Two-year follow-up of meniscal repair using a bioabsorbable arrow

2002 ◽  
Vol 18 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Hugh P. Jones ◽  
Mark J. Lemos ◽  
Richard M. Wilk ◽  
Paul M. Smiley ◽  
Robert Gutierrez ◽  
...  
Keyword(s):  
Meniscal Repair ◽  
Bioabsorbable Arrow

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.

scholarly journals What are the Risk Factors for Worse Outcomes of Meniscus Surgery in 23-39-Year-Old Patients Ligamentously Stable Knees?

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0046
Author(s):  
◽  
Megan Flynn ◽  
Anthony Egger ◽  
Yuxuan Jin ◽  
Elizabeth Sosic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adult ◽  
Patient Reported Outcomes ◽  
Meniscal Repair ◽  
Patient Specific ◽  
Lower Baseline ◽  
Patient Reported ◽  
Grade 3 ◽  
One Year

Objectives: Meniscus tears are a common and significant source of knee dysfunction in active young adult patients, and no high-quality prospective cohort or RCTs studies exist evaluating patient-reported outcomes in patients in this age group with ligamentously stable knees. Our objective was to identify patient-reported outcomes and patient-specific risk factors from a prospective cohort with a minimum of one-year follow-up following meniscal repair or excision in patients with ligamentously stable knees. We hypothesized that both groups would have significant improvement in outcomes; patients undergoing meniscal repair would have a higher reoperation rate; and articular cartilage injuries, subsequent knee surgery, and certain demographic characteristics would be significant risk factors to inferior outcomes at one year. Methods: Between February 2015 and December 2017, ligamentously stable meniscal procedures were enrolled and prospectively followed using the outcomes management evaluation system (OME) at Cleveland Clinic. Patients aged 23-39 preoperatively completed a series of validated outcome measurements including the Knee Injury and Osteoarthritis Outcome Score for both Pain (KOOS Pain) and Quality of Life (KOOS QoL). At the time of surgery, physicians documented all intra-articular findings, treatment, and surgical techniques utilized. Patients were followed at minimum of 1-year postoperatively through the OME platform and asked to complete the same outcome instruments done at baseline as well as a question designed to evaluate the Patient Acceptable Symptom State (PASS). The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of outcomes. Results: A total of 371 patients aged 23-39 underwent meniscus excision or repair during the study period. One hundred ninety-four met inclusion criteria, and one-year follow-up was obtained on 72% (n = 139) of the cohort (67% male; median age 32). Both KOOS Pain and KOOS QoL improved significantly at one-year for the entire cohort. Fourteen percent of the cohort (9% on the ipsilateral knee, 5% on the contralateral knee) underwent subsequent surgery at a minimum of one-year postoperatively. The patient-specific risk factors for worse one-year outcomes included preoperative baseline mental capacity score (VR-12 MCS), lower baseline KOOS QoL score, and the intraoperative finding of any grade 3 or 4 chondral changes. Conclusion: Young adult patients with ligamentously stable knees undergoing meniscal surgery have significantly improved patient-reported outcomes regardless of excision or repair; however, 14% of patients underwent additional knee surgery at a minimum of one-year postoperatively. The risk factors for worse outcomes include lower baseline mental health score, lower baseline KOOS QoL score, and any grade 3 or 4 chondromalacia scene.

scholarly journals Evaluation of the Meniscal repair in Bucket handle. Systematic review

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Damián Bustos ◽  
Lucas Marangoni ◽  
Pablo Bertiche ◽  
Javier Núñez ◽  
Iván Bitar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Meniscal Repair ◽  
Level Of Evidence ◽  
Meniscal Lesions ◽  
Number Of Patients ◽  
Bibliographic Search ◽  
Rate Of Failure ◽  
Bucket Handle

Introduction: Faced with a bucket meniscal lesion we have two treatment options. A frequently practiced option is to remove the bucket handle, another is to repair it. Generally, they are associated with ligament injuries. In this context, it has been shown that meniscal repair has a good result, but the evolution of isolated meniscal repairs is not entirely clear. The purpose of this systematic review is to determine the results after the repair of bucket handle injuries. Materials and Methods: A bibliographic search of the computerized database was carried out pubmed. Eight articles were included according to the inclusion and exclusion criteria. The results of interest included, level of evidence, number of patients, follow-up, average age, surgical technique,% cure,% failure, complications, associated injuries and average time from injury to surgical repair. Results: The works studied, on average, 43 patients, with ages between 16 and 33 years making 341 patients. The follow-up period was focused on 58 months. The percentage of cure varies from 52% to 98%. Conclusion: The isolated repair of this type of meniscal lesions has a good overall evolution associated with a low rate of failure and complications Level of evidence: IV Type of study systematic review

scholarly journals Anterolateral Ligament Reconstruction Protects the Repaired Medial Meniscus: A Comparative Study of 383 Anterior Cruciate Ligament Reconstructions From the SANTI Study Group With a Minimum Follow-up of 2 Years

