Risk factors for all-inside meniscal repair failure in isolation and in conjunction with anterior cruciate ligament reconstruction

Turcotte, Justin; Maley, Alyssa D.; Levermore, Sandra B.; Petre, Benjamin M.; Redziniak, Daniel E.

doi:10.1016/j.knee.2020.10.012

Cited by 11 publications

(4 citation statements)

References 25 publications

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“…Interestingly, while no statistically significant difference between isolated BHMT repair and concurrent ACLR was observed, patients undergoing isolated BHMT repair exhibited superior post‐operative outcomes, contradicting some previous studies hypothesising a positive influence of concurrent ACLR on meniscal repair [ 9 , 10 , 29 , 37 ], and akin to a number of previous publications finding no significant differences between isolated meniscal repair and concurrent ACLR [ 3 , 21 , 31 , 38 , 42 ]. While preoperative joint status might influence these results, the fact that post‐operative outcomes after BHMT repair with concurrent ACLR were in fact inferior to those after isolated repair calls into question the belief that simultaneous ACLR enhances meniscal healing.…”

Section: Discussioncontrasting

confidence: 76%

“…Recent systematic reviews have reported an overall failure rate of 14.8%–29.3%, with BHMTs being significantly more likely to fail compared to other tear types [ 5 , 8 ]. Concurrent anterior cruciate ligament reconstruction (ACLR) is speculated to improve BHMT repair outcomes [ 11 , 22 , 33 , 37 ]. However, evidence in this regard remains conflicted [ 20 , 36 ].…”

Section: Introductionmentioning

confidence: 99%

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Good mid‐ to long‐term outcomes after meniscus bucket‐handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction

Pawelczyk,

Fanourgiakis,

Feil

et al. 2024

J. exp. orthop.

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PurposeTo evaluate mid‐ to long‐term clinical outcomes after arthroscopic bucket‐handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR).MethodsA comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty‐five patients with an average follow‐up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post‐operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed.ResultsThe failure rate was 9%. Medial BHMT repair showed superior post‐operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post‐operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow‐up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post‐operative outcome measures was observed but did not reach statistical significance for most items.ConclusionArthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow‐up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes.Level of EvidenceLevel IV (retrospective case series).

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Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Good mid‐ to long‐term outcomes after meniscus bucket‐handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction

Pawelczyk,

Fanourgiakis,

Feil

et al. 2024

J. exp. orthop.

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“…Excellent results were obtained in both groups, and clinical outcomes were comparable. Dart fixation is used preferably in posterior horn lesions, but darts can cause cartilage injury, while outside‐in suturing is used preferably in anterior horn lesions [51, 57]. Majewski et al [41] analysed the long‐term effects of meniscal repair in 88 patients with a mean follow‐up of 10 years (5–17 years).…”

Section: Discussionmentioning

confidence: 99%

Outside‐in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review

Migliorini

Pilone

Bell³

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Meniscal injuries are common. Outside-in meniscal repair is one of the techniques advocated for the management of traumatic meniscal tears. This systematic review investigated the outcomes of the outside-in repair technique for the management of traumatic tears of the menisci. The outcomes of interest were to investigate whether PROMs improved and to evaluate the rate of complications. Methods Following the 2020 PRISMA statement, in May 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed with no time constraints. All the clinical investigations which reported data on meniscal repair using the outside-in technique were considered for inclusion. Only studies which reported data on acute traumatic meniscal tears in adults were considered. Only studies which reported a minimum of 24 months of follow-up were eligible. Results Data from 458 patients were extracted. 34% (155 of 458) were women. 65% (297 of 458) of tears involved the medial meniscus. The mean operative time was 52.9 ± 13.6 min. Patients returned to their normal activities at 4.8 ± 0.8 months. At a mean of 67-month follow-up, all PROMs of interest improved: Tegner scale (P = 0.003), Lysholm score (P < 0.0001), International Knee Documentation Committee (P < 0.0001). 5.9% (27 of 458) of repairs were considered failures. Four of 186 (2.2%) patients experienced a re-injury, and 5 of 458 (1.1%) patients required re-operation. Conclusion Meniscal repair using the outside-in technique can be effectively performed to improve the quality of life and the activity level of patients with acute meniscal tears. Level of evidence Level IV.

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“…Turcotte et al found that patients who underwent meniscal repair combined with ACLR were less likely to experience failure than patients with isolated repairs; however, this difference was not statistically significant [47]. Few previous studies demonstrated that concurrent ACLR may have beneficial effect on meniscal repair outcomes as well [42, 48, 49].…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk

Kalifis

Raoulis

Panteliadou

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeOutcomes after repair of bucket‐handle meniscal tears tend to be satisfying in the short‐term follow‐up. However, the literature is scarce regarding long‐term data following repair of bucket‐handle meniscal tears. The aim of this study was to assess long‐term follow‐up outcomes, focusing on knee osteoarthritis (OA) development and failure rate, and determine risk factors associated with failure. MethodsThis is a retrospective cohort study, including all patients with bucket‐handle tears within 4 mm of the menisco‐synovial junction, who underwent meniscal repair, either isolated or combined with anterior cruciate ligament reconstruction (ACLR) between 2004 and 2015. A combination of all‐inside, outside‐in, and inside‐out repair technique was used in all patients. Patients over 40 years old, concomitant multi‐ligamentous injuries, and severe cartilage lesions documented intraoperatively were excluded. During the follow‐up, a meniscus was considered healed using Barrett’s criteria, while knee OA evaluation was performed according to Kellgren–Lawrence (KL) classification using standing knee radiographs. Patients were assessed preoperatively as well as postoperatively in terms of knee function using International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). ResultsIn total, the inclusion criteria were met by 66 patients. Median age at the time of operation was 21.9 years (13–39). Median follow‐up was 114 (62–176) months. Total failure rate was approximately 33% at median time of 19 (6–39) months. Osteoarthritis was statistically significantly more prevalent in patients with failed repairs (mean KL score: 2.09) in comparison to patients with successful repairs (mean KL score: 0.54) p = 0.001. In addition, successful repairs were associated with higher KOOS score as compared with failed repairs (mean ± SD, 89.6 ± 4.6 vs 77.8 ± 4.9 p < 0.001), higher IKDC score (mean ± SD, 88.2 ± 5.1 vs 79.2 ± 5.2 p < 0.001), and Lysholm score (mean ± SD, 90.3 ± 5.3 vs 78.4 ± 7.8 p < 0.001). Patients with medial meniscus repair had 4.8 higher relative likelihood of failure compared to lateral meniscus [p = 0. 014, OR = 4.8 (95% Cl 1.2, 18.6)]. Patients over 16 years old had 5.7 higher relative likelihood of failure [p = 0. 016, OR = 5.7 (95% Cl 0.04, 0.85)]. Concurrent ACLR did not have a significant effect on the postoperative outcomes. ConclusionA high rate of clinical failure was observed after meniscal repair of bucket‐handle tears. However, successful treatment led to lower rates of knee OA development and better knee function, approximately 10 years postoperatively. Meniscal repair of bucket‐handle tears is recommended to improve knee function and prevent knee OA in young patients. Level of evidenceIII.

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Risk factors for all-inside meniscal repair failure in isolation and in conjunction with anterior cruciate ligament reconstruction

Cited by 11 publications

References 25 publications

Good mid‐ to long‐term outcomes after meniscus bucket‐handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction

Good mid‐ to long‐term outcomes after meniscus bucket‐handle tear repair: A comparative analysis with and without anterior cruciate ligament reconstruction

Outside‐in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review

Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk

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