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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

Iftach Hetsroni, MD, Associate Prof.
ISRAEL

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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

Iftach Hetsroni, MD, Associate Prof., ISRAEL Yakir Carmeli, B.Ed., ISRAEL Shiri Bretter, M.ed, ISRAEL Gabriel Marino, MD, ISRAEL Ayelet Gonen-Vonkler, BA, ISRAEL Altaieb Agbaria, MD, ISRAEL Gideon Mann, MD, Prof., ISRAEL Nissim Ohana, MD, ISRAEL Moshe Ayalon, PhD, ISRAEL

Sports Medicine Injuries Service, Orthopedic Department, Meir General Hospital and Wingate College for Sports Sciences at Netanya , Kfar Saba and Netanya, ISRAEL

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Sports Medicine

Orthopaedic Sports Medicine Outcome Studies

Diagnosis / Condition

Tears

Treatment / Technique

Arthroscopy Sutures / Knots / Anchors

Anatomic Location

Knee

Anatomic Structure

Meniscus Medial Lateral

Summary: Gold-standard inside-out meniscus repair technique results in overall 10% failure for lateral and 15% for medial meniscus. This finding, in addition to regaining closely preinjury activity levels and landing kinematics in the majority of the patients support the concept "Save the meniscus".

Objective

To identify prognostic factors and improve decision-making for meniscus repair.

Methods

During a decade (2013-2022), a gold-standard inside-out meniscus suture technique with posteromedial and posterolateral protective windows was adopted for all meniscus tears involving the peripheral half-width and requiring 3 or more sutures (i.e. tear length > 10mm). Short tears requiring 1-2 sutures and repair of radial tears were excluded from this analysis. Data collected included patient and injury characteristics and intraoperative findings and procedures. Outcomes at minimum 2 year follow-up included activity level scores, IKDC-subjective, KOOS, and knee motion and laxity. In men with healthy contralateral limb, motion-analysis laboratory setup was used to measure hopping, drop jump kinematics, and knee muscle torque.

Results

Between 2013 and 2020, 81 menisci (59 medial and 22 lateral) in 79 patients (69 male and 12 female) underwent inside-out repair using 3-13 sutures, of which 34 had concomitant ACL reconstruction (ACLR). Seven patients (7 menisci repair, 2 lateral and 5 medial) were not available for follow-up examination. Delay injury-surgery ranged 2 weeks - 36 months. Age at operation ranged 14 - 55 years. Follow-up was 2 - 8 years. Ten patients (10 menisci) of which 8 were medial and 2 lateral underwent re-arthroscopy for resection of the repaired fragment (accounting for 15% of the medial and 10% of the lateral menisci repaired), and these cases did not differ in patient age or tear chronicity compared to patients who did not undergo repeated arthroscopy for meniscus resection. In cases of concomitant ACLR, failure of the meniscus repair was dramatically lower compared to isolated meniscus repair (3% vs. 27%, p=0.03). Smoking and articular cartilage lesions (Grade II-III) did not affect the repair. At follow-up, Tegner was median 6 (range 4-10) compared to 7 (range 5-10) at preinjury. IKDC-subjective was 92±7 and slightly lower in females than males (88±9 vs. 93±6, p=0.05). KOOS-ADL, KOOS-Pain, and KOOS-Sports were inversely associated with chronicity of the tear (r=-0.3, p=0.05) but not with number of sutures. Motion analysis showed closely symmetric landing kinematics and knee muscle torques.
*Comment: Minimum 2 year follow-up in this study will eventually evaluate over a hundred patients and menisci operated between 2013 and 2022.

Conclusions

Gold-standard inside-out meniscus repair technique results in overall 10% re-arthroscopy to meniscectomize unhealed repaired fragment for lateral and 15% for medial meniscus. Lower failure rates are observed in concomitant ACLR, while isolated long meniscus repair can result in over 20% failure rates, particularly for medial meniscus. These findings in addition to regaining closely preinjury activity levels, functional scores, and objective landing kinematics after this operation in the majority of the patients can justify the concept "Save the meniscus", and this principle is applicable also to populations over 40 and 50 years of age when handling long peripheral meniscus tears with repairable meniscus tissue of good quality, particularly with concomitant ACLR. Regression analyses or machine-learning algorithms at the completion of this study may enable elaborating patient-specific decision-making protocol which can be presented not only to recreational but also to professional athletes where "Time is money" concept should as well be accounted for.