2018 ◽  
Vol 46 (8) ◽  
pp. 1819-1826 ◽  
Author(s):  
Bertrand Sonnery-Cottet ◽  
Adnan Saithna ◽  
William G. Blakeney ◽  
Herve Ouanezar ◽  
Amrut Borade ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Anterolateral Ligament ◽  
Hamstring Tendons ◽  
Anterolateral Ligament Reconstruction ◽  
Significant Difference ◽  
Anterior Cruciate

Background: The prevalence of osteoarthritis after successful meniscal repair is significantly less than that after failed meniscal repair. Purpose: To determine whether the addition of anterolateral ligament reconstruction (ALLR) confers a protective effect on medial meniscal repair performed at the time of anterior cruciate ligament reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective analysis of prospectively collected data was performed to include all patients who had undergone primary ACLR with concomitant posterior horn medial meniscal repair through a posteromedial portal between January 2013 and August 2015. ACLR autograft choice was bone–patellar tendon–bone, hamstring tendons (or quadrupled hamstring tendons), or quadrupled semitendinosus tendon graft with or without ALLR. At the end of the study period, all patients were contacted to determine if they had undergone reoperation. A Kaplan-Meier survival curve was plotted, and a Cox proportional hazards regression model was used to perform multivariate analysis. Results: A total of 383 patients (mean ± SD age, 27.4 ± 9.2 years) were included with a mean follow-up of 37.4 months (range, 24-54.9 months): 194 patients underwent an isolated ACLR, and 189 underwent a combined ACLR + ALLR. At final follow-up, there was no significant difference between groups in postoperative side-to-side laxity (isolated ACLR group, 0.9 ± 0.9 mm [min to max, –1 to 3]; ACLR + ALLR group, 0.8 ± 1.0 mm [min to max, –2 to 3]; P = .2120) or Lysholm score (isolated ACLR group, 93.0 [95% CI, 91.3-94.7]; ACLR + ALLR group, 93.7 [95% CI, 92.3-95.1]; P = .556). Forty-three patients (11.2%) underwent reoperation for failure of the medial meniscal repair or a new tear. The survival rates of meniscal repair at 36 months were 91.2% (95% CI, 85.4%-94.8) in the ACLR + ALLR group and 83.8% (95% CI, 77.1%-88.7%; P = .033) in the ACLR group. The probability of failure of medial meniscal repair was >2 times lower in patients with ACLR + ALLR as compared with patients with isolated ACLR (hazard ratio, 0.443; 95% CI, 0.218-0.866). No other prognosticators of meniscal repair failure were identified. Conclusion: Combined ACLR and ALLR is associated with a significantly lower rate of failure of medial meniscal repairs when compared with those performed at the time of isolated ACLR.

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.

Two to nineteen years follow-up of arthroscopic meniscal repair using the outside-in technique: a retrospective study

2006 ◽  
Vol 127 (4) ◽  
pp. 245-252 ◽  
Author(s):  
Ashraf Abdelkafy ◽  
Nicolas Aigner ◽  
Mohamed Zada ◽  
Yassein Elghoul ◽  
Hesham Abdelsadek ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Meniscal Repair

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

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.

scholarly journals Outcomes of Meniscal Repair versus Meniscectomy in Patients with Concomitant ACL and Bucket Handle Meniscus Tears (200)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Laura Keeling ◽  
Alexandra Galel ◽  
Cooper Ehlers ◽  
David Wang ◽  
Edward Chang
Keyword(s):  
Meniscal Repair ◽  
Meniscus Tear ◽  
Patient Specific ◽  
Surgical Decision ◽  
Meniscus Tears ◽  
Patient Reported ◽  
Specific Factors ◽  
Surgical Decision Making ◽  
Bucket Handle

