Intermediate-Term Results of Meniscal Repair in Anterior Cruciate Ligament-Reconstructed Knees

Abstract

We investigated the incidence of and risk factors for recurrent tears of repaired menisci in anterior cruciate ligament-reconstructed knees. We observed 63 patients whose menisci had been evaluated at second-look arthroscopy as healed (N = 50) or incompletely healed (N = 13) for an average of 4 years (range, 2 to 9.5). Of the 13 patients with incompletely healed menisci, 6 (46%) required additional meniscal surgery and 2 (15%) had recurrence of meniscal symptoms such as catching or locking. Among the 50 patients with healed menisci, 5 (10%) required additional meniscal surgery and 9 (18%) had recurrence of meniscal symptoms after second-look arthroscopy. The timing of the recurrence of these symptoms was from 12 to 28 months after surgical repair. Of the 11 patients who had undergone additional surgery, 6 had sustained second injuries during sports activities and the other 5 had no identifiable cause of injury. When comparing age, tear sites, rim width, side-to-side differences with KT-1000 arthrometer testing, and the pivot shift test, there were no differences between the group requiring additional surgery, the symptomatic group, and the asymptomatic group. However, the postoperative Tegner activity score of the group requiring additional surgery was statistically significantly higher than the others.

All-Inside Meniscal Repair with Bioabsorbable Meniscal Screws or with Bioabsorbable Meniscus Arrows

“…In 1993, Albrecht-Olsen et al 2 introduced a new all-inside meniscal repair device, and since then many other all-inside devices with good biomechanical and clinical results have been reported. 4,5,7,8,20,27,30 In fact, the available data in the current literature do not support the assumption that biomechanically stronger repair techniques are accompanied by better clinical outcomes. 41 However, despite multiple studies, there is a lack of prospective, randomized clinical studies comparing different all-inside meniscal repair devices.…”

Meniscal Repair and Transplantation: Indications, Techniques, Rehabilitation, and Clinical Outcome

“…29,84 Less predictable results have been reported following suture repair of meniscus tears that extend into the central one-third region. 6,12,68,80,86 Differences in outcome have occurred due to variations in suture technique and placement along the tear site, postoperative rehabilitation, and concurrent procedures such as ACL reconstruction. We have described the results of these complex repairs in 4 separate investigations, the largest of which involved 198 meniscal repairs in 177 patients.…”

“…However, preservation of meniscal tissue is an over whelming rationale in young active patients and several authors have demonstrated that tears located in the central onethird avascular zone can be successfully repaired. 6,12,58,59,68,80,82,90 sults of meniscal repair using fixators, such as arrows, 22,29,43,48,50,83,84 staples, 49 and all-inside biodegradable screws 32,38,69 ; however, arthroscopicassisted suture repair remains the gold standard and is our preferred method. In addition, we have demonstrated that a rehabilitation program that implements immediate knee motion the first postoperative day after meniscus repair (performed either alone or with anterior cruciate ligament [ACL] reconstruction) is not deleterious to the healing meniscus tissue and prevents knee arthrofibrosis.…”

High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

“…These asymptomatic incomplete or unhealed meniscal lesions cannot be detected during clinical assessment; therefore, further surgical management is generally not planned. However, we should bear in mind that asymptomatic incomplete or unhealed lesions can be potential sources of late symptomatic lesions in the mid to long-term follow-up [17]. Considering that subsequent meniscal re-operation occurred with a significantly higher frequency in patients with concomitant meniscal tears at the time of ACL injury compared to patients with ACL injuries alone, it is important to improve biologic healing of meniscal tears using proper surgical technique, or biologic augmentation, if indicated.…”