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Strength-Based Rehabilitation On Clinical Outcomes In Patients Post-Meniscectomy: A Systematic Review and Meta-Analysis ePoster Presentation Prushoth Vivekanantha, MD, CANADA Yi (David) Diao, BMSc, CANADA Dan Cohen, MD, CANADA Ben Murphy, DPT, CANADA Darren L. de SA, MD MBA FRCSC, CANADA
Meniscal And Cartilage Changes On MRI 5-9 Years After Medial Opening-Wedge High Tibial Osteotomy ePoster Presentation Satomi Abe, MD, PhD, JAPAN Keisuke Matsukura, UNITED STATES
Etiology of Posterior Meniscus Root Tears: Medial vs. Lateral ePoster Presentation Katrin Karpinski, MD, GERMANY Philipp Forkel, MD, GERMANY Martin Häner, MD, GERMANY Wolf Petersen, MD, Prof, GERMANY
Concomitant Medial Meniscal Ramp Lesions and Lateral Meniscal Tears with Anterior Cruciate Ligament Injuries are Associated with Anterior Tibial Subluxation in Knee Extension ePoster Presentation Hibiki Kakiage, MD, JAPAN Kazuhisa Hatayama, MD, PhD, JAPAN Satoshi Nonaka, MD, JAPAN Masanori Terauchi, MD, JAPAN Atsufumi Oshima, MD, JAPAN HIrotaka Chikuda, MD, PhD, JAPAN
Clinical Outcomes Of Lateral Meniscus Posterior Root Repair In The Acl-Reconstructed Knees ePoster Presentation Lika Dzidzishvili, MD, PhD, SPAIN Irene Isabel López-Torres, MD, PhD, SPAIN David Sáez, MD, SPAIN Antonio Hernández Diez, MD, SPAIN Emilio Calvo, MD, PhD, MBA, SPAIN
Meniscal Repair Is A Solution In “Older” Patients: A Systematic Literature Review with Meta-Analysis ePoster Presentation Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR Chris Saunders, PhD MBChB BMedSci (Hons), UNITED KINGDOM Matthew Sedgwick, Ph.D., UNITED KINGDOM
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Postoperative Subjective Evaluation after Meniscectomy in Patients Older than 70 Years: A Local Retrospective Study ePoster Presentation Ignacio Fernández, Md, CHILE Francesca Castelletto, MD, CHILE Enrique Sebastián Rubio, Md, CHILE Rodrigo Humberto Garcia, MD, CHILE Roberto Cisternas, md, CHILE Ignacio Lopez, CHILE
Non-Extruded Grafts Result in Better Cartilage Quality after Lateral Meniscal Allograft Transplantation: Quantitative 3-T MRI T2 Mapping ePoster Presentation Seong-Il Bin, MD, PhD, KOREA, REPUBLIC OF Jong-Min Kim, MD, PhD, KOREA, REPUBLIC OF Bum-Sik Lee, MD, KOREA, REPUBLIC OF Hyo Yeol Lee, MD, PhD, KOREA, REPUBLIC OF Ju-Ho Song, MD, KOREA, REPUBLIC OF Ho Yeon Kim, MD, KOREA, REPUBLIC OF Jaejung Ryu, MD, KOREA, REPUBLIC OF
Polyurethane Meniscal Scaffold In Postmeniscectomy Syndrome Presented Good Clinical Results At Minimum 10-Years Of Follow-Up ePoster Presentation Maximiliano Ibañez, MD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Pablo E. Gelber, MD, PhD, SPAIN Simone Perelli, MD,PhD, SPAIN Daniel Pérez-Prieto, MD, SPAIN Àngel Masferrer-Pino, MD PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN
Popliteomeniscal Fascicles Tears with Lateral Meniscus Instability: Outcomes of Arthroscopic Surgical Technique at Mid-Term Follow-Up ePoster Presentation Simone Cerciello , DR, ITALY Gianluca Ciolli, MD, ITALY Fabrizio Mocini, MD, ITALY Dario Candura, ITALY Lorenzo Proietti, MD, ITALY Roberto Simonetta, ITALY Katia Corona, MD, ITALY Gianni Di Vico, MD, ITALY
Virtual Reality Simulation is Valuable for Arthroscopic Diagnosis and Meniscectomy: A Transfer Validity Study of 36 Residents ePoster Presentation Alexandre Tronchot, MD PhD, FRANCE Tiphaine Casy, PhD, FRANCE Nicolas Vallee, MD, FRANCE Harold Common, MD, FRANCE Hervé Thomazeau, PR, FRANCE Pierre Jannin, PhD, FRANCE Arnaud Huaulme, PhD, FRANCE
Accuracy of Magnetic Resonance Imaging for Detecting Meniscal Tears in Anterior Cruciate Ligament injuries. ePoster Presentation Artit Boonrod, MD, THAILAND Watcharapong Wongsawiang , MD, THAILAND Punthip Thammaroj , MD, THAILAND Sermsak Sumanont, THAILAND Punyawat Apiwatanakul, MD, THAILAND Arunnit Boonrod, MD, THAILAND
Predictors of The Ten-Year Patient-Reported Outcome Measures After Collagen Meniscus Implant (CMI) For Partial Meniscus Deficiency ePoster Presentation Alberto Grassi, PhD, ITALY Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Giacomo Dal Fabbro, ITALY Nicola Pizza, MD, ITALY Marianna Viotto, ITALY Luca Ambrosini, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Biological Augmentation May Play A Role In Obtaining Superior Clinical Outcomes In Meniscal Root Repair With Concomitant Anterior Cruciate Ligament Reconstruction ePoster Presentation Lika Dzidzishvili, MD, PhD, SPAIN Irene Isabel López-Torres, MD, PhD, SPAIN David Sáez, MD, SPAIN Antonio Hernández Diez, MD, SPAIN Emilio Calvo, MD, PhD, MBA, SPAIN

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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

Objective

Methods

Results

Conclusions

More 2023 ISAKOS Congress Content