Meniscus repair in the anterior cruciate deficient knee

Abstract

From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 patients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent repair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose of this study was to evaluate the success rate of a meniscal repair in an anterior cruciate deficient knee. The average age of the patients at the time of surgery was 25 years and the average followup was 56 months. Six patients (26%) had mild occasional pain not requiring medication and one patient had moderate pain requiring nonnarcotic pain medication. Eight patients (26%) had occasional giving way episodes and one of them underwent ACL reconstruction 5 years later because of frequent giving way. One patient required a postoperative manipulation for inadequate range of motion, but there were no neurovascular injuries or infections. There were three patients (13%) who had failed repairs or a retear and required subsequent subtotal meniscectomies. None of the other patients had any clinical symptoms or signs of a meniscal tear. There were no significant differences between the results of open or arthroscopic repair. Even though the failure rate of meniscus repair may be greater in an unstable knee, we conclude that meniscus repair is not contraindicated in an anterior cruciate deficient knee.

Evolução funcional da reparação do menisco por implante absorvível

“…Concluíram que, mesmo que os resultados insatisfatórios sejam maiores nos pacientes com joelhos instáveis, a lesão do LCA não contraindica a reparação do menisco. Hanks et al (5) realizaram 23 reparações do menisco em joelhos instáveis, sendo 12 por artrotomia e 11 por artroscopia, e observaram nova ruptura em apenas três casos. Desses pacientes, seis referiam dor, mas só um necessitou de analgésico.…”

“…Grupo I (lesão do menisco e reparação do LCA (4) , Hanks et al (5) e Koukoulias e Papastergiou (6) os quais consideram que a instabilidade não contraindica a reparação do menisco, houve situações em que a reparação do menisco foi feita em pacientes com lesão do LCA, mas refratários a realizar a reparação ligamentar.…”

Arthroscopic meniscus repair in the ACL-deficient knee

“…Ideally, in a knee in which there is both an ACL tear and a repairable meniscal tear, the former should be reconstructed and the latter repaired [4,7,8]. However, for various reasons, some patients elect not to undergo a ligament reconstruction.…”

“…In the current study there was a failure rate of 18% (4/22) in group 2 versus 5% (1/23) in group 1. Hanks et al [8] reported a 13% failure rate of meniscal repair in the ACL-deficient knee. They concluded that even though the failure rate may be higher in an unstable knee, meniscal repair was not contraindicated in an ACL-deficient knee.…”

“…Clinical findings, however, showed no significant correlations with the KellgrenLawrence scale score and the extent of findings at MR imaging. Hanks et al [8], Magee [10] and Totty [18] suggested that MRI may prove an ideal diagnostic tool in evaluating meniscal healing. The first studies using MRI after meniscal repair reported a persistent pathological signal after meniscal suture.…”