Objectives: Bucket handle meniscus tears often present concurrently with tears of the anterior cruciate ligament (ACL). However, little is known regarding the influence of demographic factors on surgical decision-making, or on outcomes following treatment of bucket handle meniscus tears in ACL-deficient patients. Furthermore, no study has compared outcomes in this population between patients undergoing meniscectomy versus repair. The purpose of this study was therefore to determine if there is a difference in outcomes between patients presenting with concomitant ACL and bucket handle meniscus tears treated with meniscal repair versus meniscectomy. A secondary aim of this study was to discover if there is an association between the decision to perform a meniscus repair or meniscectomy based on demographic factors. Methods: In this institutional review board-approved retrospective study, we evaluated 62 patients presenting with ACL tear who were found to have a bucket handle meniscus tear preoperatively or at the time of ACL reconstruction. Of those, 30 patients underwent partial meniscectomy, while 32 underwent meniscal repair. Primary outcome measures included ACL and meniscal retear rates, as well as patient-reported outcome measures (PROMs). Documented PROMs included the International Knee Documentation Committee (IKDC), Single Assessment Numeric Evaluation (SANE), and ACL-Return to Sport after Injury (ACL-RSI) scores. Demographic and patient-specific factors evaluated included age, body mass index (BMI), smoking status, and location of meniscus tear. Results: Of 62 patients presenting for ACL reconstruction with concomitant bucket handle meniscus tear, a total of 34 patients with greater than one year (mean 22.4 month) follow-up were included. 14 patients underwent repair, and 20 underwent meniscectomy. No significant differences were noted in IKDC (p = 0.36), delta IKDC (p = 0.18), SANE (p = 0.61), or ACL-RSI (p = 0.67) scores between the repair and meniscectomy groups at final follow-up. No significant differences were found in ACL (p = 1.00) or meniscus (p = 0.49) retear rates between the two groups. Younger age, lower BMI, and tear location (red-red zone) were significantly associated with the decision to perform meniscal repair over meniscectomy (p < 0.05). Conclusions: Among patients presenting with concomitant ACL and bucket handle meniscus tears, we found no difference in patient-reported outcomes or retear rates in patients undergoing meniscal repair versus meniscectomy. Demographic and patient-specific factors including age, BMI, and tear location may influence surgical decision-making when determining the optimal treatment of bucket handle meniscus tears in this population.

Ultrasound-Guided Meniscal Injection of Autologous Growth Factors: A Brief Report

Cartilage ◽  
2021 ◽  
pp. 194760352110373
Author(s):  
Berardo Di Matteo ◽  
Daniele Altomare ◽  
Riccardo Garibaldi ◽  
Agostino La Porta ◽  
Angelo Manca ◽  
...  
Keyword(s):  
Growth Factors ◽  
Symptomatic Relief ◽  
Arthroscopic Surgery ◽  
Young Patients ◽  
Meniscal Repair ◽  
Common Finding ◽  
Meniscal Tissue ◽  
Tissue Healing ◽  
Meniscus Degeneration

Meniscal degeneration is a common finding even in young patients’ knees, and it is regarded as a predictor for the onset of early osteoarthritis (OA). When symptomatic, it represents a challenge since arthroscopic surgery provides unpredictable results: recent evidence has shown that partial meniscectomy is not better than conservative management up to 2 years of follow-up, and the removal of meniscal tissue may accelerate OA progression toward OA. Intra-articular injection of corticosteroids or hyaluronic acid may help in providing temporary symptomatic relief, but no influence should be expected on the quality of the meniscal tissue. Biologic agents have been adopted to treat a variety of degenerative musculoskeletal pathologies, and the use of platelet-derived growth factors (GFs) has become routine. Preclinical studies have documented that platelet-derived GFs may play a beneficial role in stimulating meniscal repair and regeneration by triggering anabolic pathways and stimulating local mesenchymal stem cells from synovium. Furthermore, also mechanical stimulation (e.g., arthroscopic trephination or percutaneous needling) in the red-red or red-white zone may further promote tissue healing. The purpose of the present brief report is to describe the clinical outcomes at 18 months’ follow-up in a cohort of patients affected by symptomatic medial meniscus degeneration and treated by percutaneous needling plus intra- and perimeniscal injection of autologous conditioned plasma (ACP). The procedure was shown to be safe and provided significant pain reduction and improvement in subjective scores. This treatment option deserves further investigation in a comparative setting, to establish whether it could offer advantage over isolated intra-articular injections.

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