1
|
Schweizer C, Hanreich C, Tscholl PM, Blatter S, Windhager R, Waldstein W. Meniscal Repair Outcome in 3829 Patients With a Minimum Follow-up From 2 Years Up to 5 Years: A Meta-analysis on the Overall Failure Rate and Factors Influencing Failure. Am J Sports Med 2024; 52:822-831. [PMID: 37022676 DOI: 10.1177/03635465231158385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND The importance of meniscal repair is widely accepted because of the association of loss of meniscal tissue with the development of early-onset knee arthritis. Many factors influencing the results of meniscal repair have been reported, but results remain controversial. PURPOSE This meta-analysis determines the pooled meniscal repair failure rate of studies with a minimum follow-up of 2 years up to 5 years, with a mean follow-up of 43 months. Moreover, selected failure-influencing factors are analyzed. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed and Scopus were searched for studies published between January 2000 and November 2021 reporting on meniscal repair outcome with a minimum follow-up of 24 months. The overall pooled failure rate and pooled failure rates for possible predictors were calculated. Random-effect models were used to pool failure rates, and effect estimates in the form of odds ratios with 95% CIs were established. RESULTS The initial literature search identified 6519 studies. A total of 51 studies met the inclusion criteria. In total, 3931 menisci were included with an overall failure rate of 14.8%. Subgroup analysis revealed a significantly lower failure rate for meniscal repair with concomitant anterior cruciate ligament (ACL) reconstruction compared with knees without any reported injury to the ACL (8.5% vs 14%; P = .043). The pooled failure rate for lateral meniscal repair was significantly lower than that for medial meniscal repair (6.1% vs 10.8%; P = .031). Pooled failure rates of all-inside and inside-out repair were not significantly different (11.9% vs 10.6%; P > .05). CONCLUSION This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. Meniscal repair remains a procedure with a high failure rate, especially within the first 2 postoperative years. This review and meta-analysis also identified clinically relevant factors associated with favorable outcomes such as concomitant ACL reconstruction or repair of the lateral meniscus. All-inside meniscal repair with the latest-generation devices yields failure rates of <10%. The failure mechanism and the time of failure is poorly documented; further studies are needed for a better understanding of the retear mechanism.
Collapse
Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Carola Hanreich
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philippe M Tscholl
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; ReFORM (Reseau Francophone Olympique de la Recherche en Médecine du Sport), IOC Research Centre for Prevention of Injury and Protection of Athlete Health
| | - Samuel Blatter
- Division of Orthopedics and Trauma Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Reinhard Windhager
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Wenzel Waldstein
- Department of Orthopaedic and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
2
|
Seil R, Pioger C, Siboni R, Amendola A, Mouton C. The anterior cruciate ligament injury severity scale (ACLISS) is an effective tool to document and categorize the magnitude of associated tissue damage in knees after primary ACL injury and reconstruction. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07311-4. [PMID: 36629888 DOI: 10.1007/s00167-023-07311-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023]
Abstract
PURPOSE To develop a tool allowing to classify the magnitude of structural tissue damage occurring in ACL injured knees. The proposed ACL Injury Severity Scale (ACLISS) would provide an easy description and categorization of the wide spectrum of injuries in patients undergoing primary ACL reconstruction, reaching from isolated ACL tears to ACL injuries with a complex association of combined structural damage. METHODS A stepwise approach was used to develop the ACLISS. The eligibility of each item was based on a literature search and a consensus between the authors after considering the diagnostic modalities and clinical importance of associated injuries to the menisci, subchondral bone, articular cartilage or collateral ligaments. Then, a retrospective analysis of associated injuries was performed in 100 patients who underwent a primary ACL reconstruction (ACLR) by a single surgeon. This was based on acute preoperative MRI (within 8 weeks after injury) as well as intraoperative arthroscopic findings. Depending on their prevalence, the number of selected items was reduced. Finally, an analysis of the overall scale distribution was performed to classify the patients according to different injury profiles. RESULTS A final scoring system of 12 points was developed (12 = highest severity). Six points were attributed to the medial and lateral tibiofemoral compartment respectively. The amount of associated injuries increased with ACLISS grading. The median scale value was 4.5 (lower quartile 3.0; higher quartile 7.0). Based on these quartiles, a score < 4 was considered to be an injury of mild severity (grade I), a score between ≥ 4 and ≤ 7 was defined as moderately severe (grade II) and a score > 7 displayed the most severe cases of ACL injuries (grade III). The knees were graded ACLISS I in 35%, ACLISS II in 49% and ACLISS III in 16% of patients. Overall, damage to the lateral tibiofemoral compartment was predominant (p < 0.01), but a proportional increase of tissue damage could be observed in the medial tibiofemoral compartment with the severity of ACLISS grading (p < 0.01). CONCLUSIONS The ACLISS allowed to easily and rapidly identify different injury severity profiles in patients who underwent primary ACLR. Injury severity was associated with an increased involvement of the medial tibiofemoral compartment. The ACLISS is convenient to use in daily clinical practice and represents a feasible grading and documentation tool for a reproducible comparison of clinical data in ACL injured patients. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg. .,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg. .,Orthopaedics, Sports Medicine and Digital Methods, Human Motion, Luxembourg, Luxembourg.
