Evaluation of Peripheral Vertical Nondegenerative Medial Meniscus Tears Treated With Trephination Alone at the Time of Anterior Cruciate Ligament Reconstruction

Shelbourne, K. Donald; Benner, Rodney W.; Nixon, Ryan; Gray, Tinker

doi:10.1016/j.arthro.2015.06.024

Cited by 18 publications

(25 citation statements)

References 25 publications

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“…Shelbourne et al repaired peripheral nondegenerative medial meniscus tears at least 1 cm in length by arthroscopic trephination during ACLR. 65 Failure rate was 16.3% at 5.6-year follow-up and trephination-treated tears showed 95% normal radiographs. However, none of these studies objectively evaluated anatomic meniscus healing using an imaging study or second-look arthroscopy.…”

Section: Augmentation Of Meniscus Repair Through Trephination Raspinmentioning

confidence: 87%

Augmentation Techniques for Meniscus Repair

et al. 2017

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Menisci display exquisitely complex structure and play an essential weight-bearing role in the knee joint. A torn meniscus is one of the most common knee injuries which can result in pain and mechanical abnormalities. Tear location is one aspect which determines the endogenous healing response; tears that occur in the peripheral densely vascularized zone of the meniscus have the potential to heal while the healing capacity is more limited in the less vascularized inner zones. Meniscectomy was once widely performed, but led to poor radiographic and patient-reported mid- and long-term outcomes. After the advent of arthroscopy, orthopaedic opinion in the 1980s has been swaying toward salvaging or repairing the torn meniscus tissue to prevent osteoarthritis rather than performing meniscectomy. Meniscus repair in young active individuals has been shown to be effective, reproducible, and reliable if indications are met; however, only a small proportion of all tears are considered repairable with available technologies. Biological augmentation techniques and meniscus tissue engineering strategies are being devised to enhance the likelihood and rate of healing in meniscus repair. Preclinical and clinical studies have shown that introduction of cellular elements of the blood, bone marrow, and related growth factors have the potential to enhance meniscus repair. This article reviews the current state of clinical management of meniscus tears (primary repair) as well as augmentation techniques to improve healing by meniscus wrapping with extracellular matrix materials, trephination, synovial rasping and abrasion, fibrin/blood clot placement, and platelet-rich plasma injections. In addition, the rationale for using polymer/autologous blood component implants to improve meniscus repair will be discussed.

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Section: Augmentation Of Meniscus Repair Through Trephination Raspinmentioning

confidence: 87%

Augmentation Techniques for Meniscus Repair

et al. 2017

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“…[8][9][10][11][12] Given this information, some surgeons continue to repair MMTs that are degenerative in nature and extend into the avascular zone. [13][14][15][16][17] Shelbourne and Carr 16 evaluated patients who had unstable bucket-handle MMTs that were either repaired or removed at ACL reconstruction. Although the mean subjective scores were 90.9 points in both groups, they found that, within the repair group, patients who had degenerative tears had a mean score of 87.1 compared with 93.9 in the non-degenerative group.…”

Section: See Related Article On Page 3500mentioning

confidence: 99%

“…I use trephination and abrasion with peripheral or posterior LMTs and with peripheral vertical MMTs. 5,17 In a study that included 43 peripheral vertical LMTs treated with trephination and abrasion, none required subsequent surgery. 5 In a separate study 17 of 419 peripheral vertical nondegenerative MMTs treated with trephination alone, subsequent MMTs occurred in 16.3%, which compares to other studies of medial meniscus repair.…”

Section: See Related Article On Page 3500mentioning

confidence: 99%

“…5,17 In a study that included 43 peripheral vertical LMTs treated with trephination and abrasion, none required subsequent surgery. 5 In a separate study 17 of 419 peripheral vertical nondegenerative MMTs treated with trephination alone, subsequent MMTs occurred in 16.3%, which compares to other studies of medial meniscus repair. 18 In a systematic review of 70 studies by Paxton et al, they found a reoperation rate of 17.5% at a 4-10-year follow-up in patients with medial meniscus repair combined with ACL reconstruction.…”

