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Houston A, McDonald C, Eck A, Kotzur T, Momtaz D, Heath D, Hogue GD, DeBerardino T. Identifying Risk Zones for Neurovascular Injury in Pediatric All-Inside Arthroscopic Lateral Meniscal Repair. Orthop J Sports Med 2025; 13:23259671241304817. [PMID: 40052185 PMCID: PMC11881937 DOI: 10.1177/23259671241304817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/24/2024] [Indexed: 03/09/2025] Open
Abstract
Background All-inside techniques for meniscal repairs offer comparable outcomes and healing rates with reduced operative time and fewer incisions; however, iatrogenic neurovascular injuries during arthroscopic meniscal repairs are a significant concern. Purpose To identify the zones of risk and incidence of injury concerning the common peroneal nerve (CPN) and popliteal artery in relation to the popliteal tendon (PT) from the anterolateral (AL) and anteromedial (AM) portals during a simulated all-inside technique in the pediatric population. Study Design Descriptive laboratory study. Methods Using axial knee magnetic resonance imaging scans of 124 patients, the all-inside technique was simulated by drawing direct lines from the AM and AL portals to the medial and lateral borders of the PT. If the line came into contact with the CPN, a risk of projected iatrogenic CPN injury was found. Measurements were then recorded to assess and define "risk zones." A similar simulation was performed in relation to the popliteal artery to assess distance to projected iatrogenic injury. Results The risk of CPN injury was significantly higher when using the AL portal (45%) compared with the AM portal (19%) when simulating repair at the lateral edge of the PT (P < .001). Similarly, there was a significantly higher risk of peroneal nerve injury when using the AM portal (29%) compared with the AL portal (8.9%) when simulating repair from the medial edge of the PT (P < .001). The risk of injury when repairing the body of the lateral meniscus through the AM portal extended 2.20 ± 0.98 mm laterally from the lateral edge of the PT and 3.14 ± 1.92 mm medially from the medial edge of the PT. The risk of injury when repairing the body of the lateral meniscus through the AL portal extended 2.58 ± 1.31 mm lateral to the lateral edge of the PT and 2.02 ± 1.61 mm medial to the medial edge of the PT. Conclusion The authors found that the AM portal was safer for repairing the body of the lateral meniscus while simulating repair at the lateral edge of the PT, while the AL portal was safer for repairing the lateral meniscus while simulating repair from the medial edge of the PT. Clinical Relevance By understanding these risk profiles, surgeons can adopt safer approaches for meniscal repairs in pediatric patients, thereby minimizing the likelihood of injuring sensitive neurovascular structures.
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Affiliation(s)
- Annat Houston
- Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Casey McDonald
- Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Andrew Eck
- Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Travis Kotzur
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David Momtaz
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David Heath
- Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Grant D. Hogue
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Thomas DeBerardino
- Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Iguchi M, Takahashi T, Handa M, Takeshita K. All-Inside Arthroscopic Tie-Grip Suture Repair for Radial Tear in the Midbody of Lateral Meniscus Using an All-Inside Device and Slotted Cannula. Arthrosc Tech 2024; 13:103139. [PMID: 39780872 PMCID: PMC11704906 DOI: 10.1016/j.eats.2024.103139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/24/2024] [Indexed: 01/11/2025] Open
Abstract
Inside-out repair of meniscal tears is the gold standard surgical approach; however, its use is limited by the need for a posterior incision and neurovascular risk. In this Technical Report, we present details of the all-inside arthroscopic tie-grip approach for repairing a radial tear of the midbody of the lateral meniscus using an all-inside device (TRUESPAN) and a slotted cannula. In contrast to the inside-out approach, this technique helps reduce surgical invasiveness and provides stable fixation as the vertical mattress sutures bundle the circumferential fibers and act as rip stops for the horizontal sutures. However, the operating surgeon must understand proper insertion techniques to successfully use the devices required for this procedure.