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Renaud Siboni
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Reims Teaching Hospital, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, 51092, Reims, France
| | | | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg
| |
Collapse
|
3
|
Cronström A, Tengman E, Häger CK. Return to Sports: A Risky Business? A Systematic Review with Meta-Analysis of Risk Factors for Graft Rupture Following ACL Reconstruction. Sports Med 2023; 53:91-110. [PMID: 36001289 PMCID: PMC9807539 DOI: 10.1007/s40279-022-01747-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified. OBJECTIVE The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR. METHODS A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model (effect measure: odds ratio [OR] with 95% confidence interval [CI]) were performed. The GRADE tool was used to assess evidence quality. RESULTS Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury (OR 3.91, 95% CI 1.69-9.04), increased tibial slope (degrees) (OR 2.21, 95% CI 1.26-3.86), lower psychological readiness to return to sport (RTS) (OR 2.18, 95% CI 1.32-3.61), early surgery (< 12 vs ≥ 12 months) (OR 1.87, 95% CI 1.58-2.22), RTS (pre-injury level) (OR 1.87, 95% CI 1.21-2.91) and family history of ACL injury (OR 1.76, 95% CI 1.34-2.31) were all associated with increased odds of graft rupture. Higher age (OR 0.47, 95% CI 0.39-0.59), female sex (OR 0.88, 95% CI 0.79-0.98), fewer self-reported knee symptoms pre-reconstruction (OR 0.81, 95% CI 0.69-0.95) and concomitant cartilage injuries (OR 0.70, 95% CI 0.62-0.79) instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture. CONCLUSION Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.
Collapse
Affiliation(s)
- Anna Cronström
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
4
|
de Geofroy B, Ghabi A, Jouvion AX, Limouzin J, de Landevoisin E. Return to duty in military personnel after ACL reconstruction: STG versus ST4 double adjustable-loop device. Orthop Traumatol Surg Res 2022; 108:103378. [PMID: 35907624 DOI: 10.1016/j.otsr.2022.103378] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION ACL ligamentoplasty with a quadruple semitindosus graft (ST4) and double adjustable endobutton (ST4E) allow the preservation of the gracilis, which should allow more rapid recovery of soldiers following ACL reconstruction. However, the literature does not report any superiority of this technique over others in terms of return to duty and sport. HYPOTHESIS The ST4E system allows a return to military duty at least equivalent to the semitendinosus and gracilis graft (STG) with screw fixation. MATERIAL AND METHOD A total of 133 soldiers operated on for ACL were included, 64 by the STG technique and 69 by ST4E, with an average follow-up of 4 years. The return to duty was assessed, with recovery of skills between the first and second postoperative year, as well as the medico-administrative status at the last follow-up, muscle recovery through isokinetic tests, the sports level before/after surgery, and the failure rate. RESULTS No difference was found in the return to the soldier's previous post between the STG (64%) and the ST4E (64%) (p=0.97). No difference was found for the medico-administrative status at the last follow-up, but the short-term muscle recovery, the return to sport, and the failure rate were in favor of the ST4E group. DISCUSSION The ST4E, adjustable double endobutton system, is comparable to the STG technique in terms of return to military duty. On the other hand, it offers faster muscle recovery with better sports results and fewer patients on prolonged sick leave (PSL). This study demonstrated that two-thirds of soldiers operated on for anterior cruciate ligamentoplasty regained their initial aptitude regardless of the technique used, which influences the army's operational capacity and on disability pension requests after service. LEVEL OF EVIDENCE III, single center retrospective comparative study.
