Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot

Jong, Ho; Ha, Jeong Ku; Jang, Suhyun; Lee, Dhong Won

doi:10.1007/s00167-012-2191-3

Cited by 122 publications

(113 citation statements)

References 19 publications

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“…Repair of these larger radial tears with this technique has been shown to improve the contact mechanics of the joint, which has translated into favorable clinical outcomes. [10][11][12] Newer current-generation all-inside repair devices lack long-term outcomes data. In a recent systematic review of long-term meniscal repair results, the review was unable to identify reports of these newer devices' outcomes at greater than 5 years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Inside-Out Meniscus Repair

Nelson

Bonner

2013

Arthroscopy Techniques

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Meniscus repair over resection, when feasible, should be strongly considered in an effort to preserve meniscus integrity and function, especially in younger patients. Currently, a number of techniques and implants may be used to achieve a successful result. Although all-inside meniscus repair devices have evolved significantly since their introduction and have become the repair technique of choice for many surgeons, the classic inside-out repair technique is still very useful to have in one's armamentarium. Though less popular because of the ease of current-generation fixators, the inside-out technique can still offer advantages for those surgeons who are proficient. With the versatility to address most tear patterns, the ability to deliver sutures with smaller needle diameters, and proven long-term results, it has been considered the gold standard in meniscus repair. We review the inside-out repair technique for both a medial and lateral meniscus tear with some helpful tips when performing the technique, and we present a video demonstration of the lateral meniscus repair technique.

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Section: Discussionmentioning

confidence: 99%

Inside-Out Meniscus Repair

Nelson

Bonner

2013

Arthroscopy Techniques

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“…Newer options for meniscus transplantation and tissue engineering have shown some promise, but current evidence regarding long-term outcomes compared with meniscus repair is lacking [5,26]. Recent studies have focused on biologic augmentation techniques to enhance repair healing with the goal of improving patient outcomes [19,21,28,32]. Common methods to enhance vascularity or healing of the meniscus include trephination, synovial abrasion, and application of a fibrin clot.…”

Section: Introductionmentioning

confidence: 99%

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Griffin

Hadeed

Werner

et al. 2015

Clinical Orthopaedics &Amp; Related Research

124

160

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Background Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. Questions/purposes We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes. Methods Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was À1.1 (À2.1 to À0.05) requiring 12 patients treated with PRP and 17 without to find statistically significant differences at p = 0.05 and power = 80%. Results There was no difference in the proportion of patients who underwent reoperation in the PRP group (27% [four of 15]) compared with the non-PRP group (25% [five of 20]; p = 0.89). Functional outcome measures were not different between the two groups based on the measures used (mean IKDC score, 69; SD, 26 with PRP and 76; SD, 17 without PRP; p = 0.288; mean, Tegner Lysholm Knee Scoring Scale, 66, SD, 32 with PRP and 89; SD, 10 without PRP; p = 0.065). With the numbers available there was no difference in the proportion of patients who returned to

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“…Peripheral healing was confirmed in all patients during second look arthroscopy (5 of 5) in short-term follow-up and maintained at 71 months in all patients (3 of 3) evaluated with MRI. In a more recent small series of patients with complete radial tears treated with exogenous fibrin clot a 92 % healing rate (11 of 12) was noted on follow-up MRI at 30 months postoperatively [30]. Seven of the 12 patients had second-look arthroscopies that confirmed healing in 6 of 7 patients.…”

Section: Fibrin Clotmentioning

confidence: 93%

Augmentation techniques for isolated meniscal tears

Taylor

Rodeo

2013

Curr Rev Musculoskelet Med

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Meniscal tears are relatively common injuries sustained by athletes and non-athletes alike and have far reaching functional and financial implications. Studies have clearly demonstrated the important biomechanical role played by the meniscus. Long-term follow-up studies of post-menisectomy patients show a predisposition toward the development of degenerative arthritic changes. As such, substantial efforts have been made by researchers and clinicians to understand the cellular and molecular basis of meniscal healing. Proinflammatory cytokines have been shown to have a catabolic effect on meniscal healing. In vitro and some limited in vivo studies have shown a proliferative and anabolic response to various growth factors. Surgical techniques that have been developed to stimulate a healing response include mechanical abrasion, fibrin clot application, growth factor application, and attempts at meniscal neovascularization. This article discusses various augmentation techniques for meniscal repair and reviews the current literature with regard to fibrin clot, platelet rich plasma, proinflammatory cytokines, and application of growth factors.

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Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot

Abstract: Case series, level IV.

Cited by 122 publications

References 19 publications

Inside-Out Meniscus Repair

Inside-Out Meniscus Repair

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Augmentation techniques for isolated meniscal tears

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