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Affiliation(s)
- Masaki Iguchi
- Department of Orthopedic Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Tsuneari Takahashi
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Mikiko Handa
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Katsushi Takeshita
- Department of Orthopaedics, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Oosten JD, DiBartola AC, Wright JC, Cavendish PA, Milliron EM, Magnussen RA, Duerr RA, Kaeding CC, Flanigan DC. More Is Not Merrier: Increasing Numbers of All-Inside Implants Do Not Correlate with Higher Odds of Revision Surgery. J Knee Surg 2024; 37:361-367. [PMID: 37336501 DOI: 10.1055/a-2112-8158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The purpose of this study was to evaluate the relationship between the number of all-inside meniscal repair implants placed and the risk of repair failure. We hypothesized that the use of higher numbers of all-inside meniscus repair implants would be associated with increased failure risk. A retrospective chart review identified 351 patients who underwent all-inside meniscus repair between 2006 and 2013 by a sports medicine fellowship-trained orthopaedic surgeon at a single institution. Patient demographics (age, body mass index [BMI], sex) and surgical data (number of implants used, concomitant anterior cruciate ligament reconstruction [cACLR], and tear type/size/location) were recorded. Patients who received repairs in both menisci or who had follow-up < 1-year postoperatively were excluded. Repair failure was identified through chart review or patient interviews defined as a revision surgery on the index knee such as partial meniscectomy, total knee arthroplasty, meniscus transplant, or repeat repair. Logistic regression modeling was utilized to evaluate the relationship between the number of implants used and repair failure. A total of 227 all-inside meniscus repairs were included with a mean follow-up of 5.0 ± 3.0 years following surgery. Repair failure was noted in 68 knees (30.3%)-in 28.1% of knees with fewer than four implants and in 35.8% of knees with four or more implants (p = 0.31). No significant increase in failure was observed with increasing number of all-inside medial (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.79-1.7; p = 0.46) or lateral (OR: 0.86; 95% CI: 0.47-1.57; p = 0.63) implants after controlling for patient age, BMI, cACLR, tear type, or size. Tears of the lateral meniscus located in the red-white and white-white zones had lower odds of failure (OR: 0.14; 95% CI: 0.02-0.88; p = 0.036) than tears within the red-red zone, and patients with cACLR had lower odds of repair failure (OR: 0.40; 95% CI: 0.18-0.86, p = 0.024) than those without. The number of all-inside implants placed during meniscus tear repair did not affect the likelihood of repair failure leading to reoperation after controlling for BMI, age, tear type, size, location, and cACLR. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- James D Oosten
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jonathan C Wright
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Parker A Cavendish
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Eric M Milliron
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Duerr
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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Koiwa K, Oshiba H, Yamazaki H. Common Peroneal Nerve Injury Due to an All-Inside Repair of the Posterior Horn of Lateral Meniscus: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00026. [PMID: 36735799 DOI: 10.2106/jbjs.cc.22.00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/02/2022] [Indexed: 02/05/2023]
Abstract
CASE An 18-year-old man sustained a peroneal nerve (PN) injury during an all-inside repair of the posterior horn of the lateral meniscus from the medial portal. Although he could dorsiflex his ankle actively after emergence from general anesthesia, he had a foot drop on the day after surgery. Exploration of the PN at 5 months postoperatively revealed that the nerve was entrapped by the suture. Fifteen months after a nerve repair using a sural nerve graft, he recovered from the foot drop. CONCLUSION This case report highlights the risk of PN injury during an all-inside repair of the posterior horn of the lateral meniscus.
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Affiliation(s)
- Kai Koiwa
- Department of Orthopedics, Aizawa Hospital, Matsumoto, Japan
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Abstract
Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is of significant importance. This review will discuss the potential vascular complications for both knee and shoulder sports surgery, review the relevant anatomy, and discuss the treatment and expected outcome of each.
