In-Office Needle Arthroscopy Can Evaluate Meniscus Tear Repair Healing as an Alternative to Magnetic Resonance Imaging

Abstract

Purpose To assess the healing of horizontal cleavage tears of the meniscus 1 year after surgical repair and to determine what modality is best to determine healing. Methods Patients were prospectively followed for 12 months after surgical meniscus repair using a circumferential compression stitch. Inclusion criteria were preoperative magnetic resonance imaging (MRI) evidence of horizontal cleavage tear, age between 18 and 50 years, and no concomitant anterior cruciate ligament reconstruction. Patients were excluded if they were >50 years old, had a meniscus tear pattern other than horizontal cleavage tear, and underwent concomitant ligament reconstruction. MRIs were performed 1-year postoperatively for evaluation of repair healing. Preoperative and postoperative MRIs of tears were evaluated blindly by a musculoskeletal radiologist. In-office needle arthroscopy was performed at 6 months post-operatively. Results Eight patients were included and had surgery between March 2016 and November 2017. There were 4 medial and 4 lateral meniscus tears. No patients had recurrence of preoperative symptoms or evidence of retear. Six repairs evaluated by in-office needle (at 5.9 months postsurgery) arthroscopy demonstrated complete healing. Seven of the 8 patients had grade III changes on preoperative MRI, and 1 patient had grade IIc changes. On postoperative MRI, 5 of 7 patients had grade III changes, 1 patient had IIc changes, and 1 had IIb changes. There was no significant difference in the proportion of patients with grade III changes preoperatively compared with postoperatively ( P = .57). One of 8 patients with preoperative MRIs demonstrated extrusion where no patients demonstrate postoperative MRI evidence of extrusion ( P = .47). Conclusions Horizontal cleavage meniscal tears repaired with a circumferential compression stitch demonstrate healing on in-office needle arthroscopy 6 months after surgery. No evidence of incomplete or failed healing was found. MRI at 1 year after surgery demonstrated residual tear evidence for all patients. Level of Evidence IV, therapeutic case series.

Comparison of Visibility and Risk of Neurovascular Tissue Injury Between Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric Study

“…In the clinical situation, IONA has been typically used for younger patients. 4,9 However, IONA would be indicated for any patients, young or old, as long as their medical status allowed it to be performed in the office instead of an operating room. Sixth, only a 1.9-mm arthroscope with 0° was investigated in the present study; regardless, there are other 1.9-mm arthroscopes with a 25° lens.…”

“…1 Reportedly, IONA can be utilized to diagnose and treat several musculoskeletal disorders, including biceps tenotomy, rotator cuff repair, meniscectomy, meniscal repair, and cheilectomy for hallux rigidus. 4,9,11,15,17,24,29,38 Regarding ankle disorders, Dankert et al 7 reported that IONA was valuable in removing loose osseous bodies that could not be identified by MRI. Colasanti et al 4 reported that IONA for anterior ankle impingement resulted in high patient satisfaction.…”

In-office needle arthroscopic assessment after primary ACL repair: short-term results in 15 patients

“…In-office needle arthroscopy was also used to assess the status of a surgically repaired meniscus. DiBartola et al [ 6 ] demonstrated through in-office needle arthroscopy the healing of four repaired horizontal cleavage tears of the medial meniscus and four of the lateral meniscus six months after surgery.…”

In-Office Diagnostic Needle Arthroscopy Using the NanoScope™ Arthroscopy System

“… 1 Further, in some settings, this procedure has been found to be statistically equivalent in both efficiency and accuracy when compared to diagnostic surgical arthroscopy, and more accurate than MRI, without increased complications. 3 , 4 , 5 Real-time visualization of intra-articular pathology in an office setting can lead to reduced duration of time between diagnosis and ultimate management (whether surgical or nonsurgical), therefore, reducing time between injury and recovery. 6 , 7 Indications for an in-office diagnostic needle arthroscopy of the knee include patients who are unable to obtain an MRI (i.e., due to a pacemaker, claustrophobia, etc.…”

“…), patients with suspected intra-articular pathologies, including meniscal tears, chondral lesions, ligament tears, and loose bodies; and further, can be used for second-look arthroscopy following a variety of procedures, including meniscus and/or cartilage repair/restoration when MRI may not provide clear results. 5 , 6 The purpose of this Technical Note is to describe a standard in-office needle arthroscopy technique using the NanoScope™ (Arthrex Inc., Naples, FL) arthroscopy system.…”