Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket-Handle Meniscal Tears: A Propensity-Matched Analysis

Abstract

Background:There are limited data comparing the outcomes of all-inside versus inside-out meniscal repair techniques.Purpose:To assess failure rates and clinical outcomes after the surgical repair of bucket-handle meniscal tears utilizing either an all-inside or inside-out technique.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with bucket-handle meniscal tears undergoing all-inside or inside-out repair at a single institution between 2003 and 2013 were analyzed. A total of 28 mensici repaired utilizing second-generation all-inside suturing devices and 42 menisci repaired using an inside-out technique were eligible for inclusion. Rigorous propensity matching was performed on the basis of age, sex, tear laterality, rim width, and concomitant anterior cruciate ligament reconstruction (ACLR), resulting in a total of 40 patients equally distributed between the 2 repair techniques for comparison. Retear-free survival as well as preoperative and postoperative International Knee Documentation Committee (IKDC) and Tegner scores and physical examination findings were subsequently analyzed.Results:Twenty patients who underwent all-inside repair (14 male; mean age, 23.7 ± 6.7 years) were successfully propensity matched to 20 patients who underwent inside-out meniscal repair (15 male; mean age, 22.5 ± 7.6 years), with a mean retear-free follow-up of 4.4 years (range, 2.5-7.4 years). Four (20%) all-inside repairs and 4 (20%) inside-out repairs failed over the course of follow-up (P > .999), with a mean time to failure of 2.7 years (range, 1.3-4.4 years) and 5.0 years (range, 0.8-7.5 years), respectively (P = .25). Increasing patient age trended toward a decreased clinical retear rate, independent of the repair technique (hazard ratio, 0.86; P = .056). There were no significant differences in the Tegner scores, IKDC scores, or range of motion between the groups as a whole or when subcategorizing by age, sex, body mass index, tear complexity, rim width, isolated versus concomitant ACLR, or medial- versus lateral-sided repair. There were no complications in the all-inside group, while there was a 10% rate of minor complications in the inside-out group (P = .49).Conclusion:Overall, satisfactory clinical outcomes are achievable at short-term to midterm follow-up with both inside-out and all-inside repair techniques of bucket-handle meniscal tears in rigorously matched patients with similar meniscal tear patterns.

¿Does ACL reconstruction have any influence in meniscal repair?. Sports return, quality of life and failure rate. 2-12 years follow up.

“…Returning to sports activities is one of the fundamental objectives of meniscal reconstructions, with or without ACL reconstruction. The literature describes a very high percentage of patients that return to sports activities satisfactorily [28,29]. Our series also revealed a high return rate (92%), which was even higher in the group 1 (isolated meniscal repair) in comparison to group 2(ACL associated) (Table 4), which can be explained by the further complexity of ACL injuries, but no statistically diference were found (p 0,38).…”

Relationship between ACL reconstruction and meniscal repair. Quality of life, sports return and meniscal failure rate. 2 to 12 years follow-up

“…Returning to sports activities is one of the fundamental objectives of meniscal reconstructions, with or without ACL reconstruction. The literature describes a very high percentage of patients that return to sports activities satisfactorily [26,27]. Our series also revealed a high return rate (92%), which was even higher in the group 1 (isolated meniscal repair) in comparison to group 2(ACL associated) (Table 4), which can be explained by the further complexity of ACL injuries, but no statiscally diference for this result (p 0,38).…”

Editorial Commentary: All-Inside Meniscal Repair Devices: Should We Cease and De-Cyst?

“…Ó 2019 by the Arthroscopy Association of North America 0749-8063/181577/$36.00 https://doi.org/10.1016/j.arthro.2018.12.024 inside-out repair. 1 The incidence of cyst formation in this study does not tip the balance of complications between the techniques in 1 direction or the other but should increase readers' awareness regarding the possibility of cyst formation with these devices. As a completely nonscientific aside, I will tell you how I personally had the opportunity to compare allinside and inside-out repair as a patient.…”

“…Even in the hands of skilled surgeons, failure rates are considerable, regardless of the fixation technique used. 1 All-inside repair techniques have been developed in an attempt to simplify and improve the outcome for this procedure, although the outcomes of various repair techniques have been found to be comparable by most authors. [2][3][4] As with all arthroscopic procedures, complications are possible, including scuffing of the joint surface, nerve or vascular injury from needles or incisions, and failure of the repair.…”