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Deep flexion helps to avoid popliteal artery injury during all-inside lateral meniscal repair: A cadaveric study. Knee 2021; 33:159-168. [PMID: 34624750 DOI: 10.1016/j.knee.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 07/09/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopic meniscus repair rarely leads to major complications such as popliteal artery injury. The distance between the suturing device and the popliteal artery, and the risk of popliteal artery injury at different knee flexion angles during all-inside lateral meniscal repair remain unclear. METHODS All-inside devices were inserted into 10 human cadaveric knees at the posterior horn of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120° knee flexion; posterior segment of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120°; and anteromedial portal at 90°. Distance and positional relationship between the device and popliteal artery were measured radiographically. RESULTS In posterior horn repair through the anterolateral portal, the median distance increased from 5.7 mm at 60° to 9.1 mm at 90° (P = 0.63) and 18.0 mm at 120° (P = 0.02). The device pushed the wire at 60° in three cases, 90° in one case, and 120° in 0 cases. In posterior segment repair through the anterolateral portal, the median distance was 12.6 mm at 60°, 10.4 mm at 90°, and 18.3 mm at 120° (P = 0.08). The median distance at 90° was 18.1 mm through the anteromedial portal, the same as that at 120° through the anterolateral portal (P = 0.43), but greater than that at 90° through the anterolateral portal (P = 0.04). The wire was not pushed in any case. CONCLUSION Although all-inside repair of the posterior part of the lateral meniscus through the anterolateral portal is risky, deeper knee flexion reduces the risk of popliteal artery injury.
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Oehler N, Foerg A, Haenle M, Blanke F, Vogt S. Assessment of popliteal neurovascular safety during all-inside suturing of the posterior horn of the lateral meniscus using Upright MRIs of the knee joint. Knee 2021; 33:234-242. [PMID: 34717095 DOI: 10.1016/j.knee.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/21/2021] [Accepted: 10/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND To examine the risk of injury to the popliteal neurovascular bundle (pNVB) during all-inside repair of the posterior horn of the lateral meniscus (PHLM) using Upright-MRIs. METHODS Upright-MRIs of 61 knees in extension (ext) and 90°-flexion (flex) were included. Distance D from the PHLM to the pNVB was compared between extended and 90°-flexed position, subgroups with/without joint-effusion and evaluated according to demographics. Portal safety was assessed simulating suturing of the PHLM via four arthroscopy portals. Distance d (shortest space from the simulated suturing-device trajectory lines to the pNVB) was compared among portals in increasing distances from the posterior cruciate ligament (PCL). RESULTS D is longer in flex (17.3 ± 6.0 mm) than in ext (11.3 ± 4.2 mm, p < 0.0001). MRIs with joint-effusion displayed longer values of D than scans without joint-effusion (flex: 20.4 ± 7.1 mm vs. 16.1 ± 5.2 mm, p = 0.012). Shorter distances are associated with female gender, lower body weight and lower BMI. At 0 mm from the PCL, the 1 cm-lateral portal was the safest (p < 0.0001) whereas at 3 mm/6mm/9mm/12 mm the 1 cm-medial portal showed the longest d values (p < 0.0001 each). CONCLUSION All-inside suturing of the PHLM is safer in 90°-flexion, in presence of intraarticular fluid and in male patients with increasing weight/BMI. Sutures of the PHLM at 0 mm from the PCL are safer from a 1 cm-lateral portal whereas for tears located ≥ 3 mm from the PCL a 1 cm-medial portal involves a lower neurovascular risk. Upright-MRI proves excellent for preoperative planning to minimize neurovascular risks.
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Affiliation(s)
- Nicola Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany.
| | - Andreas Foerg
- Institute for Upright MRI Munich, Aschheim/Munich, Germany.
| | - Maximilian Haenle
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany; Clinic and Policlinic for Orthopedic Surgery, University Rostock, Rostock, Germany.
| | - Fabian Blanke
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany; Clinic and Policlinic for Orthopedic Surgery, University Rostock, Rostock, Germany; Department for Orthopedic Surgery, Schoen Klinik Munich Harlaching, Munich, Germany.
| | - Stephan Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany; Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany.
