Indirect Magnetic Resonance Arthrography May Help Avoid Second Look Arthroscopy for Assessment of Healing After Bucket Handle Medial Meniscus Repairs: A Prospective Clinico-Radiological Observational Study

Tapasvi, Sachin; Shekhar, Anshu; Chandorkar, Aparna; Patil, Anupama V.; Patil, Shantanu

doi:10.1007/s43465-020-00334-w

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…However, studies combining patient-reported outcome measures, clinical evaluation, and radiographic assessment of postoperative healing are very limited [15,[19][20][21]. Thus, the purpose of the present study was to evaluate clinical and radiological outcomes of patients undergoing repair for acute bucket-handle meniscal tears as well as to assess the postoperative healing rate.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome and healing rate after meniscal bucket handle tear repair

Muench

Achtnich

Krivec

et al. 2022

BMC Musculoskelet Disord

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Background Reports combining patient-reported outcome measures, clinical evaluation, and radiographic assessment of postoperative healing after arthroscopic repair of bucket-handle meniscal tears (BHMT) are scarce. Methods Patients who underwent arthroscopic repair for acute traumatic BHMTs between October 2011 and March 2016 with a minimum follow-up of two years were included. Postoperative outcome scores comprised the International Knee Documentation Society Score (IKDC), Lysholm score, Tegner activity score (TAS), and visual analog scale (VAS) for pain. Clinical meniscal healing failure was assessed according to Barrett’s criteria. Side-to-side difference in knee laxity was measured using KT-2000. Radiographic healing was assessed by 3-Tesla magnetic resonance imaging (MRI) and classified according to Henning’s criteria at final follow-up. Results Forty patients with a mean age of 32.0 ± 11.5 years were available for follow-up after 51.8 ± 14.3 months. Revision surgery by means of arthroscopic partial meniscectomy was performed in four patients (10%) prior to the follow-up visit. The clinical healing rate was 83.3% at final follow-up. Mean IKDC score was 82.8 ± 13.8 and Lysholm score was 77.4 ± 24.8. Of all patients, 87.5% reached or exceeded the patient-acceptable symptomatic state (PASS) criteria for the IKDC score at final follow-up. The median TAS was 6 and VAS for pain was 0.46 ± 0.9. Side-to-side difference in knee laxity was higher in patients with concomitant ACL reconstruction (2.1 ± 2.7 mm) compared to isolated BHMTs (1.0 ± 2.0 mm). MR examination showed 69.4% healed, 25.0% partially healed, and 5.6% unhealed menisci. Conclusion Patients who underwent repair for acute traumatic BHMTs achieved good to excellent clinical outcome along with a high rate of meniscal healing at a minimum follow-up of two years. Clinical and radiological healing rates were similarly satisfactory and most patients exceeded the PASS criteria for the IKDC score. Patients were able to reach a high postoperative activity level. Level of evidence Case Series; IV.

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Section: Introductionmentioning

confidence: 99%

Clinical outcome and healing rate after meniscal bucket handle tear repair

Muench

Achtnich

Krivec

et al. 2022

BMC Musculoskelet Disord

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“…Additionally, it is widely recognized that postoperative MRI is less efficient than second-look arthroscopy or MR/CT arthrography in assessing the healing status of a repaired meniscus [19,22,23]. The second-look arthroscopy, if there are any postoperative issues, is the most accurate test, which remains the "gold standard" [19].…”

Section: Discussionmentioning

confidence: 99%

“…Alternative diagnostic procedures such as magnetic resonance (MR) or computed tomography (CT) arthrography, as well as second-look arthroscopy, have been proposed as more effective than traditional MRI. However, their invasive nature and the associated risks of ionizing radiation make them unsuitable for routine usage, particularly in young patients [19,[22][23][24]. Therefore, conventional MRI is still a test that is frequently referred to patients with functional restrictions or long-term clinical difficulties after a meniscus repair treatment because it is noninvasive and easily accessible.…”

Section: Introductionmentioning

confidence: 99%

Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?—A Prospective Comparative Cohort Study

Martinkėnienė,

Austys,

Šaikus

et al. 2024

Clinics and Practice

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Background: The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. Methods: A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. Results: MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. Conclusions: To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients.

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“…Nevertheless, it appears to be comparable with those found in the literature. 36,37,42 The absence of a meniscal tear subgroup was because of the low number of patients included. However, the MRI findings were identical for all tear types.…”

Section: Limitationsmentioning

confidence: 99%

MRI Criteria for Healing at 1 Year After Repair of a Traumatic Meniscal Tear

Schwach,

Grange,

Klasan

et al. 2023

Am J Sports Med

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Background: Meniscal repair for a traumatic meniscal tear is increasingly used to preserve the meniscus. Interpreting postoperative magnetic resonance imaging (MRI) scans remains challenging, especially in symptomatic patients. There is a lack of reliable MRI criteria to affirm the healed character of a traumatic meniscal injury repair. Purpose: To identify relevant MRI criteria for meniscal healing after meniscal repair. Study Design: Case series; Level of evidence, 4. Methods: We prospectively included all patients with a traumatic meniscal injury who underwent either an isolated meniscal repair or a repair during a concomitant anterior cruciate ligament reconstruction. A standardized preoperative and postoperative clinical evaluation was performed, along with collection of functional scores—Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee, Lysholm Score, and 36-Item Short Form Health Survey. An MRI scan was performed 1 year postoperatively and compared with the preoperative MRI scan. The following MRI aspects were analyzed: variation of morphology and fat-saturated (FS) T2 intensity signal and pre- and postoperative tear diastasis measurement. Results: Fifty patients (age, mean ± SD, 28.7 ± 8.5 years [range, 16-45 years]) who were 1 year postoperative were included. All patients were considered clinically healed had the same MRI characteristics. A signal change (FS T2) was observed from a high signal intensity fluid to a nonfluid moderate signal intensity. The morphology of the lesion was more complex: from the initial lesion, line ramifications appeared, creating the appearance of tree branches. The tear diastasis decreased (from 2.3 ± 0.5 mm [range, 1.3-3.5] to 1.1 ± 0.28 mm [range, 0.5-1.5]). Conclusion: MRI criteria confirming meniscal healing after traumatic meniscal repair at 1 year were identified: a change in the intrameniscal signal becoming nonfluid and moderate in intensity; a reduction in tear diastasis to <1.5 mm; and a change in the signal morphology of the repaired meniscus.

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Indirect Magnetic Resonance Arthrography May Help Avoid Second Look Arthroscopy for Assessment of Healing After Bucket Handle Medial Meniscus Repairs: A Prospective Clinico-Radiological Observational Study

Cited by 4 publications

References 29 publications

Clinical outcome and healing rate after meniscal bucket handle tear repair

Clinical outcome and healing rate after meniscal bucket handle tear repair

Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?—A Prospective Comparative Cohort Study

MRI Criteria for Healing at 1 Year After Repair of a Traumatic Meniscal Tear

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