Arthroscopic Meniscal Repair – <i>Analysis of Treatment Failures</i>

Bach, Bernard R.; Dennis, Michael G.; Balin, Jefferson; Hayden, Jennifer

doi:10.1055/s-0030-1248192

Cited by 49 publications

(30 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is generally believed that poor vascular supply limits the healing capability of the central zones (Arnoczky and Warren 1982). The results of our study and those of others suggest that the repair of meniscal tears in children and adolescents is successful regardless of their location and of the vascular zone (Noyes and Barber-Westin 2002, Bach et al 2005, Lorbach et al 2009). In the adult meniscus, only the peripheral one-third is vascularized, whereas at birth the meniscus in its entirety is vascular and in children these vessels can still be identified throughout the inner zones (Clark and Ogden 1983).…”

Section: Discussionsupporting

confidence: 78%

“…There are a multitude of reports on the results of repairing meniscal tears in adults or in a mixed population of adults and adolescents. In this population, the success of meniscal repair depends on the type of tear, location within the meniscus (particularly with regard to the vascular zone), tear length, rim width, and other factors (Bach et al 2005, Kimura et al 1995, Tenuta and Arciero 1994, Scott et al 1986). Success rates for meniscal repairs in these groups are reported to be good to fair (Barber 1987, Eggli et al 1995).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcome of repaired unstable meniscal tears in children and adolescents

Kraus¹,

Heidari²,

Švehlík³

et al. 2012

Acta Orthopaedica

View full text Add to dashboard Cite

BackgroundUnstable meniscal tears are rare injuries in skeletally immature patients. Loss of a meniscus increases the risk of subsequent development of degenerative changes in the knee. This study deals with the outcome of intraarticular meniscal repair and factors that affect healing. Parameters of interest were type and location of the tear and also the influence of simultaneous reconstruction of a ruptured ACL.MethodsWe investigated the outcome of 25 patients (29 menisci) aged 15 (4–17) years who underwent surgery for full thickness meniscal tears, either as isolated lesions or in combination with ACL ruptures. Intraoperative documentation followed the IKDC 2000 standard. Outcome measurements were the Tegner score (pre- and postoperatively) and the Lysholm score (postoperatively) after an average follow-up period of 2.3 years, with postoperative arthroscopy and MRT in some cases.Results24 of the 29 meniscal lesions healed (defined as giving an asymptomatic patient) regardless of location or type. 4 patients re-ruptured their menisci (all in the pars intermedia) at an average of 15 months after surgery following a new injury. Mean Lysholm score at follow-up was 95, the Tegner score deteriorated, mean preoperative score: 7.8 (4–10); mean postoperative score: 7.2 (4–10). Patients with simultaneous ACL reconstruction had a better outcome.InterpretationAll meniscal tears in the skeletally immature patient are amenable to repair. All recurrent meniscal tears in our patients were located in the pars intermedia; the poorer blood supply in this region may give a higher risk of re-rupture. Simultaneous ACL reconstruction appears to benefit the results of meniscal repair.

show abstract

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Outcome of repaired unstable meniscal tears in children and adolescents

Kraus¹,

Heidari²,

Švehlík³

et al. 2012

Acta Orthopaedica

View full text Add to dashboard Cite

show abstract

“…This is different from prior studies in adult populations that have focused solely on repair of peripheral, long-itudinal tears. 6,16,17,20 These tear types are known to have improved repair results, 4,27 likely because of improved vascularity 2 and biology. 43 In addition, only 40% of the patients in this study had a concomitant ACL reconstruction, an additional factor known to improve meniscal healing results.…”

Section: Discussionmentioning

confidence: 99%

“…38,44,45,49-51 While the repair technique evolved from earlier all-open meniscal repairs 44,49,50 to less invasive all arthroscopic inside-out and all-inside meniscal repair techniques, 38,45,51 failure rates stayed at a constant level. Investigators previously reported that patient age, 7 time since injury, 28 complex tears, 11 and ligamentous instability 4 are risk factors for poor clinical outcome of meniscus repair; however, little is known about the effect of perioperative NSAID use.…”

mentioning

confidence: 99%

The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair

Proffen

Nielson

Zurakowski

et al. 2014

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background There has been recent interest in the effect of nonsteroidal anti-inflammatory medications on musculoskeletal healing. No studies have yet addressed the effect of these medications on meniscal healing. Hypothesis The administration of ketorolac in the perioperative period will result in higher rates of meniscal repair clinical failure. Study design Cohort study; Level of evidence, 3. Methods A total of 110 consecutive patients underwent meniscal repair at our institution between August 1998 and July 2001. Three patients were lost to follow-up, and the remaining 107 (mean age, 15.9 ± 4.4 years) had a minimum 5-year follow-up (mean follow-up, 5.5 years). Thirty-two patients (30%) received ketorolac perioperatively. The primary outcome measure was reoperation for continued symptoms of meniscal pathology. Asymptomatic patients were evaluated by the International Knee Documentation Committee (IKDC) Subjective Knee Form, Short Form–36 (SF-36) Health Survey, and Knee Outcome Osteoarthritis Score (KOOS). Results Kaplan-Meier survivorship revealed no difference in reoperation rates with and without the administration of perioperative ketorolac (P = .95). There was an overall failure rate of 35% (37/107 patients), with a 34% failure rate in patients receiving ketorolac (11/32 patients). Multivariable Cox regression confirmed that age, duration of symptoms, meniscal tear type, fixation technique, concurrent anterior cruciate ligament repair, and ketorolac usage did not have an impact on the rate of failure (P > .05 for all; ketorolac use, P > .50). Female sex (P = .04) and medial location (P = .01) were predictive of an increased risk for reoperation. Conclusion Failure of meniscal repair was not altered with the administration of perioperative ketorolac. Further work studying the effects of longer term anti-inflammatory use after meniscal repair is necessary before stating that this class of medications has no effect on meniscal healing. Clinical Relevance Results of this study suggest that nonsteroidal anti-inflammatory ketorolac can be administered perioperatively during a meniscal repair procedure to harness its benefits of decreased narcotic requirement, decreased pain, and shorter length of hospital stay without negatively influencing the long-term outcome of the surgery.

show abstract

“…Indeed, the potential recovery of a meniscal tear depends on various factors: first of all on the age of the patient ; in younger patients with greater vascularization, the prognosis for meniscal repair is better [8][9][10]. The topography of the tear influences results of meniscal sutures; sutures of tears located at the anterior or posterior horn are reported in the literature with more favorable results [11,12].…”

mentioning

confidence: 99%