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Chuaychoosakoon C, Wuttimanop W, Tangjatsakow P, Charoenrattanawat S, Parinyakhup W, Boonriong T, Chernchujit B. The Danger Zone for Iatrogenic Neurovascular Injury in All-Inside Lateral Meniscal Repair in Relation to the Popliteal Tendon: An MRI Study. Orthop J Sports Med 2021; 9:23259671211038397. [PMID: 34631905 PMCID: PMC8493316 DOI: 10.1177/23259671211038397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Lateral meniscal repair can endanger the nearby neurovascular structure (peroneal nerve or popliteal artery). To our knowledge, there have been no studies to evaluate the danger zone of all-inside meniscal repair through the anteromedial (AM) and anterolateral (AL) portals in relation to the medial and lateral edges of the popliteal tendon (PT). Purpose: To establish the risk of neurovascular injury and the danger zone in repairing the lateral meniscus in relation to the medial and lateral edges of the PT. Study Design: Descriptive laboratory study. Methods: Using axial magnetic resonance imaging (MRI) studies at the level of the lateral meniscus, lines were drawn to simulate a straight, all-inside meniscal repair device, drawn from the AM and AL portals to both the medial and lateral edges of the PT. In cases in which the line passed through the neurovascular structure, a risk of iatrogenic neurovascular injury was deemed, and measurements were made to determine the danger zones of neurovascular injury in relation to the medial or lateral edges of the PT. Results: Axial MRI images of 240 adult patients were reviewed retrospectively. Repairing the body of the lateral meniscus through the AM portal had a greater risk of neurovascular injury than repairs made through the AL portal in relation to the medial edge of the PT (P = .006). The danger zone in repairing the lateral meniscus through the AM portal extended 1.82 ± 1.68 mm laterally from the lateral edge of the PT and 3.13 ± 2.45 mm medially from the medial edge of the PT. Through the AL portal, the danger zone extended 2.81 ± 1.94 mm laterally from the lateral edge of the PT and 1.39 ± 1.53 mm medially from the medial edge of the PT. Conclusion: Repairing the lateral meniscus through either the AM or the AL portals in relation to the PT can endanger the peroneal nerve or popliteal artery. Clinical Relevance: The surgeon can minimize the risk of iatrogenic neurovascular injury in lateral meniscal repair by avoiding using the all-inside meniscal device in the danger zone area as described in this study.
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Affiliation(s)
- Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Watit Wuttimanop
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Preyanun Tangjatsakow
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Wachiraphan Parinyakhup
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tanarat Boonriong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Bancha Chernchujit
- Department of Orthopedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Posterolateral approach for all-inside arthroscopic lateral meniscus repair in athletes: technique and outcomes. Arch Orthop Trauma Surg 2021; 141:1101-1108. [PMID: 32507947 DOI: 10.1007/s00402-020-03504-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/31/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The past 2 decades have been marked by substantial progress in our knowledge of meniscus anatomy, function, and biomechanics, and also by the shifting of the surgical treatment of meniscal lesions from traditional meniscectomy towards arthroscopic repair to get away from the early osteoarthritis associated with meniscectomy. Posterior horn injuries of the lateral meniscus (LM) have been less studied due to their lower incidence and also due to the historical technical complexity of performing a repair in the posterolateral compartment. MATERIALS AND METHODS A retrospective analysis of prospectively collected data was performed of all athletic patients who had a peripheral longitudinal tear of the lateral meniscal posterior horn and who underwent at least one repair procedure with a posterolateral approach between 2014 and 2018. The type of injury, extent of lateral meniscal tear, and characteristics of sutures placed were assessed. Clinical assessment included objective and subjective IKDC ratings. The Tegner activity level score was determined before the injury and at the last follow-up visit. Failure was defined as a need for revision surgery. All complications were documented. RESULTS The study population comprised 24 athletes with a mean follow-up of 25.2 ± 10 months. The Tegner activity level was exactly the same before the injury as after the surgery. The mean IKDC score significantly increased from 41.8 (12.2) before the surgery to 94.5 (9.1) after. There were four reoperations for failure (16.6%) that required a new suture repair. None of these revised repairs sustained a new failure as of the last follow-up. CONCLUSION Despite the long learning curve, the posterolateral approach is a safe and effective technique for longitudinal tears of the posterior horn of the LM. The results of all-inside suture repair through a posterolateral portal are comparable to other techniques.