Collapse
Affiliation(s)
- Bernard de Geofroy
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - Ammar Ghabi
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Arnaud-Xavier Jouvion
- Physical Medicine and Rehabilitation Department, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Jacques Limouzin
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France
| | - Emmanuel de Landevoisin
- Department of Orthopaedic surgery and traumatology, Military teaching hospital Laveran, 34, boulevard Laveran, 13013 Marseille, France; Department of Orthopaedic surgery and traumatology, Hôpital Privé Toulon Hyères-Saint-Roch, 99, avenue Saint-Roch, 83000 Toulon, France
| |
Collapse
|
5
|
Gracia G, Cavaignac M, Marot V, Mouarbes D, Laumonerie P, Cavaignac E. Epidemiology of Combined Injuries of the Secondary Stabilizers in ACL-Deficient Knees: Medial Meniscal Ramp Lesion, Lateral Meniscus Root Tear, and ALL Tear: A Prospective Case Series of 602 Patients With ACL Tears From the SANTI Study Group. Am J Sports Med 2022; 50:1843-1849. [PMID: 35416066 DOI: 10.1177/03635465221092767] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial meniscal ramp lesion (MMRL), lateral meniscus root tear (LMRT), and anterolateral ligament (ALL) tear are individual injuries that have been described in patients who have an anterior cruciate ligament (ACL) tear. However, the prevalence of these lesions and their combination has not been defined. PURPOSES To define the individual and combined prevalence of MMRL, LMRT, and ALL tears in a case series of patients undergoing ACL reconstruction and to identify the risk factors for combined injuries. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients aged >15 years undergoing primary ACL reconstruction between January 2019 and June 2021 were enrolled in the study. A preoperative ultrasound scan was performed to look for an ALL tear. The presence of MMRL and LMRT was determined during a standardized arthroscopy exploration. A multivariate logistic regression model was used to determine the individual effect of patient variables on the risk of associated single, dual, triad, or tetrad injuries (MMRL, LMRT, ALL, ACL), represented by an adjusted odds ratio. RESULTS The case series consisted of 602 patients who underwent primary ACL reconstruction. An isolated ACL injury was present in 147 patients (24%). A dual injury was detected in 34 patients (6%) who had ACL-MMRL, 16 (2.65%) who had ACL-LMRT, and 265 (44%) who had ACL-ALL. A triad injury was detected in 80 patients (13.28%) who had ACL-ALL-MMRL, 36 (6%) who had ACL-ALL-LMRT, and 3 (0.5%) who had ACL-MMRL-LMRT. A tetrad injury pattern was detected in 21 patients (3.5%). Multivariate analysis showed that the occurrence of tetrad injury was significantly lower in older patients (adjusted odds ratio by year, 0.93 [95% CI, 0.88-0.99]; P = .028). Identifying LMRT increased the likelihood of finding MMRL-ALL injuries by 2.11 times (95% CI, 1.09-3.12; P = .031). CONCLUSION Isolated ACL tear is less common than combined injuries, which are quite frequent. Younger age is a risk factor for combined injuries. The search for damaged secondary stabilizers of the knee must be meticulous and systematic, especially when 1 injured structure has already been diagnosed.
Collapse
Affiliation(s)
- Gauthier Gracia
- Department of Orthopaedic Surgery, Polyclinique Côte Basque Sud, Saint-Jean-de-Luz, France
| | | | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Dany Mouarbes
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | | | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| |
Collapse
|
6
|
Zhou W, Li M, Ma R, Yao G, Zhu C, Chen G. Diagnosis and Treatment of Schatzker Type II Tibial Plateau Fracture with An Isolated Bone Fragment: A Case Report and Literature Review. Orthop Surg 2022; 14:1011-1015. [PMID: 35343059 PMCID: PMC9087443 DOI: 10.1111/os.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND An isolated bone fragment from the posterolateral tibial plateau retrieved from the patellofemoral compartment is a rarely seen Schatzker type II tibial plateau fracture and is prone to misdiagnosis. To the best of our knowledge, this injury mechanism has not been previously described. CASE PRESENTATION A 63-year-old female sustained left knee pain and activity limitation after falling off an electric bicycle. Local hospital ignored the intra-articular bone fragment and failed to provide effective treatment. This case described an uncommon Schatzker type II tibial plateau fracture with an isolated bone fragment, its physical examination and radiological findings, the potential injury mechanism, and surgical protocol. CONCLUSIONS Combining the physical examination and radiological findings to evaluate the potential injury mechanism is important for developing an appropriate surgical protocol.
