All-Inside Versus Inside-Out Meniscal Repair With Concurrent Anterior Cruciate Ligament Reconstruction: A Meta-regression Analysis

Westermann, Robert W.; Duchman, Kyle R.; Amendola, Annunziato; Glass, Natalie; Wolf, Brian R.

doi:10.1177/0363546516642220

Cited by 64 publications

(66 citation statements)

References 50 publications

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“…Clinical symptoms and meniscus re-operation are the most common ways to identify and report meniscus repair failures, as observed from reports in the current literature [3,9,10]. However, failed biologic healing after meniscus repair may not represent all of the clinical failures.…”

Section: Discussionmentioning

confidence: 99%

“…As the meniscus has an important role for normal knee function, preservation of the meniscus as much as possible during ACL reconstruction (ACLR) has been generally accepted. Success rates of meniscus repair performed concurrently with ACLR can be range in the range of 80-95% [2][3][4]. Many factors, such as residual laxity, tear length, tear location, patient age, patient physical activity level, and repair integrity, can all affect the biologic healing of meniscal tears and thus clinical outcomes [5,6].…”

Section: Introductionmentioning

confidence: 99%

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

Kim

Baek

et al. 2019

Knee Surg & Relat Res

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Background: The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent reoperation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries. Methods: We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus. Results: There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the "successful healing" rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025). Conclusions: There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears. Level of study: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kim

Baek

et al. 2019

Knee Surg & Relat Res

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“…Systematic reviews and meta-analyses have found that there are no significant differences in failure rates, functional outcomes, or complication rates between allinside repair and inside-out repair. [3][4][5] All-inside meniscal repair is very useful, especially for the posterior lateral meniscal tear, because we do not need to explore the complex structure of the posterolateral corner. However, we need to be vigilant about possible popliteal artery, vein, and tibial or common peroneal nerve injuries.…”

Section: See Related Article On Page 1557mentioning

confidence: 99%

Editorial Commentary: The Benefits of Three-Dimensional Computed Tomography Images to Evaluate the Safety of All-Inside Meniscal Repair

Adachi

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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All-inside meniscal repair is a useful alternative to inside-out repair, particularly for the posterior horn of the lateral meniscus, because open approach to the complex posterolateral corner can be avoided. However, risk to the neurovascular structures is a major concern, and surgeons must be aware of portal placement, degree of penetration, patient size, and patient positioning. Imaging studies may be misleading, as they are generally obtained with the knee in extension. In the future, advanced imaging by 3-dimensional computed tomography may better allow us to preoperatively plan for a safe approach to the posterior horn of the lateral meniscus using all-inside repair techniques.

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“…14 In contrast, a metaanalysis of 21 Level IV studies of meniscus repair done in association with an ACL reconstruction found that the clinical failure rate for all-inside meniscal repair was 16%, whereas the failure rate for the inside-out repair was only 10% (P ¼ .016). 15 Furthermore, this meta-analysis found that implant irritation and device migration were the most common problems reported with the all-inside repair. 15…”

mentioning

confidence: 93%

“…15 Furthermore, this meta-analysis found that implant irritation and device migration were the most common problems reported with the all-inside repair. 15…”

mentioning

confidence: 93%

Editorial Commentary: Feeling the Pressure! A Biomechanical Analysis of All-Inside and Inside-Out Knee Meniscus Repair

Barber¹

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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A biomechanical, time-zero comparison found that both No. 2-0 UltraBraid inside-out sutures and FasT-Fix 360 all-inside devices used to repair a displaced bucket handle knee meniscus tear increased the contact area in deeper flexion angles (at 45°-60°) and reduced the peak contact pressure (at 45°-90°). No significance difference was observed between the inside-out and all-inside repair techniques.

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All-Inside Versus Inside-Out Meniscal Repair With Concurrent Anterior Cruciate Ligament Reconstruction: A Meta-regression Analysis

Abstract: There may be fewer early clinical failures when the inside-out technique is utilized for meniscal repair at the time of concomitant ACLR. Additional long-term studies will be useful to determine the operative success of these repairs over time.

Cited by 64 publications

References 50 publications

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

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

Editorial Commentary: The Benefits of Three-Dimensional Computed Tomography Images to Evaluate the Safety of All-Inside Meniscal Repair

Editorial Commentary: Feeling the Pressure! A Biomechanical Analysis of All-Inside and Inside-Out Knee Meniscus Repair

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