Clinical and Radiological Outcomes After Isolated Anterior Horn Repair of Medial and Lateral Meniscus at 24 Months’ Follow-up, With the Outside-In Technique

Raoulis, Vasileios; Fyllos, Apostolos; Baltas, Christos; Schuster, Philipp; Bakagiannis, George; Zibis, Aristeidis; Hantes, Michael

doi:10.7759/cureus.17917

Cited by 3 publications

(10 citation statements)

References 29 publications

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“…The treatment for lesions is basically organized by tear type, but they are not consistent in different papers. 40 , 87 , 176 , 249 Several techniques treating longitudinal tears along the meniscosynovial junction or the red-red zone of the anterior horn of the lateral meniscus have been published in succession. 39 , 111 , 127 , 140 Raoulis et al 176 reported that repair of the anterior horn of the lateral meniscus can achieve improved outcomes and tissue healing in young and active patients after a 24-month follow-up period.…”

Section: Resultsmentioning

confidence: 99%

“… 40 , 87 , 176 , 249 Several techniques treating longitudinal tears along the meniscosynovial junction or the red-red zone of the anterior horn of the lateral meniscus have been published in succession. 39 , 111 , 127 , 140 Raoulis et al 176 reported that repair of the anterior horn of the lateral meniscus can achieve improved outcomes and tissue healing in young and active patients after a 24-month follow-up period. Dai et al 51 found that covering the repair site with an infrapatellar pedicle fat flap may improve meniscal healing and does not increase the complication rate.…”

Section: Resultsmentioning

confidence: 99%

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Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine

Zhang

Chen

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The lateral meniscus is a unique structure of the knee joint, and its anatomy, function, pathological process, and treatment are distinct from those of the medial meniscus. To date, no consensus on the management of lateral meniscal lesions has been published, and clinical decision-making is challenging. To facilitate this, consensus and practice guidelines for lateral meniscal lesions were developed and endorsed by the Chinese Society of Sports Medicine. Study Design: Consensus statement. Methods: This project followed the Delphi approach to the consensus process, involving steering, rating, and peer review groups. A total of 61 experts in the fields of sports medicine and arthroscopic surgery were invited to participate in the compilation of a consensus statement on lateral meniscal lesions. (The discoid lateral meniscus was addressed by separate consensus.) To begin, the steering group drafted a set of questions and replies regarding lateral meniscal lesions. An online panel discussion was then held to provide initial agreement and comments on the statements, followed by a round of anonymous voting. Results and feedback were sent to the steering group for a second draft. A second round of voting was then held, and each statement was discussed during a combined meeting of the steering and rating groups. Finally, a consensus draft was evaluated by a review group. Results: Fifty-three questions and answers addressing lateral meniscal lesions were drafted, and 20 statements were excluded because of redundant information during the first round of voting. Ultimately, 33 statements were completed, 9 of which were unanimous. Conclusion: This expert consensus process focused on the anatomy, function, pathological processes, and treatment of lateral meniscal lesions. Accepted recommendations in these areas can assist doctors and therapists in standardizing the management of related pathology. The consensus statement indicates that certain types of lateral meniscal tears that were previously considered irreparable can be repaired. Preservation of the lateral meniscus should be the first-line treatment whenever possible, because the long-term clinical and radiological outcomes are worse after partial meniscectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine

Zhang

Chen

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Excellent results were obtained in both groups, and clinical outcomes were comparable. Dart fixation is used preferably in posterior horn lesions, but darts can cause cartilage injury, while outside‐in suturing is used preferably in anterior horn lesions [51, 57]. Majewski et al [41] analysed the long‐term effects of meniscal repair in 88 patients with a mean follow‐up of 10 years (5–17 years).…”

Section: Discussionmentioning

confidence: 99%

“…The lesion must be in the red‐red or red‐white zone, although successful meniscal repairs have been described in the white–white zone using fibrin clot augmentation [13, 36, 60]. The surgical technique entails passing two needles, from outside inward, through the capsule and the meniscal tear [29, 51]. One needle carries a loop of thread or metal, and the other the suture [28, 50, 68].…”

