthopedic surgeons across the country to complete a questionnaire. Participants were asked to respond to 10 questions about their demographic information, their general surgical approach to meniscal tears, and their experience with intraoperative complications specific to all-inside meniscus sutures. We performed a correlation analysis using the SPSS program to evaluate the statistical significance of the data we obtained.RESULTSA total of 100 orthopedic surgeons participated in our study. Of these, 37% had been working as an orthopedic surgeon for more than 10 years. Twenty-five percent performed more than two arthroscopic knee surgeries per week. Fifty-six percent of the surgeons were protective for the displaced red-white zone meniscal tears. The participants preferred all-inside sutures for tears in the posterior horn and the corpus of the meniscus. Although 90% of the participants stated that the technique was easier, only 12% thought the clinical results were better than the other techniques. More than 50% of the participants stated that they had difficulty in placing the sutures successfully. The most common difficulty was inability to fix the meniscus sufficiently and deformation of the instruments inside the joint. When we compared the complications according to the experience of the surgeon, even among the surgeons who performed more than 100 arthroscopic surgeries per year, 34% had trouble in successfully applying these sutures. CONCLUSIONAlthough all-inside meniscus sutures are generally believed to decrease the operative time and to be technically easier, even the most experienced surgeons have difficulty in applying these sutures, and the reliability of these sutures is low. Level of Evidence: Level IV, Cross-sectional survey study