Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears

Abstract

Background In irreducible bucket-handle medial meniscal tears (BHMMTs), the displaced central fragment is rotated 180° or more, meaning reduction is impossible without derotation of the tear. In chronic cases, the rotated meniscus is deformed and degenerated; thus, the issue of reproducibility and repairability arises. This study presents the clinical outcomes of chronic irreducible and unstable locked BHMMTs. Radiological outcomes were also evaluated using magnetic resonance imaging (MRI). Methods This is a retrospective study of 37 patients with 11 cases of irreducible BHMMT and 26 cases of reducible but unstable chronic BHMMT who underwent operations between 2011 and 2016. Posterior arthroscopy was performed after temporary meniscus fixation using a provisional needle fixation technique. After the posterior repair with vertical mattress sutures was completed using an all-inside technique, the classic outside-in technique was performed for the anterior third of the meniscus. The Lysholm, International Knee Documentation Committee (IKDC), and Tegner activity scores were obtained from all patients before surgery and at the latest follow-up. Radiological evaluations were performed using MRI before surgery and at 6 months postoperatively. Results Between 2011 and 2016, a total of 37 consecutive patients with irreducible and chronic BHMMTs underwent surgery. The average postoperative follow-up was 7.2 ± 1.4 years (mean ± SD). Postoperative Lysholm (89.57 ± 2.7) and IKDC (87.22 ± 3.2) scores improved significantly at the last follow-up when compared with the pre-operative scores (38.44 ± 4.5 and 23.52 ± 7.8, respectively). According to the Tegner activity scale, patients’ postoperative activity levels remained unchanged compared to preoperative levels at the last follow-up. Conclusion Posterior knee arthroscopy with the all-inside posterior suture and inside-out anteromedial suture technique presented in this study yielded excellent clinical outcomes when used to repair chronic irreducible or unstable BHMMTs. Level of evidence: Level IV.

LARAI portal provides a safe method for lateral meniscus repair: three-dimensional computed tomography and cadaveric assessment

“…In addition, due to their improper insertion angle, surgeons rarely used these accessory portals to perform all-inside device repairs of tears extending to the AHLM. To date, the outside-in method remains the standard strategy for repairing the anterior horn of the meniscus [ 20 ]. However, it requires a skin incision to bury the suture thread, and if the stitch is made over the lateral fascia with a non-absorbable monofilament wire, it may cause knots protrusion or local pain due to tissue strangulation and knots irritation [ 21 – 24 ].…”

Hypermobile lateral meniscus: A systematic review of current treatment options

“…Due to the popularity of 'save the meniscus' concept, which aimed to mitigate contact pressure and degeneration in the affected area of the knee, recent efforts have been made to introduce successful repair techniques for treating HLM [20,23,37]. Up to this date, several review articles have been published regarding the HLM and its related structures, such as the PMF [2,3,5,14,52].…”

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

“…Both the lateral and medial menisci help preserve the knee biomechanics, and are important for shock absorption, joint stability, joint lubrication, and proprioception [ 6 , 66 , 90 ]. Meniscal tears have different aetiologies and injury patterns [ 44 , 47 , 60 ]. First, a distinction is made between acute and degenerative tears [ 39 , 56 ].…”