Failure Rates of Repaired Bucket-Handle Tears of the Medial Meniscus Concomitant With Anterior Cruciate Ligament Reconstruction: A Cohort Study of 253 Patients From the SANTI Study Group With a Mean Follow-up of 94 Months

Abstract

Background: Failure rates of repaired bucket-handle medial meniscal tears (BHMMTs) concomitant with anterior cruciate ligament reconstruction (ACLR) are as high as 20%. The outcomes of posteromedial portal suture hook repair have not been compared with all-inside repair techniques for this subtype of meniscal lesion. Purpose/Hypothesis: The aim of this study was to evaluate the outcomes and failure rates of patients who underwent BHMMT repair concomitant with ACLR using an all-inside technique, suture hook + all-inside technique, or suture hook + outside-in technique. It was hypothesized that no significant differences in failure rates would be found between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed on patients diagnosed with a BHMMT who underwent meniscal repair during primary ACLR and had a minimum follow-up of 2 years. Patients were grouped based on the meniscal repair technique used: all-inside repair, suture hook + all-inside repair, or suture hook + outside-in repair. At the end of the study period, secondary medial meniscectomy rates were determined. Results: The study population comprised 253 patients who underwent repair of a BHMMT with concomitant ACLR with a mean follow-up of 94.0 ± 47.6 months. A total of 114 patients (45.1%) underwent all-inside repair, 61 patients (24.1%) underwent suture hook + all-inside repair, and 78 patients (30.8%) underwent suture hook + outside-in repair. Overall, there were 36 failures. The failure rates were 20.2%, 14.8%, and 5.1%, respectively ( P = .0135). All-inside repairs were >4 times more likely to fail than suture hook + outside-in repairs (hazard ratio [HR], 4.103; 95% CI, 1.369-12.296; P = .0117). Failure was also 3 times higher (HR, 2.943; 95% CI, 1.224-7.075; P = .0159) for patients <30 years of age compared with those aged ≥30 years. An additional anterolateral ligament reconstruction (ALLR) was also found to reduce the failure rate of repaired BHMMTs concomitant with ACLR. Conclusion: Combined suture hook + outside-in repair of BHMMTs resulted in significantly fewer failures than all other techniques. Furthermore, age <30 years and no additional ALLR were associated with higher failure rates.

Clinical Outcomes of Different Management Techniques for Medial Meniscal Type 3 Ramp Lesions in Anterior Cruciate Ligament Reconstruction: A Comparative Analysis Between All-inside Repair, Suture Hook Repair, and Lesions Left In Situ

“…This may occur more often when an all-inside implant is used than a suture hook because of the size of the implant, the area of the penetration point of the needle/suture hook in meniscal tissue (Cooper zone 1 or 2), and the potential role of the nonabsorbable suture in the recurrence of the tear. All-inside devices might causebe exposed to a suture cut-through or cheese-wiring effect, 12 whereas this effect might be less present when performing suture hook repair with a resorbable suture, as suggested by Gousopoulos et al 7 This difference between suturing with PDS absorbable sutures and all-inside repair with implants was also reported by El Helou et al, 6 who showed that the failure rate of patients who underwent bucket-handle medial meniscal tear repair with concomitant ACLR was 4 times higher with all-inside repair than with suture hook + outside-in repair. In our series, we had a greater rate of secondary meniscectomy in the suture hook group, compared to the all-side group, however, this can be explained by the fact that this represents the overall failure rate in patients who had a secondary meniscectomy at the same time as a failure of their graft (which represents half of the cases in the suture hook group).…”

Meniscus tears and repair: assessing failure rates of all-inside and outside-in methods

“…After reviewing four articles published since 2014, a total of 702 cases were identified. [13][14][15][16] The average follow-up period from surgery to postoperative evaluation was four years. Among the identified patients, 122 lateral and 571 medial meniscus surgeries were performed.…”

“…Four articles met the inclusion criteria and were identified. [13][14][15] To assess the success of the surgery, the number of unsuccessful operations was determined. Failure was characterized as the recurrence of clinical symptoms or the need for a meniscal reintervention, involving either repair or resection of the meniscus.…”

Incomplete meniscal healing in early second-look arthroscopy does not indicate failure of repair: a case series

“…Similarly, Seo et al [ 10 ] described second-look arthroscopic findings of a meniscal posterior horn of MM or LM repair with concomitant ACL reconstruction and demonstrated better healing with a suture hook (82.1%) than with all-inside repair devices (54.5%). Helou et al [ 17 ] reported that out of 61 patients with bucket-handle MM tears who underwent all-inside meniscal repair with suture hooks during primary ACLR, there were nine repair failures (14.8%), which was defined by the number of secondary medial meniscectomies. The clinical outcomes of several studies that had performed meniscal repairs of post-traumatic, longitudinal, vertical, meniscal tears using suture hooks are summarised in (Table 3 ).…”