Favorable Reoperation Rate at 2 Years Following Repair of Horizontal Cleavage Tears Using an All Suture-Based Technique: A Prospective, Multicenter Trial

Abstract

Purpose: This prospective, multicenter trial evaluates the clinical success (as measured by reoperation rates and improvements in patient-reported outcome measures) of using circumferential compression stitches with all-suture techniques for horizontal cleavage tears (HCTs) of the meniscus. Methods: Investigators enrolled 30 patients (mean age, 38.2 years; standard deviation, 11.1 years) aged 18 to 60 years with HCTs in the symptomatic compartment at 8 centers in the United States who underwent HCT repair with all-suture circumferential stitches using a self-retrieving all-inside suture passing device. Postoperative follow-up visits were conducted at 6 months, 1 year, and 2 years. Study outcomes included freedom from reoperation of the index meniscus repair site; knee pain and function, as measured by International Knee Documentation Committee Knee evaluation (IKDC), Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, and Tegner Activity Scale; and serious complications observed during the study. Minimal clinically important difference at 1 year was assessed for IKDC and Lysholm. Results: Twenty-three patients had 2-year follow-up data available. Freedom from reoperation was 96.0% at 6 months (26/27, 91.7% at 1 year [23/25], and 82.6% at 2 years [19/23]). Significant improvement was observed in over baseline at 2 years for IKDC (36.7-82.5; P < .001), Knee injury and Osteoarthritis Outcome Score (52.2-89.3; P < .001), Lysholm (50.2-87.4; P < .001), and Tegner scores (3.3-5.3; P ¼ .007). Minimal clinically important difference was met or exceeded for IKDC and Lysholm scores at 1 year 69.2% and 65.4% of patients, respectively. Four patients (6.7%) experienced serious complications, of which 2 were assessed as being related to the procedure. Conclusions: Repair of HCTs using all-suture circumferential stitches placed with a self-retrieving all-inside suture passing device leads to a favorable reoperation rate (17.4%), significant improvements in clinical outcomes, and an acceptable rate of serious complications (6.7%) at 2 years, supporting the viability of this treatment approach in this indication. Level of Evidence: Level IV, therapeutic case series.

Treatment Trends in Meniscal Pathology in the Setting of Concomitant ACL Injuries in Pediatric and Young Adult Patients: An Insurance Database Study

“…Moreover, we confirm previous findings 4 demonstrating a trend toward meniscal repair—rather than meniscectomy—across all age groups. Such findings are likely a result of multiple advancements in the field of orthopaedics: appreciation of the adverse effect of meniscectomy, 18 improvement in all-inside meniscal repair devices, 15 and an increase in procedures performed by fellowship-trained specialists. 4,25…”

“…repair-rather than meniscectomy-across all age groups. Such findings are likely a result of multiple advancements in the field of orthopaedics: appreciation of the adverse effect of meniscectomy, 18 improvement in all-inside meniscal repair devices, 15 and an increase in procedures performed by fellowship-trained specialists. 4,25 To our knowledge, this study represents the first to describe the increased utilization of concurrent meniscal procedures in male patients as compared with female patients.…”

Repair of a Horizontal Cleavage Tear of the Lateral Meniscus with Circumferential Compression Stitches and Marrow Venting Augmentation

“…demonstrated the viability of using the Novostitch device (Smith & Nephew, Andover, MA) for HCTs. 22 The authors concluded that circumferential compression sutures using the Novostitch device (Smith & Nephew, Andover, MA) is appropriately indicated for repairing HCTs.…”

Arthroscopic Saucerization and Repair of the Lateral Discoid Meniscus

“…Copyright @ 2021 JPOSNA www.jposna.org change over time. Importantly, repair of the degenerative horizontal tear can yield good results, 15,16,17 evidenced by validated patient reported outcomes scores 15,16,17 and healing rates on follow-up arthroscopy. 16 Meniscus repair preserves meniscus tissue and is complementary to saucerization in the management the symptomatic discoid lateral meniscus where degenerative tears and instability are common as it addresses both tears and instability to improve load transmission.…”

“…In recent years, meniscus repair has also been advocated over resection of horizontal cleavage tears to prevent excessive tibiofemoral contact pressures associated with complete resection. 14 Favorable outcomes have been shown in degenerative horizontal meniscal tear repairs, 15,16,17 and peripheral meniscus instability can be concurrently addressed with the same repair techniques by anchoring the meniscus to the joint capsule. 18 As tears are commonly associated with the discoid lateral meniscus, 2,19,20 especially in the degenerative horizontal cleavage configuration, 21,22 meniscal repair should be performed in conjunction with saucerization to create a functional meniscus for improved shock absorption and load transmission.…”