Summary: For those meniscus tears which are considered to have a poorer chance of healing, fibrin clot augmentation of the repair, in selected cases, may result in a 90% rate of clinical healing.

Introduction

While meniscal repair is preferable to meniscectomy, some cases are at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure. We propose to determine which tear patterns are most suitable for FC augmentation.

Methods

A retrospective case series (Group 1) of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. A prospective series was commenced in mid-2023 (Group 2). Cases thought be at higher risk of failure included chronic, radial, complex, horizontal cleavage, retears after previous repair and tears not in the red – red zone. Patients were excluded if they had a concomitant anterior cruciate ligament reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score. Group 1 patients were all contacted at a mean of 46 months (IQR 22.5 22-87). Group 2 patients have been contacted at 12 months.

Results

Group 1 comprised 51 inside-out meniscal repairs using FC in 50 patients (62% male). The mean age was 34 years (range 14-70). The median time from injury to repair was 122 days (range 4-1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% included repair in the white-white zone. 16% of cases were revision meniscal repairs. FC was used in only 43% of isolated meniscal repairs during the study period at our institution. All patients were followed to a median of 46 months (range 22-87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months indicating a clinical failure rate of 10%. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p=0.4).
Group 2 comprised 42 patients (45% male) with radial 24%, complex 38% and revision 24%. At 12 months no patients have reported symptoms suggestive of recurrent tearing. This group will be followed out to five years.

Conclusions

FC augmented meniscal repair for tears considered to be more likely to fail resulted in a clinical failure rate of only 10% at minimum 2 years.
The study of Group 1 patients has been published:
Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases. Peter S.E. Davies, Michael Goldberg, Jon A. Anderson, John Dabis, Andrew Stillwell,
Timothy J. McMeniman, Peter T. Myers,
Journal of ISAKOS 9 (2024) 100316 https://doi.org/10.1016/j.jisako.2024.100316

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Safety and Efficacy of a Novel Polyglycolic Acid Meniscal Scaffold for Irreparable Meniscal Tear in Human Clinical Trial ePoster Presentation Shuhei Otsuki, MD, JAPAN
Relationship Between Patient-Reported Outcome Measures (Proms) And Mri Abnormalities In Early Knee Osteoarthritis ePoster Presentation Kentaro Fujita, MD, JAPAN Yasushi Takata, MD, PhD, JAPAN Tomoyuki Kanayama, MD, JAPAN Yoshihiro Ishida, MD, JAPAN Naoki Takemoto, MD, JAPAN Manase Nishimura, MD, JAPAN Takuya Sengoku, PT, PhD, JAPAN Yushin Mizuno, MSc, PT, JAPAN Junsuke Nakase, MD, PhD, JAPAN
The Adequate Volume Of Midbody During The Intraoperative Finding Is 11Mm For Reshaping Surgery Of Discoid Lateral Meniscus ePoster Presentation Yusuke Hashimoto, MD, PhD, JAPAN Yohei Nishida, MD, JAPAN Kazuya Nishino, MD, JAPAN Ken Iida, MD, JAPAN Shuko Tsumoto, MD, JAPAN
Description Of A Novel Surgical Technique For Repairing Complete Radial Tears Of The Lateral Meniscus And Results Of Our Series ePoster Presentation Juan Pablo Zicaro, MD, ARGENTINA Mariano Manuel Zapata, MD, ARGENTINA Mariano Agustin Revah, MD, ARGENTINA Matias Costa-Paz, MD, PhD, ARGENTINA Carlos H. Yacuzzi, MD, ARGENTINA Oscar Alejandro Zicaro, MD, ARGENTINA
Proof Of Concept Of A Novel Surgical Technique To Improve The Treatment Of Horizontal Cleavage Meniscus Tears: “The Quad Tendon Augmentation Technique”. ePoster Presentation Maximiliano Ibañez, MD, SPAIN Caroline Mouton, PhD, LUXEMBOURG Felix Hoffmann, MD, LUXEMBOURG Romain Seil, MD, Prof., LUXEMBOURG
Joint Line Obliquity Can Increase Meniscus Root Tension ePoster Presentation Shuntaro Nejima, MD, PhD, JAPAN Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM Andrew A. Amis, FREng, DSc, PhD, UNITED KINGDOM
Meniscoplasty And Centralization For Medial Meniscus Degenerative Tears With Extrusion: A Novel Technique And Initial Clinical Outcomes ePoster Presentation Benjamin Murray, DO, UNITED STATES S. Ali Ghasemi, MD, UNITED STATES James Raphael, MD, UNITED STATES Gene Shaffer, MD, UNITED STATES

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Fibrin Clot Augmentation of High-Risk Meniscal Repairs May Result in Clinical Healing in up to 90% of Cases

Fibrin Clot Augmentation of High-Risk Meniscal Repairs May Result in Clinical Healing in up to 90% of Cases

Introduction

Methods

Results

Conclusions

Knee Meniscus ePosters

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Fibrin Clot Augmentation of High-Risk Meniscal Repairs May Result in Clinical Healing in up to 90% of Cases

Fibrin Clot Augmentation of High-Risk Meniscal Repairs May Result in Clinical Healing in up to 90% of Cases

Introduction

Methods

Results

Conclusions