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Takahashi T, Kimura M, Takeshita K. All-Inside Arthroscopic Meniscal Stacked Suture Repair for Hypermobile Lateral Meniscus With FASTFIX 360. Arthrosc Tech 2021; 10:e1757-e1761. [PMID: 34336573 PMCID: PMC8322567 DOI: 10.1016/j.eats.2021.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/16/2021] [Indexed: 02/03/2023] Open
Abstract
Even though inside-out repair of meniscal tears is still the gold standard, the need for a posterior incision is a certain disadvantage of this approach. However, all-inside arthroscopic meniscal stacked suture repair can be performed for hypermobile lateral meniscus using all-inside devices and slotted canula. This technique is able not only to reduce surgical invasion but also preserve meniscal mobility, since sutures are placed on the peripheral area of the lateral meniscus. To successfully use the devices required for this procedure, surgeons must understand proper insertion techniques. The purpose of this Technical Note is to demonstrate this technique using FASTFIX 360.
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Affiliation(s)
- Tsuneari Takahashi
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke,Address correspondence to Tsuneari Takahashi, M.D., Ph.D., Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan.
| | - Masashi Kimura
- Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke
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Gilat R, Agar G, Shohat N, Dahan M, Beer Y, Lindner D. Avoiding Injury to the Popliteal Neurovascular Bundle in All-Inside Suturing of the Posterior Horn of the Lateral Meniscus: A Magnetic Resonance Imaging Assessment of Portal Selection and Safety. Arthroscopy 2020; 36:492-498. [PMID: 31901385 DOI: 10.1016/j.arthro.2019.08.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE We assessed the risk of injury to the popliteal neurovascular bundle (PNVB) while suturing the posterior horn of the lateral meniscus (PHLM). METHODS We simulated all-inside suturing of the PHLM using magnetic resonance imaging of 60 knees. Lines were drawn from the medial and the lateral edges of the patellar tendon to the PHLM at increasing distances from the posterior cruciate ligament (PCL) to simulate suturing device trajectory. Distance from each line to the PNVB was measured (d). A similar analysis was performed using lines drawn from 1 cm medial and 1 cm lateral to the patellar tendon. We compared the average "d" at increasing distances from the PCL, between the different simulated portal entry points. We have also analyzed the association between different demographic characteristics and the shortest distance from the PVNB to the PHLM. RESULTS Of 1200 measurements performed, the simulated suturing trajectory transected the PNVB 343 times (28.6%). At 0 mm from the PCL, the safest portal was the 1-cm lateral portal (P < .001), with an average "d" of 2.7 mm. At 3 mm, 6 mm, 9 mm, and 12 mm from the PCL, the safest portal was the 1-cm medial portal (P < .001), with average "d" of 3.8 mm, 6.9 mm, 10.1 mm, and 13.5 mm, respectively. Average distance between the PHLM and the PNVB was 7.8 mm. Shorter distance between the PHLM and the PNVB was associated with younger age and female sex (P = .014 and .001, respectively). CONCLUSIONS All-inside suturing of the PHLM at 0 mm from the PCL is safer with a more lateral portal. Beyond 3 mm from the PCL, a more medial portal carries a lower risk to the PNVB. Young and female patients have a shorter distance between the PHLM and the PNVB, suggesting a greater risk for injury to the PNVB. Careful preoperative magnetic resonance imaging assessment may assist in safer portal selection when planning repair of the PHLM. CLINICAL RELEVANCE This study describes a magnetic resonance imaging-based risk assessment for injury of the PVNB while suturing the PHLM. It allows the orthopaedic surgeon a better understanding of the anatomic relationship between the popliteal neurovascular bundle and the lateral meniscus and can assist in portal selection and safety.
