Outcomes After Repair of Chronic Bucket-Handle Tears of Medial Meniscus

Espejo-Reina, Alejandro; Serrano-Fernández, José Miguel; Martín-Castilla, Belén; Estades-Rubio, Francisco Javier; Briggs, Karen K.; Espejo-Baena, Alejandro

doi:10.1016/j.arthro.2013.12.020

Cited by 80 publications

(107 citation statements)

References 34 publications

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“…3 Data describing the influence of time interval between the moment of injury and the moment of meniscal repair on meniscal repair survival is scarce. 7,8 The time interval in which it is still possible to perform a meniscal repair is controversial. With advancing age, meniscal tissue becomes degenerative which may lead to a decreased healing response.…”

mentioning

confidence: 99%

Time Interval between Trauma and Arthroscopic Meniscal Repair Has No Influence on Clinical Survival

et al. 2015

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Arthroscopic meniscal repair is the gold standard for longitudinal peripheral meniscal tears. The time interval between trauma and meniscal repair remains controversial. The aim of this study was to evaluate failure rates and clinical outcome of arthroscopic meniscal repair in relation to chronicity of injury. A total of 238 meniscal repairs were performed in 234 patients. Anterior cruciate ligament (ACL) was reconstructed in almost all ACL-deficient knees (130 out of 133). Time interval between injury and repair was divided into acute (< 2 weeks), subacute (> 2 to < 12 weeks), and chronic (> 12 weeks). Patients completed postal questionnaires to evaluate clinical outcome and failure rates. Study instruments included Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner scoring systems. At a median follow-up of 41 months (interquartile range [IQR], 34-53 months) 55 medial and 10 lateral meniscal repairs failed (overall failure rate, 27%). There was a significant higher failure rate for medial meniscal repair (p < 0.05) and ACL-deficient knees without ACL reconstruction. Functional outcome scores showed only significant differences on the KOOS subscale "function in daily living" (95% confidence interval, 1.05-15.27, p < 0.05). No significant difference was found for any interval between trauma and repair. The interval between trauma and arthroscopic meniscal repair has no influence on the failure rate. Differences in survival rate of meniscal repair are more dependent on location of the lesion and ACL status, rather than chronicity of injury.

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confidence: 99%

Time Interval between Trauma and Arthroscopic Meniscal Repair Has No Influence on Clinical Survival

et al. 2015

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“…This is where they lost me and appeared to have stepped beyond the scope of their study, given that there is more than an abundance of literature to refute their contention. [11][12][13][14][15] Also concerning is the recommendation of Venjakob et al 5 that absorbable sutures should be used if a meniscal repair were undertaken. If sutures can abrade the overlying cartilage, they reasoned that it may be beneficial to use a suture that disintegrates over time to minimize this exposure.…”

Section: Catch-22?mentioning

confidence: 99%

Editorial Commentary: A Stitch in Time May Save the Meniscus…but Not the Articular Cartilage?

Kurzweil¹

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Early-generation meniscal fixators sometimes caused iatrogenic articular cartilage damage. This resulted in injury to the very structure one tries to preserve when repairing a meniscal tear. Advances in suture-based meniscal implants and all-inside suture devices have allowed us to safely repair meniscal tears, even ones thought previously irreparable, and without the need for a secondary incision. As the techniques for meniscal repair continue to improve, orthopaedic surgeons should be encouraged to consider repair with more complex meniscal tear patterns.

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“…2 Repair of the chronically torn medial meniscus has a relatively low failure rate; however, simultaneous ACLR improves healing rates. 16,17 All-inside repair devices can have reported similar healing rates to inside-out sutures devices; however, sutures remain the gold standard. 18 Meniscal repair after ACLR has a significantly higher failure rate.…”

Section: Fig 11mentioning

confidence: 99%

A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees

Vertullo

Wijenayake

Grayson

2016

Arthroscopy Techniques

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Abstract:It is customary to perform medial meniscus repair before anterior cruciate ligament (ACL) graft placement when undertaken as a combined procedure. However, in chronic ACL-deficient knees, intraoperative anterior tibiofemoral translation can cause the medial meniscus repair to be more technically challenging. Intraoperative anterior tibiofemoral translation can both reduce the visualization of the medial meniscus and make its reduction unstable. An operative sequence alteration of ACL graft placement and tensioning before medial meniscal repair improves medial meniscus visualization in chronically ACL-deficient knees by using the ACL graft's ability to prevent anterior tibiofemoral translation. The technique sequence is as follows: (a) the medial meniscus is reduced, (b) ACL reconstruction is undertaken using a hamstring graft without final tibia fixation, (c) distal graft tension is manually applied to distal graft sutures by the surgeon to prevent tibiofemoral subluxation, (d) the medial meniscus is repaired while graft tension is applied, and (e) the graft is then fixed to the tibia using an interference screw or another device.

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Outcomes After Repair of Chronic Bucket-Handle Tears of Medial Meniscus

Cited by 80 publications

References 34 publications

Time Interval between Trauma and Arthroscopic Meniscal Repair Has No Influence on Clinical Survival

Time Interval between Trauma and Arthroscopic Meniscal Repair Has No Influence on Clinical Survival

Editorial Commentary: A Stitch in Time May Save the Meniscus…but Not the Articular Cartilage?

A Technique of Improved Medial Meniscus Visualization by Anterior Cruciate Ligament Graft Placement in Chronic Anterior Cruciate Deficient Knees

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