Collapse
Affiliation(s)
- Wei Zhou
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Meng Li
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Ruixiang Ma
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Gang Yao
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Chen Zhu
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Guang Chen
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| |
Collapse
|
7
|
Higher re-rupture rate in quadriceps tendon ACL reconstruction surgeries performed in Denmark: let's return to the mean. Knee Surg Sports Traumatol Arthrosc 2020; 28:3655-3656. [PMID: 32239273 DOI: 10.1007/s00167-020-05961-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/23/2020] [Indexed: 12/28/2022]
|
8
|
Baldairon F, Toanen C, Pujol N. Functional and anatomical outcomes of single-stage arthroscopic bimeniscal replacement. Orthop Traumatol Surg Res 2019; 105:1383-1387. [PMID: 31615750 DOI: 10.1016/j.otsr.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/26/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Meniscal replacement by an allograft or scaffold has been proven effective in patients with post-meniscectomy pain syndrome. Replacement of both menisci is a rarely performed procedure about which little is known. The primary objective of this work was to assess the functional outcomes of arthroscopic bimeniscal replacement. The secondary objectives were to evaluate meniscal healing and the time-course of cartilage lesions. HYPOTHESIS Single-stage arthroscopic bimeniscal replacement provides good functional and anatomical outcomes, similar to those seen after replacement of a single meniscus, in adults with post-meniscectomy pain syndrome. MATERIAL AND METHODS Five patients received regular follow-up after single-stage arthroscopic bimeniscal replacement by an allograft and/or substitute, with or without concomitant anterior cruciate ligament reconstruction. Median follow-up was 30 months (range, 24-68 months). Radiographs and magnetic resonance imaging scans of the knee obtained before surgery and at last follow-up were evaluated. The following parameters were recorded: KOOS and IKDC score, knee osteoarthritis, knee alignment, condition of the cartilage, healing of the meniscal replacement material, meniscal extrusion, and other complications. RESULTS Allografts were used to replace both menisci in 3 patients, whereas 2 patients received a lateral allograft and a medial scaffold. The median subjective IKDC score was 83.9 (range, 55.1-94.3) and the median objective IKDC score was B (range, A-C). The median global KOOS was 85.7 (range, 65.7-92.3). Extrusion occurred for one medial and two lateral menisci. CONCLUSION Bimeniscal replacement by an allograft and/or substitute provides good short-term functional and anatomical outcomes. Nevertheless, this procedure is warranted only in highly selected patients. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- Florent Baldairon
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - Cécile Toanen
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - Nicolas Pujol
- Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 78150 Le Chesnay, France.
| |
Collapse
|
9
|
Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:3441-3452. [PMID: 30719542 DOI: 10.1007/s00167-019-05389-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this review was to compare the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with either meniscal repair or meniscectomy for concomitant meniscal injury. The primary hypothesis was that short-term clinical outcomes (≤ 2-year follow-up) for ACLR concomitant with either meniscal repair or resection would be similar. The secondary hypothesis was that ACLR with meniscal repair would result in better longer term outcomes compared with meniscal resection. METHODS The authors searched two online databases (EMBASE and MEDLINE) from inception until March 2018 for the literature on ACLR and concurrent meniscal surgery. Two reviewers systematically screened studies in duplicate, independently, and based on a priori criteria. Quality assessment was also performed in duplicate. The Knee injury and Osteoarthritis Outcome Score (KOOS) sub-scale scores at 2 years post-operatively were combined in a meta-analysis of proportions using a random-effects model. RESULTS Of 2566 initial studies, 25 studies satisfied full-text inclusion criteria. Mean follow-up was 2.09 years, with a total sample of 37,087 subjects including controls. The meta-analysis demonstrated equivocal results at 2 years, except for KOOS symptom scores which favoured meniscal resection over repair. Mean KT-1000 side-to-side difference (SSD) scores were 1.51 ± 0.60 mm for meniscal repair, 1.96 ± 0.36 mm for meniscal resection, and 1.58 ± 0.20 for control patients (isolated ACLR). Medial meniscal repair showed decreased anterior knee joint laxity compared to medial meniscal resection (P < 0.001). Patients with meniscal repair had higher rates of re-operation (13.3% vs 0.8% for meniscal resection, P < 0.001). CONCLUSION Patients with ACLR combined with meniscal resection demonstrate better symptoms at 2-year follow-up compared to patients with ACLR combined with meniscal repair. ACLR combined with meniscal repair results in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term, but also higher re-operation rates. LEVEL OF EVIDENCE III.
