Clinical Outcomes of Revision Meniscal Repair

Imade, Shinji; Kumahashi, Nobuyuki; Kuwata, Suguru; Kadowaki, Masaru; Ito, Syuji; Uchio, Yuji

doi:10.1177/0363546513508261

Cited by 17 publications

(14 citation statements)

References 34 publications

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“…A second major limitation was the lack of subgroup analysis to evaluate for differences that may have been present among patient tear types, ages, or demographics. Several studies have suggested that complex or challenging tears are less likely to heal reliably [6,13,27]. In this setting, although PRP may have enhanced the biology of the repaired meniscus, failure resulting from tear characteristics may have been inevitable.…”

Section: Discussionmentioning

confidence: 99%

“…Such findings have led to a renewed focus on meniscal preservation strategies to prevent articular cartilage degeneration. Recent efforts have been directed toward repair or enhancement rather than resection of the injured meniscus [6,11,13,17,[20][21][22]26]; however, even with the best techniques, meniscus repairs can fail. Newer options for meniscus transplantation and tissue engineering have shown some promise, but current evidence regarding long-term outcomes compared with meniscus repair is lacking [5,26].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Griffin

Hadeed

Werner

et al. 2015

Clinical Orthopaedics &Amp; Related Research

126

160

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Background Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. Questions/purposes We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes. Methods Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was À1.1 (À2.1 to À0.05) requiring 12 patients treated with PRP and 17 without to find statistically significant differences at p = 0.05 and power = 80%. Results There was no difference in the proportion of patients who underwent reoperation in the PRP group (27% [four of 15]) compared with the non-PRP group (25% [five of 20]; p = 0.89). Functional outcome measures were not different between the two groups based on the measures used (mean IKDC score, 69; SD, 26 with PRP and 76; SD, 17 without PRP; p = 0.288; mean, Tegner Lysholm Knee Scoring Scale, 66, SD, 32 with PRP and 89; SD, 10 without PRP; p = 0.065). With the numbers available there was no difference in the proportion of patients who returned to

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Griffin

Hadeed

Werner

et al. 2015

Clinical Orthopaedics &Amp; Related Research

126

160

View full text Add to dashboard Cite

show abstract

“…121 The healing status of repaired menisci can be assessed with various outcomes measures, including patient pain/function, imaging, and second-look arthroscopy (Fig. 19).…”

Section: Repair Outcomesmentioning

confidence: 99%

Magnetic Resonance Imaging of the Postoperative Meniscus

Boutin

Fritz²,

Marder

2014

Magnetic Resonance Imaging Clinics of North America

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“…Until now, meniscectomy seems to be the preferred technique to address failed meniscus repairs [14–17]. However, revision meniscal repair may provide better long-term outcomes than meniscectomy, but the results of this procedure remain underreported [18–21]. It is therefore unclear if revision meniscal repair is worthwhile.…”

Section: Introductionmentioning

confidence: 99%

Isolated revision meniscal repair – failure rates, clinical outcome, and patient satisfaction

Fuchs

Kloos

Bode

et al. 2018

BMC Musculoskelet Disord

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BackgroundFailure of isolated primary meniscal repair must be expected in approximately 10–25% of cases. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported. The purpose of this study was therefore to evaluate the outcome and failure rates of isolated revision meniscal repair in patients with re-tears or failed healing after previous meniscal repair in stable knee joints.MethodsA chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction.ResultsA total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 (± 23.4) months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, successful re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 (± 4.2) with a range of 90–100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8 ± 1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either satisfied or very satisfied with the outcome.ConclusionIn patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is slightly higher compared to isolated primary meniscal repair, but still acceptable. Therefore, revision meniscal repair is worthwhile in selected cases in order to save as much meniscal tissue as possible.

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Clinical Outcomes of Revision Meniscal Repair

Abstract: Revision meniscal repair should be considered in the setting of a retorn meniscus without degenerative changes.

Cited by 17 publications

References 34 publications

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Platelet-rich Plasma in Meniscal Repair: Does Augmentation Improve Surgical Outcomes?

Magnetic Resonance Imaging of the Postoperative Meniscus

Isolated revision meniscal repair – failure rates, clinical outcome, and patient satisfaction

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