Section: Introductionmentioning

confidence: 99%

Outside‐in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review

Migliorini

Pilone

Bell³

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Meniscal injuries are common. Outside-in meniscal repair is one of the techniques advocated for the management of traumatic meniscal tears. This systematic review investigated the outcomes of the outside-in repair technique for the management of traumatic tears of the menisci. The outcomes of interest were to investigate whether PROMs improved and to evaluate the rate of complications. Methods Following the 2020 PRISMA statement, in May 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed with no time constraints. All the clinical investigations which reported data on meniscal repair using the outside-in technique were considered for inclusion. Only studies which reported data on acute traumatic meniscal tears in adults were considered. Only studies which reported a minimum of 24 months of follow-up were eligible. Results Data from 458 patients were extracted. 34% (155 of 458) were women. 65% (297 of 458) of tears involved the medial meniscus. The mean operative time was 52.9 ± 13.6 min. Patients returned to their normal activities at 4.8 ± 0.8 months. At a mean of 67-month follow-up, all PROMs of interest improved: Tegner scale (P = 0.003), Lysholm score (P < 0.0001), International Knee Documentation Committee (P < 0.0001). 5.9% (27 of 458) of repairs were considered failures. Four of 186 (2.2%) patients experienced a re-injury, and 5 of 458 (1.1%) patients required re-operation. Conclusion Meniscal repair using the outside-in technique can be effectively performed to improve the quality of life and the activity level of patients with acute meniscal tears. Level of evidence Level IV.

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“…A prior study also inferred that the postoperative high signal in the meniscus extending to the surface might be indicative of immature fibrovascular granulation tissue or mature fibrocartilaginous scar tissue at the repair site [37]. This type of signal could persist on MR imaging in a long time span even in successful meniscus repairs [35, 36]. Additionally, the FasT‐Fix (Smith & Nephew Endoscopy, Andover, MA) used for all‐inside repair in all patients is nonabsorbable and thus may cause more reaction, being more likely to result in grade 3 signals on MRI than other devices [29], so the presence of grade 3 signals on MRI may not represent the failed repair.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic repair of degenerative medial meniscus tears in patients aged over 45 years resulted in favorable clinical outcomes and low clinical failure rates at a minimum 2-year follow-up

Zhu

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThis study aimed to investigate clinical and radiological results of arthroscopic repair for isolated medial degenerative meniscus tears (DMTs) in patients over 45 years old at a minimum 2‐year follow‐up. MethodsFrom 2013 to 2017, patients aged over 45 years with isolated medial DMT refractory to conservative management or with true mechanical symptoms who had undergone arthroscopic repair were retrospectively reviewed. Arthroscopic meniscus repair was performed using all‐inside or all‐inside and inside‐out technique in combination with bone marrow venting procedure. Tear patterns were classified according to arthroscopic findings. Magnetic resonance imaging (MRI) and outcome evaluations, including Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) score, were evaluated preoperatively and at the final follow‐up. International Cartilage Repair Society grades of the medial compartments and MRI signal at tear sites were assessed preoperatively and at the final follow‐up. A grade 0 to 2 signal at the repair site suggested a healed meniscus, whereas a grade 3 signal suggested an unhealed meniscus. Clinical failure was determined according to Barrett criteria. ResultsTwenty‐seven patients (mean age, 57.7 ± 7.4 years) were enrolled. The mean follow‐up was 52.0 ± 15.6 months. Among tear patterns, 48% were complex tears, 30% were horizontal tears, and 22% were other patterns. The mean Lysholm score and IKDC score significantly improved from 53 ± 25 to 89 ± 15 (p < 0.001) and 34 ± 24 to 72 ± 15 (p < 0.001) at the final follow‐up, respectively. The median Tegner activity score significantly improved from 1 (range 1–4) to 4 (range 2–7, p < 0.001). Three (11%) patients were considered clinical failures, and five patients (19%) had cartilage lesion progression. At the final follow‐up, MRI showed grade 0 in one (4%) patient, grade 1 in nine (33%) patients, grade 2 in six (22%) patients, and grade 3 in eleven (41%) patients. ConclusionArthroscopic repair of isolated medial DMT refractory to conservative management or with true mechanical symptoms in patients aged over 45 years had good to excellent clinical outcomes with low clinical failure rates, despite unhealed menisci being observed on MRI in 41% of patients at a mean 4.3‐year follow‐up. Arthroscopic repair could be a treatment option for these patients. Level of evidenceIV.

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Clinical and Radiological Outcomes After Isolated Anterior Horn Repair of Medial and Lateral Meniscus at 24 Months’ Follow-up, With the Outside-In Technique

Cited by 3 publications

References 29 publications

Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine

Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine

Outside‐in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review

Arthroscopic repair of degenerative medial meniscus tears in patients aged over 45 years resulted in favorable clinical outcomes and low clinical failure rates at a minimum 2-year follow-up

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