Diagnostic Values of 3 Methods for Evaluating Meniscal Healing Status After Meniscal Repair

Ming, Yu; Yu, Jia-Kuo; Ao, Yingfang; Zheng, Zhuozhao; Gong, Xiaofeng; Leung, Kevin Kar Ming

doi:10.1177/0363546510388930

Cited by 77 publications

(56 citation statements)

References 27 publications

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“…32,33 Miao et al 32 compared these techniques and found that strict clinical evaluation underestimates the healing rate compared with that determined by MRI or second-look arthroscopy. However, physical examination is still an accepted assessment tool because routine second-look arthroscopy or MRI investigation of every patient to assess meniscal healing is not feasible in routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term studies have shown that, after meniscectomy, there is an increased incidence of radiological signs of arthritis. 6,32 Arthroscopic repair of torn menisci has therefore become the mainstay treatment method if repair is possible. 41 Inside-out, 8,18 outside-in, 43 and all-inside repair 37 —currently widely used—are the accepted arthroscopic repair techniques.…”

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confidence: 99%

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Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears

Uzun

Mısır

Kızkapan

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs.Purpose:To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears.Study Design:Case series; Level of evidence, 4.Methods:A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated.Results:The mean follow-up period was 51.2 ± 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both Ps <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; P = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; P = .008). Failure rates were higher for smokers than for nonsmokers (9/24, 37.5% vs 3/56, 5.3%; P = .008).Conclusion:Peripheral tears and early repairs have better outcomes and patient satisfaction. Smoking adversely affects meniscal healing.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears

Uzun

Mısır

Kızkapan

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Due to its high cost and invasiveness, it is rarely used. Miao et al [40] recently compared clinical assessment, magnetic resonance imaging and second-look arthroscopy and although clinical assessment was likely to under-estimate the healing rate (63 confirmed healed cf 77 arthroscopy), they suggested that when combined with MR, may be sufficient to exclude a re-tear.…”

Section: All-insidementioning

confidence: 99%

“…Current studies suggest that meniscectomy predisposes patients to early onset degenerative changes and also that patients with a meniscal repair have a higher functional outcomes. Evaluating long-term outcomes of meniscal repair [26, 39, 40], degenerative changes are seen ranging from 14 to 28% at a pooled follow-up of 12.5 years; however, it is important to note that patients with failed repairs were often excluded from further evaluation, and in those patients degenerative changes can be seen in as many as 56–57% of patients [39, 40]. Petty and Lubowitz [46] performed a systematic review of 5 studies and found a significantly higher rate of degenerative changes in patients undergoing partial meniscectomy (up to 53%) compared with the contralateral uninjured knee; however clinical symptoms of osteoarthritis were not observed at follow-up ranging from 8 to 16 years.…”

Section: All-insidementioning

confidence: 99%

Current concepts in the techniques, indications and outcomes of meniscal repairs

Karia

Ghaly

Al-Hadithy

et al. 2018

Eur J Orthop Surg Traumatol

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Knee arthroscopy for meniscal tears is one of the most commonly performed orthopaedic procedures. In recent years, there has been an increasing incidence of meniscal repairs, as there are concerns that meniscectomy predisposes patients to early osteoarthritis. Indications for meniscal repair are increasing and can now be performed in older patients who are active, even if the tear is in the avascular zone. Options for meniscal tear management broadly fall into three categories: non-operative management, meniscal repair or meniscectomy. With limited evidence directly comparing each of these options optimal management strategies can be difficult. Decision making requires thorough assessment of patient factors (e.g. age and comorbidities) and tear characteristics (e.g. location and reducibility). The purpose of this paper is, therefore, to review the management options of meniscal tears and summarize the evidence for meniscal tear repair.

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“…Miao et al . 35 have recently compared meniscal treatment techniques, and found that strict clinical evaluation resulted in lower estimates of the healing rate compared with MRI or second-look arthroscopy. Similarly to Miao and Pujol, we are of the opinion that a thorough clinical evaluation, including medical history and physical examination, seems to remain the “gold standard” in short-term follow-up, and this may be supplemented with imaging studies when needed.…”

Section: Discussionmentioning

confidence: 99%

Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection

et al. 2015

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ObjectiveTo collect and analyze the 2-year follow-up clinical and MRI results of patients treated with an arthroscopic technique of collagen membrane-based meniscus repair.Design53 consecutive patients with combined (horizontal and radial or longitudinal component) and complex meniscal tears (tear extended through avascular zones or/and composed with two or more morphological tear pattern) were treated with an “all-inside” arthroscopic suture of meniscus and wrapping with a collagen membrane (Chondro-Gide) technique with bone marrow blood injection. The IKDC 2000 subjective score, IKDC 2000 clinical evaluation score, Lysholm score and Barret clinical criteria of meniscal healing were recorded. All patients were examinated by MRI 2 years postoperatively, using modified WORMS criteria for meniscal integrity.ResultsThe 2 year follow-up was achieved in 50 cases. Of these, 2 patients were excluded from the evaluation due to incomplete data and 2 patients underwent partial meniscectomy and were classified as failures. In 46 patients (86.8% of the intended to treat cases), a statistically significant improvement in IKDC 2000 subjective, Lysholm scores and IKDC 2000 clinical assessment between preoperative and the 2-year follow-up time points were obsereved. Barret criteria demonstrated an improved clinical outcome between pre- and post-operative values. MRI revealed a non-homogeneous signal without meniscal tear (WORMS grade 1) in 76% of the operated menisci (13% WORMS grade 2).ConclusionsThe 2-year follow-up data demonstrate that this technique is safe and can offer an additional tool to save the meniscus in the patients otherwise scheduled for meniscal removal. Level of evidence IV

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Diagnostic Values of 3 Methods for Evaluating Meniscal Healing Status After Meniscal Repair

Cited by 77 publications

References 27 publications

Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears

Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears

Current concepts in the techniques, indications and outcomes of meniscal repairs

Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection

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