Collapse
|
10
|
Ouanezar H, Blakeney WG, Latrobe C, Saithna A, Fernandes LR, Delaloye JR, Thaunat M, Sonnery-Cottet B. The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement. Knee Surg Sports Traumatol Arthrosc 2018; 26:3611-3619. [PMID: 29502169 DOI: 10.1007/s00167-018-4889-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/28/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. METHODS A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2 years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. RESULTS Two hundred patients (mean age 28.6 ± 10.2 years) with a mean follow-up of 45.5 ± 12.8 months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1 year was 0.6 ± 1.0 mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8 months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. CONCLUSION Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears using a suture placed in the popliteus tendon is a safe technique. It is associated with a very low failure rate with no specific complications. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Charles Latrobe
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Adnan Saithna
- Department of Orthopaedic Surgery, Southport and Ormskirk Hospital, Southport, UK
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Jean Romain Delaloye
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France.
| |
Collapse
|
11
|
Subacute Clinical Features After Arthroscopy Surgical Reconstruction of Complete Anterior Cruciate Ligament Rupture: A Case-Control Study. J Manipulative Physiol Ther 2018; 41:596-601. [PMID: 30269932 DOI: 10.1016/j.jmpt.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the clinical features in the subacute phase after surgical reconstruction of complete anterior cruciate ligament rupture (ACLR) with respect to healthy participants. METHODS A case-control observational study was performed. A total sample of 80 participants was recruited from an outpatient clinic and divided into case (n = 40 patients after ACLR reconstruction in subacute phase) and control (n = 40 healthy participants) groups. Outcomes, including pain intensity, range of motion (ROM), stability, and functionality were assessed by the visual analogue scale, universal goniometer, the Star Excursion Balance Test, and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. RESULTS There were no statistically significant differences (P > .05) for sex, side, age, and body mass index between patients with ACLR after reconstruction surgery and healthy participants. Statistically significant differences (P < .001) with a large effect size (Rosenthal r) from -0.86 to -0.93 were shown for ROM (median ± interquartile range [IQR], -70.00° ± 10.00°) and Star Excursion Balance Test (mean ± standard deviation, -38.31 cm ± 4.52 cm) reduction, as well as higher visual analogue scale (median ± IQR, 7.00 ± 1.00) and Western Ontario and McMaster Universities Osteoarthritis Index (median ± IQR, 68.77 ± 6.29) scores in favor of the ACLR reconstructed group, with respect to the healthy control group. CONCLUSIONS Measurable clinical differences of functionality, stability, and ROM should be considered during the evaluation of patients at a subacute period after complete ACLR reconstruction surgery with respect to healthy matched controls.
Collapse
|
12
|
Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res 2017; 103:S237-S244. [PMID: 28873348 DOI: 10.1016/j.otsr.2017.08.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
Meniscectomy remains one of the most frequent orthopedic procedures, despite meniscal sparing having been advocated for several decades now. Incidence is excessive in the light of scientifically robust studies demonstrating the interest of meniscal repair or of nonoperative treatment for traumatic tear and of nonoperative treatment for degenerative meniscal lesions. It is high time that the paradigm shifted, in favor of meniscal preservation. In traumatic tear, and most particularly longitudinal vertical tear in vascularized zones, repair shows a high success rates in terms of recovery time, functional outcome and cartilage protection. Leaving the meniscus alone may be an option in asymptomatic lesions of the lateral meniscus during anterior cruciate ligament (ACL) reconstruction. Posterior ramp lesions (in associated ACL tear), traumatic root tears and radial lesions are also excellent indications for repair, although it has to be borne in mind that the natural history of these lesions is not completely understood and nonoperative treatment also may be considered. Degenerative meniscal lesions are frequently revealed by MRI in middle-aged or elderly subjects. They are closely related to tissue aging and thus probably to osteoarthritic processes. Meniscectomy was long considered the treatment of choice. All but 1 of the 8 recent randomized studies reported non-superiority of arthroscopy over nonoperative treatment, which should thus be the first-line choice, with arthroscopic meniscectomy reserved for cases of failure, or earlier in case of "considerable" mechanical symptoms. Horizontal cleavage in young athletes is a particular case, requiring meniscal repair, to avoid a meniscectomy, which would inevitably be extensive in a young active patient. More than ever, the take-home message is: save the meniscus!
Collapse
Affiliation(s)
- P Beaufils
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - N Pujol
- Service d'orthopédie traumatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| |
Collapse
|