Clinical outcome and failure analysis of medial meniscus bucket-handle tear repair: a series of 96 patients with a minimum 2 year follow-up

Thaunat, Mathieu; Fournier, Gaspard; O’Loughlin, Padhraig F.; Kouevidjin, Biova; Clowez, Gilles; Borella, Matteo; Fayard, Jean-Marie; Sonnery‐Cottet, Bertrand

doi:10.1007/s00402-020-03346-1

Cited by 20 publications

(27 citation statements)

References 23 publications

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“…This may be due to the small sample size and the preoperative score has nothing to do with whether the meniscus repair ultimately failed. Consistent with the findings of Thaunat et al., 28 no statistically significant difference was found in postoperative scores between the 2 groups in this study, which may indicate that no correlation exists between postoperative score and failure of meniscus suture. However, further studies are needed to confirm this.…”

Section: Discussionsupporting

confidence: 92%

“…However, some researchers have concluded that young age and high activity level of patients affect the outcomes of meniscus repair and increase the risk of repair failure. 23 , 25 , 28 In this study, the proportion of patients younger than 24 years old in the failure group was 71.4%, which was higher than that in the non-failure group (27.4%); this is consistent with the above results.…”

Section: Discussionsupporting

confidence: 90%

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Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing

Yang

et al. 2022

Chinese Journal of Traumatology

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Purpose To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair. Methods From May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant. Results Seven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly ( p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years ( p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly ( p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly ( p = 0.046 for both). Conclusion The failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing

Yang

et al. 2022

Chinese Journal of Traumatology

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“…Failures occurred within 6 months of repair in 8 cases (30.8%), between 6 months and 24 months in 16 cases (61.5%), and after 24 months postoperatively in 2 cases (7.7%). A further 5 studies 7, 41, 47, 51, 55 reported the average time from BHMT repair to failure, which ranged from 9.7 months 41 to 44 months. 51…”

Section: Resultsmentioning

confidence: 99%

What Is the Failure Rate After Arthroscopic Repair of Bucket-Handle Meniscal Tears? A Systematic Review and Meta-analysis

Costa¹,

Grassi

Zocco³

et al. 2021

Am J Sports Med

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Background: Meniscal repair has become the treatment of choice for meniscal tears, especially in the subset of bucket-handle meniscal tears (BHMTs). However, a comprehensive estimate of the corresponding failure rate is not available, thus maintaining doubts about the healing potential of these tears. Furthermore, a wide range of factors to predict high failure rates have been reported but with conflicting evidence. Purpose: To determine the failure rate after arthroscopic repair of BHMTs as reported in the literature, compare this with the failure rate of simple meniscal tears extracted from the same studies, and analyze the influence of factors previously reported to be predictive of meniscal repair failure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic search was conducted by 2 independent reviewers using principal bibliographic databases (PubMed, Scopus, Cochrane Library, and EMBASE). After a stepwise exclusion process, 38 articles met the inclusion criteria. Failure rate data were analyzed with a random-effects proportional meta-analysis (weighted for individual study size), and forest plots were constructed to determine any statistically significant differences between BHMTs versus simple tears (longitudinal, radial, or horizontal), medial versus lateral BHMTs, isolated procedures versus repairs with concomitant anterior cruciate ligament reconstruction, and tears in red-red versus red-white zones. Moreover, a meta-regression analysis was conducted to evaluate the effect of patient age and sex, suture technique (in-out or all-inside), time from injury to surgery, mean number of stitches, and length of follow-up on failure rates. Results: The pooled failure rate was 14.8% (95% CI, 11.3%-18.3%; I2 = 77.2%). A total of 17 studies provided failure rates of both BHMT repairs (46/311 repairs) and simple tear repairs (54/546 repairs), demonstrating a significantly higher failure rate for BHMT repairs (risk ratio [RR] = 1.50; 95% CI, 1.05-2.15; I2 = 0%; P = .03). Medial BHMT repairs (RR = 1.94; 95% CI, 1.25-3.01; I2 = 0%; P = .003) and isolated repairs (RR = 1.77; 95% CI, 1.15-2.72; I2 = 0%; P = .009) had statistically higher risk of failure, but no statistically significant difference was found between tears in red-red versus red-white zones. Among the other factors evaluated with meta-regression, only the mean number of stitches showed a statistically significant effect on failure rates. Conclusion: Based on the currently available literature, this systematic review provides a reasonably comprehensive analysis of failure rate after arthroscopic BHMT repair; failure is estimated to occur in 14.8% of cases. Medial tears and isolated repairs were the 2 major predictors of failure.

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“…Grade-C injuries include PCL-and LCL-ruptures as well as meniscus damage. The reconstruction of ligaments and menisci should be targeted as early as possible, as time of treatment plays an important role for the definite outcome, especially in axial and root tears as well as posterior horn detachments [22,[24][25][26][27][28][29]. Usually, this is the case 2-3 weeks after injury when soft-tissue injuries are healed and the Table 4 The performed procedures that were performed in this study are presented with their total numbers and their percentages in relation to the collective [30], the LCL, and meniscal injuries as well as avulsions of the ACL are generally addressed first.…”

Section: New Classification System For Complete Dislocations Of the Kneementioning

confidence: 99%

Epidemiology of complete knee dislocations: an updated classification system

Mühlenfeld

Berthold

Münch

et al. 2021

Arch Orthop Trauma Surg

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Introduction Current classifications of complete knee dislocations do not capture the extent of the complex concomitant ligamentous and bony injuries, which may have an impact on future outcomes. The purpose of this retrospective study was to evaluate the epidemiology of complete knee dislocations as well as to present an updated classification system based on the author’s experience at a Level-I trauma center. Materials and methods Only patients with complete loss of contact of the articulating bones and ≥ 18 years of age who admitted in our level-I trauma center between 2002 and 2019 were included. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Results Final data included 80 patients, with the majority of patients being male (n = 64; 80.0%). Mean age was 34.9 years (range: 18–70 years). External protective fixation was applied in 32 patients (40.0%). Reconstruction of the posterior cruciate ligament and the anterior cruciate ligament were performed in 56.3% (n = 45) and 55.0% (n = 44) of cases, respectively. The lateral collateral ligament complex was surgically addressed in 47.5% (n = 38), while the medial collateral ligament complex was reconstructed in 40% (n = 32). Surgery of the lateral meniscus and the medial meniscus was needed in 31.1% (n = 25) and 30.0% (n = 24). Neurovascular surgery occurred in 13.8% (n = 11). From the characteristic injury-patterns the authors of this study present a new classification system that ranks the injuries from Grade-A to Grade-D according to their severity. Conclusion This retrospective study demonstrates that the historically used classification systems for dislocations of the knee are insufficient for these severe injuries. Concomitant ligamentous, neurovascular, bony, and meniscal injuries were frequent, and required several staged procedures. Consequently, an updated classification system is proposed.

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Clinical outcome and failure analysis of medial meniscus bucket-handle tear repair: a series of 96 patients with a minimum 2 year follow-up

Cited by 20 publications

References 23 publications

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing

What Is the Failure Rate After Arthroscopic Repair of Bucket-Handle Meniscal Tears? A Systematic Review and Meta-analysis

Epidemiology of complete knee dislocations: an updated classification system

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