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Affiliation(s)
- Ron Gilat
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Gabriel Agar
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Noam Shohat
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Moshe Dahan
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Dror Lindner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel; Tel Aviv University, Tel Aviv, Israel
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Miller MD. Editorial Commentary: Caveat Medicus-Beware of Meniscal Repair. Arthroscopy 2020; 36:499-500. [PMID: 32014179 DOI: 10.1016/j.arthro.2019.11.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 02/02/2023]
Abstract
Perform meniscal repair with care and beware! Because of the well-known adverse consequences of meniscectomy, especially in the lateral compartment, meniscal repair should be considered for every meniscal tear even if it requires pushing the envelope. Nevertheless, the surgeon must be keenly aware of neuromuscular risks associated with this technique. For the posterior horn of the lateral meniscus, extreme caution must be exercised, particularly in younger and presumably smaller female patients. When a surgeon is performing all-inside repair of the posterior horn of the lateral meniscus, a medial portal 1 cm medial to the patellar tendon is recommended for placement of sutures. In addition, he or she should limit the depth of penetration of all-inside needles and exercise extreme vigilance during and after surgery (checking for potential neurovascular injury in the recovery room).
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Wang Z, Xiong Y, Tang X, Li Q, Zhang Z, Li J, Chen G. An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair. BMC Musculoskelet Disord 2019; 20:614. [PMID: 31870350 PMCID: PMC6929296 DOI: 10.1186/s12891-019-2984-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND At present, most repair techniques for meniscal tears fix the meniscus directly over the capsule. This changes the normal anatomy and biomechanics and limits the activity of the meniscus during motion. We introduce an arthroscopic repair technique by suturing the true meniscus tissue without the capsule and subcutaneous tissue. METHODS After confirmation of a tear, a custom-designed meniscal repair needle first penetrates percutaneously, crossing the capsular portion and the torn meniscus, and exits from the femoral surface of one side of the torn meniscus. Then a No. 2 PDS suture is passed through the needle and retrieved through the arthroscopy portal. Next, the needle is withdrawn to the synovial margin of the meniscus and is reinserted, exiting the femoral surface of the other side of the torn meniscus. The suture is pulled out through the same portal with a grasper. Finally, arthroscopic knotting is performed. RESULTS We had 149 cases of meniscal tears repaired with this outside-in transfer all-inside technique since July 2016. CONCLUSIONS It is a simple, minimally invasive, and economical procedure that is appropriate for most parts of the meniscus except the posterior horn of the lateral meniscus, and it can be used to fix torn meniscus tissue firmly while also preserving the inherent activity of the meniscus.
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Affiliation(s)
- Zhiqiang Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.,Department of Orthopaedic Surgery, Suining Central Hospital, No. 127, West Desheng Rd., Chuanshan District, Suining, Sichuan, 629000, China
| | - Yan Xiong
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Xin Tang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Qi Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Zhong Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Jian Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
| | - Gang Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.
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Massey P, Parker D, Feibel B, Ogden A, Robinson J, Barton RS. Proximity of the Neurovascular Bundle During Posterior-Lateral Meniscal Repair: A Comparison of the Transpatellar, Anteromedial, and Anterolateral Portals. Arthroscopy 2019; 35:1557-1564. [PMID: 31000388 DOI: 10.1016/j.arthro.2018.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the neurovascular proximity of the transpatellar portal with that of the medial and lateral portals and to determine the safe penetration depth for an all-inside device for use on the posterior horn lateral meniscus. METHODS Dissection of the popliteal fossa was performed in 10 cadaveric knees to identify all structures. Arthroscopy was performed using penetration depths of 10, 12, 14, and 16 mm with the all-inside system through the anteromedial, anterolateral, and transpatellar portals. Penetrations were made 5 and 10 mm lateral to the posterior horn root at the meniscocapsular junction. Needle-tip distances were measured from the popliteal artery and vein, tibial nerve, and common peroneal nerve. RESULTS Among 240 trials, the average distance to the popliteal neurovascular bundle using the medial, transpatellar, and lateral approaches was 6.9 mm, 6.5 mm, and 3.1 mm, respectively. The transpatellar-portal needle had a larger distance from the neurovascular bundle than the lateral portal (P = .001), with no statistical difference compared with the medial portal (P = .58). Compared with the position at a 10-mm distance from the root, the position at a 5-mm distance from the root was closer to the neurovascular bundle in all approaches (P = .001). The transpatellar approach set to 14 mm had a 5% rate of capsular underpenetration and 10% rate of gastrocnemius penetration. The transpatellar and medial portals had no neurovascular penetrations, whereas the lateral approach had a 14% rate of penetration (P < .05). CONCLUSIONS The transpatellar portal and anteromedial portal are in less proximity to the neurovascular bundle compared with the anterolateral portal for all-inside meniscal repair of the posterior horn lateral meniscus. Low rates of neurovascular penetration, gastrocnemius muscle penetration, and capsular underpenetration occurred with a depth setting of 14 mm. CLINICAL RELEVANCE This study shows the utility of medial and transpatellar portals when using all-inside devices to repair posterior horn lateral meniscal tears and neurovascular proximity based on penetration depth.