Section: See Related Article On Page 3500mentioning

confidence: 99%

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Editorial Commentary: Meniscus Tears Seen at the Time of Anterior Cruciate Ligament Reconstruction Are Overtreated

Shelbourne

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…15,18,28 Among patients with ACL tears, many risk factors have been identified for the presence of an associated meniscal tear, including patient age, sex, and time from initial injury. 4,9,10,14,21,28,31,34 Although past studies have helped elucidate the risk factors associated with concomitant ACL-meniscal injury, the optimal treatment strategy for meniscal injury in the setting of ACL reconstruction remains somewhat controversial, 28 as studies have demonstrated acceptable outcomes for both observation 6,22,30,32 and meniscal repair. 39,40 Prior studies also highlight rates of failed meniscal repair in young patients.…”

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confidence: 99%

Trends in Concomitant Meniscal Surgery Among Pediatric Patients Undergoing ACL Reconstruction: An Analysis of ABOS Part II Candidates From 2000 to 2016

Cruz

Gao

Ganley

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Rates of anterior cruciate ligament (ACL) reconstruction among pediatric and adolescent patients are increasing. Limited knowledge exists about population-level rates of concomitant meniscal surgery in this age group.Purpose/Hypothesis:This study sought to examine trends in concomitant meniscal procedures and describe short-term complications in pediatric and adolescent patients undergoing ACL reconstruction. We hypothesized that overall meniscal surgery rates are increasing and that the likelihood of performing meniscal repair or meniscectomy is associated with patient- and surgeon-specific factors.Study Design:Cross-sectional study.Methods:We queried ACL procedures in patients younger than 19 years reported by American Board of Orthopaedic Surgery (ABOS) part II examination candidates from 2000 to 2016. Regression models examined associations between patient and surgeon characteristics, year of surgery, follow-up time, meniscal procedure type, and number and type of complications.Results:A total of 9766 cases were identified. Females represented 46% (n = 4468) of included cases. Mean patient age was 16.1 years (SD, 1.62 years; range, 0-18 years). The rate of concomitant ACL-meniscal procedures increased from the years 2000 to 2016 (49%-60%; P = .005). Surgeons with sports medicine (+7.0%) or pediatric orthopaedic fellowship (+6.6%) training had a higher likelihood of reporting a concomitant ACL-meniscal procedure ( P = .003 and .006, respectively). Sports medicine–trained surgeons were more likely to perform meniscal repair compared with meniscectomy (+3.0%; P = .016). Younger patient age was associated with increased likelihood of undergoing meniscal repair compared with meniscectomy. Overall reported complication rate was 12.8%. Notable reported complications included infection (1.61%), arthrofibrosis (1.14%), and deep venous thrombosis or pulmonary embolism (0.11%). Sports medicine and pediatric orthopaedic fellowship training was associated with higher rates of reporting postoperative stiffness and/or arthrofibrosis.Conclusion:Among ABOS part II candidates, concomitant ACL-meniscal surgery has become more common than isolated ACL procedures. Procedures involving sports medicine fellowship–trained surgeons and younger patients were associated with increased rates of meniscal repair compared with meniscectomy. Pediatric orthopaedic and sports medicine training was associated with a greater likelihood of being involved in a concomitant ACL-meniscal procedure of any kind, and surgeons with such training also reported a higher incidence of postoperative stiffness and/or arthrofibrosis in patients.

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Evaluation of Peripheral Vertical Nondegenerative Medial Meniscus Tears Treated With Trephination Alone at the Time of Anterior Cruciate Ligament Reconstruction

Cited by 18 publications

References 25 publications

Augmentation Techniques for Meniscus Repair

Augmentation Techniques for Meniscus Repair

Editorial Commentary: Meniscus Tears Seen at the Time of Anterior Cruciate Ligament Reconstruction Are Overtreated

Trends in Concomitant Meniscal Surgery Among Pediatric Patients Undergoing ACL Reconstruction: An Analysis of ABOS Part II Candidates From 2000 to 2016

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