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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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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
Morphological Analysis of Discoid Lateral Meniscus on Magnetic Resonance Imaging Comparing Pre- and Postoperative Images ePoster Presentation Shunya Tsuji, MD, JAPAN Masakazu Ishikawa, MD, PhD, JAPAN Naofumi Hashiguchi, MD,MPH, JAPAN Goki Kamei, MD, PhD, JAPAN Atsuo Nakamae, MD, PhD, JAPAN Nobuo Adachi, MD, PhD, JAPAN
A New Arthroscopic Pull-In All-Suture Anchor Meniscus Root Tear Repair Shows Comparable Biomechanical Properties as Conventional Trans-Osseous Pull-Out and Anchor Repair ePoster Presentation Thorben Briese, MD, GERMANY Amaris Kieninger, MD, GERMANY Elmar Herbst, MD, PhD, GERMANY Johannes Glasbrenner, MD, GERMANY Christian Peez, MD, GERMANY Adrian Deichsel, MD, GERMANY Maurice Balke, MD, GERMANY Jens Wermers, MD, GERMANY Matthias Klimek, M. Sc., GERMANY Michael J. Raschke, MD, Prof., GERMANY Christoph Kittl, MD, MD(res), GERMANY
Associated Fracture of Spinal Tuberosity with Anterior Root Injury of Lateral Meniscus ePoster Presentation Mohamed Amine Gharbi , MD, TUNISIA Rami Triki, TUNISIA Mohamed Hedi Ezzine, MD, TUNISIA Houssem Eddine Chahed, MD, TUNISIA Anis Tebourbi, MD, TUNISIA Ramzi Bouzidi, PhD, TUNISIA Khelil Ezzaouia, PhD, TUNISIA Mouadh Nefiss, MD, TUNISIA
Predictors of Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction With Concurrent Treatment of Bucket-Handle Meniscus Tears ePoster Presentation Gregory Perraut, MD, UNITED STATES Rachel E Cherelstein, BS, UNITED STATES Alexandra Galel, MD, UNITED STATES Laura Keeling, MD, UNITED STATES Christopher M Kuenze, PhD, UNITED STATES Andrew Curley, MD, UNITED STATES David X. Wang, MD, UNITED STATES Kaitlin A Malekzadeh, , UNITED STATES Edward S. Chang, MD, UNITED STATES
Cross-Sectional Effects of Isolated Meniscal Tears on In Vivo Biomechanics of the Knee: A Systematic Review Of Motion Analysis Studies ePoster Presentation Enzo Salviato Mameri, MD, MSc, BRAZIL Garrett Jackson, MD, UNITED STATES Harkirat Jawanda, BS, UNITED STATES Jonathan A Gustafson, PhD, UNITED STATES Leonardo Metsavaht, MD PhD, BRAZIL Jorge Chahla, MD, PhD, UNITED STATES
Biomechanics Comparison Between Transtibial Pullout, Suture Anchor And All-Suture Anchor Technique For Posterior Medial Meniscal Repair ePoster Presentation Nadhaporn Saengpetch, MD, THAILAND Napat Prasitmeeboon, MD, THAILAND Tanapol Janyawongchot, MD, THAILAND Sorawut Thamyongkit , MD, THAILAND
Lateral Meniscal Posterior Root Repair with Concurrent ACL Reconstruction: Patient-Report Outcomes and Risk Factors for Failure ePoster Presentation Evan W. James, MD, UNITED STATES Per-Henrik Randsborg, MD, PhD, NORWAY Joseph T. Nguyen, MPH, UNITED STATES Anil S. Ranawat, MD, UNITED STATES Answorth A. Allen, MD, UNITED STATES Scott A. Rodeo, MD, UNITED STATES Robert G. Marx, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Do All Meniscal Ramp Lesions Require Repair? A Prospective Study Of Ramp Lesions with Concomitant ACL Injury? ePoster Presentation Silvampatti Ramasamy Sundararajan, MS(Orth), INDIA Meet Mehta, MD orthopaedics, INDIA Terence Dsouza, MS, DNB, FNB, INDIA Ramakanth Rajagopalakrishnan, D.ortho, DNB(ortho).D.SICOT, INDIA S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, INDIA
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
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
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
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

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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

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Conclusions

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