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Affiliation(s)
- Patrick Massey
- Department of Orthopaedics, Louisiana State University Health - Shreveport, U.S.A
| | - David Parker
- Department of Orthopaedics, Louisiana State University Health - Shreveport, U.S.A
| | - Benjamin Feibel
- Department of Orthopaedics, Louisiana State University Health - Shreveport, U.S.A.
| | - Alan Ogden
- Department of Orthopaedics, Louisiana State University Health - Shreveport, U.S.A
| | - James Robinson
- Department of Orthopaedics, Louisiana State University Health - Shreveport, U.S.A
| | - Richard S Barton
- Department of Orthopaedics, Louisiana State University Health - Shreveport, U.S.A
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Treatments of Meniscus Lesions of the Knee: Current Concepts and Future Perspectives. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2017. [DOI: 10.1007/s40883-017-0025-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Uchida R, Mae T, Hiramatsu K, Iuchi R, Kinugasa K, Shino K, Yoshikawa H, Nakata K. Effects of suture site or penetration depth on anchor location in all-inside meniscal repair. Knee 2016; 23:1024-1028. [PMID: 27802925 DOI: 10.1016/j.knee.2016.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/06/2016] [Accepted: 06/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND To evaluate the effects of suture site or penetration depth on anchor location in all-inside meniscal repair. METHODS Eight fresh-frozen cadaveric knees were evaluated after meniscal repair using eight FasT-Fix360 (FF360) devices (Smith & Nephew Endoscopy, Andover, MA) (16 anchors) for each knee. The penetration depth was 14mm, the distance same from the periphery to insertion point, in four knees (Group A) and that in the remaining four knees (Group B) was 18mm. The anchor location in two groups was evaluated after attentive dissection. RESULTS Of 32 anchors for the medial meniscus, 94% were on the capsule, including the superficial medial collateral ligament (sMCL) in both groups. For the lateral meniscus, 47% anchors in Group A and 44% anchors in Group B were on the capsule. Total three anchors were over the lateral collateral ligament (LCL), whereas 15 anchors were behind the popliteus tendon (POP). Although all three anchors settled in the subcutaneous fat were in Group B, no significant difference was observed in anchor location between two groups. CONCLUSIONS Secure fixation to thin membranous tissue can be achieved for the medial meniscal repair using FF360, while some were located in/on bunchy LCL or POP in lateral meniscal repair. Only anchors with additional four-millimeter penetration depth were in the subcutaneous fat, although there was no effect of the penetration depth to anchor location. Clinically, for lateral meniscal repair, penetrating toward POP/LCL should be avoided and four-millimeter deeper penetration depth might be a risk for the subcutaneous irritation.
