Second-Look Arthroscopic Findings After Repairs of Posterior Root Tears of the Medial Meniscus

Seo, Hee-Soo; Lee, Su-Chan; Jung, Kwang Am

doi:10.1177/0363546510382225

Cited by 156 publications

(259 citation statements)

References 35 publications

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“…Commensurate with recent interest in MMPRT fixation, several fixation studies have been conducted. [2][3][4] Pullout fixation is typically performed using simple stitches and tends to produce favorable results. However, some studies that have used simple stitches have not reported any reduction in meniscal extrusion.…”

Section: Discussionmentioning

confidence: 99%

“…However, some studies that have used simple stitches have not reported any reduction in meniscal extrusion. 2,4,8 Furthermore, during second-look arthroscopy, cases of partial, incomplete, and failed healing, in addition to scar tissue, have been reported, 3 probably because of weak holding power and a small meniscus-bone contact area. In a comparative study of MMPRT fixation using simple or modified Mason-Allen stitches, the modified stitches were associated with significantly superior outcomes on magnetic resonance imaging, with respect to postoperative meniscal extrusion and healing.…”

Section: Discussionmentioning

confidence: 99%

“…8 Several factors may lead to arthritic progression after MMPRT fixation, including an incomplete reduction in meniscal extrusion, which may cause shock absorption failure, loose healing after pullout fixation, and weak tensile strength and meniscus holding power. 3 Therefore, the modified Mason-Allen stitch is strongly recommended during MMPRT fixation, as it confers several potential advantages. First, PDS (a bioabsorbable suture material) is used, and the suture ends are tied over a Hewson button placed under the periosteum, allowing for tension adjustments that in turn confer flexibility with respect to normal meniscal excursion, meniscus mobility (for maximum dynamic congruity), and facilitation of meniscus load transmission (thus avoiding excessive strain on the sutures).…”

Section: Discussionmentioning

confidence: 99%

“…1 Fixation is typically achieved using a simple stitch. [2][3][4] However, such stitches can result in poorer meniscal healing because of reduced holding strength. 5 In contrast, the modified Mason-Allen stitch technique can produce better meniscal healing because of the superior holding power conferred by its locking effect.…”

mentioning

confidence: 99%

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Arthroscopic Medial Meniscus Posterior Root Fixation Using a Modified Mason-Allen Stitch

Chung

Jong

et al. 2016

Arthroscopy Techniques

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A complete radial tear of the meniscus posterior root, which can effectively cause a state of total meniscectomy via loss of hoop tension, requires that the torn root be repaired. Several methods have been used to repair medial meniscus posterior root tears, most of which are based on a simple stitch technique that is known to have stitch-holding strength. We applied a modified version of the Mason-Allen stitch technique, which is recognized as a method for rotator cuff repair surgery because its locking effect overcomes the potential weakness of simple stitches. This article introduces the medial meniscus posterior root tears repair procedure based on a modified Mason-Allen stitch technique in which 2 strands (i.e., 1 simple horizontal and 1 simple vertical stitch) are used.S everal biomechanical studies have reported that medial meniscus posterior root tear (MMPRT) increases the contact surface and decreases peak pressure because of a loss of hoop tension after disruption of circumferential fibers, similar to the effects observed in knees subjected to total meniscectomy. 1 Fixation by restoring hoop tension is crucial to prevent degenerative changes. 1 Fixation is typically achieved using a simple stitch. 2-4 However, such stitches can result in poorer meniscal healing because of reduced holding strength. 5 In contrast, the modified Mason-Allen stitch technique can produce better meniscal healing because of the superior holding power conferred by its locking effect. 6 We herein introduce a method of MMPRT fixation using a modified version of the Mason-Allen stitch technique. Surgical TechniqueGeneral arthroscopic examination is routinely performed via anterolateral (AL) and anteromedial (AM) portals; the arthroscope (Linvatec, Largo, FL) is introduced through the AL portal, and the working instruments through the AM portal. This position allows for excellent visualization of the posterior horn root detachment.First, if MMPRT is confirmed on arthroscopic examination, the superficial medial collateral ligament (MCL) is released to provide a sufficient working space. A 3-cm longitudinal skin incision is made at the anteromedial aspect of the proximal tibia, and superficial MCL release is achieved using a periosteum elevator directed toward the distal tibial side and performing periosteal stripping while preserving the proximal tibial attachment and deep MCL.Second, landmarks relevant to the insertion of the posterior horn of the medial meniscus, including the PCL insertion point, medial tibial spine, and articular margin of the posteromedial tibial plateau, should be identified by arthroscopy after superficial MCL release. A full-radius resector is used to remove fibrous tissue and identify the edge of the meniscus. Debridement of the torn meniscal edge is performed using a shaver (Linvatec).Third, a curette is inserted through the AM portal to create a bony bed at the insertion site.Fourth, a crescent-shaped suture hook (Linvatec) loaded with No. 1 polydioxanone (PDS) (Ethicon, Somerville, NJ) is then ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Arthroscopic Medial Meniscus Posterior Root Fixation Using a Modified Mason-Allen Stitch

Chung

Jong

et al. 2016

Arthroscopy Techniques

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“…Seo et al [54] performed second look arthroscopies in 11 patients who underwent arthroscopic repair of the posterior root attachment at 13.4 mo postoperatively and in none of them had the repair healed. A study [55] evaluating healing after meniscal repair using artho-CT scan also found that posterior segment healing rate was lower compared to middle portion tears.…”

Section: Meniscal Repairmentioning

confidence: 99%

Treatment of meniscal tears: An evidence based approach

Mordecai

Al-Hadithy

Ware

et al. 2014

WJO

200

164

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Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g. , age, co-morbidities and compliance) and tear characteristics (e.g. , location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g. , nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.

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