Summary

For difficult meniscus repairs, pulling a blood clot into the tear with a suture ensures that it stays in place during the repair. This is a reliable and successful technique for tears which may otherwise not heal due to chronicity, vascularity or complexity.

Abstract

Introduction

Repairing a torn meniscus is preferable to removing it. However, some tears may have a poor chance of healing due to chronicity, vascularity or complexity. In many of these cases augmentation of the repair with fibrin blood clot may enhance the healing capacity. Pulling the clot into the tear with a suture ensures that it stays in position while repair is undertaken. This technique has been studied in a consecutive series of patients. The aim of this paper is to evaluate the outcome of this technique and to assess survivorship of the repairs.

Methods

A consecutive series of 52 patients over a 4-year period undergoing suture repair of a meniscus tear with blood clot augmentation were collected from a prospectively collected database. These have been followed and have completed outcome scores and a questionnaire. Survivorship end point was defined as pain secondary to meniscal pathology, further arthroscopy for re-repair or resection and further knee surgery such as osteotomy or replacement. Clinical examination or MRI scanning was not undertaken as part of the review.

Results

The cohort comprised 32 males and 20 females with a mean age of 35 (14-70). There were 28 left and 24 right knees and the medial meniscus was repaired in 32 knees and the lateral in 20. Complete radial tears were the most common type repaired followed by longitudinal and transverse cleavage tears. Only 2% of tears were considered to be in the red-red zone while 82% were in the white-white zone. Follow-up ranged from 12 months to 7 years. Only 1 patient is known to have come to subsequent arthroscopic surgery to the repaired meniscus at another hospital. Lysholm scores improved from 53.97 (SD 18.14) to 92.08 (SD 8.97), Oxford Knee Scores improved from 29.84 (SD 9.65) to 45.79 (SD 2.66), KOOS pain scores improved from 61.49 (SD 22.76) to 93.54 (SD 8.06) and Tegner scores improved from 4.56 (SD 3.35) to 6.05 (SD 2.41).

Conclusions

Pulling a fibrin blood clot into a meniscus tear with a suture ensures that the clot remains in place while the meniscus is repaired. Patients have shown excellent outcomes at a mean follow up of 45 months with 98% survivorship at that time. This is a reliable technique for augmenting meniscus repairs especially for tears which would commonly otherwise not have been repaired.