Suture Hook Versus All-Inside Repair for Longitudinal Tears of the Posterior Horn of the Medial Meniscus Concomitant to Anterior Cruciate Ligament Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

Abstract

Background: Secondary meniscectomy rates after repair of longitudinal tears of the posterior horn of the medial meniscus (PHMM) performed concomitantly with anterior cruciate ligament reconstruction (ACLR) are reported to be as high as 25% with an all inside repair technique. Posteromedial portal suture hook repair is an emerging technique; however, it is unknown whether it confers a significantly reduced secondary meniscectomy rate compared with the current gold standard. Purpose/Hypothesis: The primary objective of this study was to compare the secondary meniscectomy rates of suture hook repair and all inside repair for longitudinal tears of the PHMM performed concomitant to ACLR. The secondary outcome was to determine the risk factors associated with the failure of the repair. It was hypothesized that repair with an all inside device would be associated with higher secondary meniscectomy rates when compared with suture hook repair and that concomitant anterolateral ligament reconstruction (ALLR) would confer improved meniscal repair survivorship. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with longitudinal tears of the PHMM who underwent meniscal repair during primary ACLR between January 2011 and December 2015 at our institution were eligible for the study. Patients undergoing suture hook repair were propensity matched in a 1:1 ratio to patients who underwent all inside repair. At the end of the study period, secondary meniscectomy rates were determined. Results: The study population comprised 237 matched pairs. The mean follow up was 97.7 ± 17.3 months. Patients who underwent an all inside repair had a >2-fold higher failure rate compared with patients who underwent suture hook repair through a posteromedial portal (31.2% vs 15.6%; P = .0003). Patients in the suture hook repair group undergoing additional ALLR demonstrated a >3-fold higher meniscal repair survival rate compared with all other subgroups ( P = .0014). This association was not seen in the all inside repair group. The only statistically significant risk factor for meniscal repair failure was the suture repair technique (hazard ratio, 2.133 [95% CI, 1.383-3.292]; P = .0008). Conclusion: Suture hook repair through a posteromedial portal is associated with a significantly lower secondary meniscectomy rate when compared with the all inside meniscal repair of longitudinal tears of the PHMM performed at the time of ACLR. Furthermore, patients in the suture hook repair group who underwent an additional ALLR had a significantly better meniscal repair survivorship compared with all other subgroups.

Failure Rates of Repaired Bucket-Handle Tears of the Medial Meniscus Concomitant With Anterior Cruciate Ligament Reconstruction: A Cohort Study of 253 Patients From the SANTI Study Group With a Mean Follow-up of 94 Months

“…29,47 Recently, a suture hook repair through a posteromedial portal was found to be associated with a significantly lower secondary meniscectomy rate when compared with the all-inside meniscal repair of longitudinal tears of the posterior horn of the medial meniscus performed at the time of ACLR. 17 These results are similar to the current study and can be compared with the more traditional repair methods that have reported inconsistent results. 6,46 A systematic review in 2017 found no difference in clinical or anatomic failure rates (clinical failure: 11% vs 10%, respectively; anatomic failure: 13% vs 16%, respectively) and similar complication rates of 4.6% for the all-inside technique versus 5.1% for the inside-out technique for isolated meniscal tears.…”

“…1,30,48 Repair of medial meniscal lesions through a posteromedial portal using a suture hook is an emerging technique, with one recent study reporting significantly lower secondary meniscectomy rates when compared with the all-inside meniscal repair, albeit for longitudinal tears of the posterior horn of the medial meniscus with an associated ACLR. 17 The aim of this study was to evaluate the outcomes and failure rates of patients who underwent repair of BHMMTs concomitant with an ACLR using an all-inside repair technique, a suture hook 1 all-inside repair technique, and a suture hook 1 outside-in technique. It was hypothesized that no significant differences in failure rates would be found between the groups at a minimum 2-year follow-up.…”

“…1,30,48 Repair of medial meniscal lesions through a posteromedial portal using a suture hook is an emerging technique, with one recent study reporting significantly lower secondary meniscectomy rates when compared with the all-inside meniscal repair, albeit for longitudinal tears of the posterior horn of the medial meniscus with an associated ACLR. 17…”

Combined Repair of Medial Meniscal Ramp Lesions and Posterior Root Tears of the Lateral Meniscus During Anterior Cruciate Ligament Reconstruction

“…MMRLs can be repaired using inside-out, all-inside, or hybrid combination techniques (outside-in, inside-in, and/or all-inside) 16,17 . While inside-out repairs are more technically challenging, the technique offers greater flexibility with suture placement and the number of sutures placed, potentially creating a stronger repair 12 .…”

Defining Failure

“…Because reoperation is easiest to identify unequivocally, secondary meniscectomy or subsequent arthroplasty is often used to define failure of meniscal surgery. 7,9,17,23 Symptoms of pain, swelling, catching, or locking may be recorded if patients are interviewed and examined, 1,20 which is often not the case. A meniscal repair that fails to heal or a transplant that extrudes from the joint has probably lost much of its intended function but may not cause symptoms sufficient to warrant an additional procedure.…”