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Affiliation(s)
- Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Seifu Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kunihiko Hiramatsu
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryo Iuchi
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Hu Y, Xu X, Pan X, Yu H, Zhang Y, Wen H. Combined outside-in and FasT-Fix sutures for the treatment of serious discoid meniscal tears: A midterm follow-up study. Knee 2016; 23:1143-1147. [PMID: 27651201 DOI: 10.1016/j.knee.2015.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/15/2015] [Accepted: 10/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The treatment of discoid meniscus is debatable. This study aimed to assess the clinical efficacy of combined outside-in and FasT-Fix sutures for the treatment of serious discoid meniscal tears. METHODS This study included 32 consecutive patients who underwent arthroscopic meniscal plasty for serious discoid meniscal tears (full-thickness vertical, longitudinal tears >10mm) between October 2006 and June 2012. A combination of outside-in and FasT-Fix sutures was used to treat serious discoid meniscal tears. Disappearance of clinical symptoms (locked knee, pain, and clicking) and negative results in the McMurray and Apley grind tests were assessed during follow-up (26 to 47months). The Lysholm, IKDC, and Tegner scores were assessed for therapeutic efficacy. Some patients were followed up with MRI. RESULTS Symptoms (pain, clicking, and locking) disappeared in all patients. The Lysholm score improved from 39.1±9.2 to 89.6±6.7 at six months, and to 90.1±6.3 at the last follow-up. The same trends were observed for the IKDC score (from 38.0±9.5 to 90±6.3, and to 91.1±6.4) and the Tegner score (from 2.8±0.6 to 5.2±0.6, and to 5.2±0.5). Among all patients, 13 were followed up with MRI. Among these patients, four had an unhealed stitched edge, but they did not complain of any discomfort in the knees. CONCLUSIONS The use of a combination of outside-in and FasT-Fix sutures for meniscal plasty had good outcomes for serious discoid meniscal tears and can thus be regarded as a good surgical option.
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Affiliation(s)
- Yuezheng Hu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xinxian Xu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Xiaoyun Pan
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Huachen Yu
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Hong Wen
- Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China.
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Çetinkaya E, Kuyucu E, Gül M, Lapçin O, Albayrak K, Gürsu S. A suture technique for easier reduction and repair of bucket-handle meniscal tears while using the all-inside devices. SICOT J 2016; 2:42. [PMID: 27892399 PMCID: PMC5125161 DOI: 10.1051/sicotj/2016035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/29/2016] [Indexed: 11/15/2022] Open
Abstract
Arthroscopic repair of bucket-handle meniscal tears is difficult due to their complex pathology. Many meniscal repair techniques such as all-inside, inside-out, and outside-in have been described for the treatment of these tears. Loss of reduction is a likely complication with the use of new-generation, all-inside suture instruments, as the tip of the needle is extracted following advancement of the first implant behind the capsule. The complication may be encountered quite often and renders the use of the meniscus repair instrument unusable and causes an irreparable iatrogenic injury in the meniscus. The application of a simpler and more efficient technique is necessary until surgical experience is gained. The aim of this study was to define a new, simpler, and more efficient combination of suturing method in the treatment of bucket-handle meniscal repairs and minimize the rate of complications which may be caused by this technique.
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Affiliation(s)
- Engin Çetinkaya
- Baltalimani Bone and Joint Diseases Training and Research Hospital, Department of Ortopaedics and Traumatology, 34470 Istanbul, Turkey
| | - Ersin Kuyucu
- Department of Orthopaedics and Traumatology, Medipol University, 34214 Istanbul, Turkey
| | - Murat Gül
- Baltalimani Bone and Joint Diseases Training and Research Hospital, Department of Ortopaedics and Traumatology, 34470 Istanbul, Turkey
| | - Osman Lapçin
- Baltalimani Bone and Joint Diseases Training and Research Hospital, Department of Ortopaedics and Traumatology, 34470 Istanbul, Turkey
| | - Kutalmış Albayrak
- Baltalimani Bone and Joint Diseases Training and Research Hospital, Department of Ortopaedics and Traumatology, 34470 Istanbul, Turkey
| | - Sarper Gürsu
- Baltalimani Bone and Joint Diseases Training and Research Hospital, Department of Ortopaedics and Traumatology, 34470 Istanbul, Turkey
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McCulloch PC, Jones HL, Lue J, Parekh JN, Noble PC. What Is the Optimal Minimum Penetration Depth for "All-Inside" Meniscal Repairs? Arthroscopy 2016; 32:1624-30. [PMID: 27056289 DOI: 10.1016/j.arthro.2016.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify desired minimum depth setting for safe, effective placement of the all-inside meniscal suture anchors. METHODS Using 16 cadaveric knees and standard arthroscopic techniques, 3-dimensional surfaces of the meniscocapsular junction and posterior capsule were digitized. Using standard anteromedial and anterolateral portals, the distance from the meniscocapsular junction to the posterior capsule outer wall was measured for 3 locations along the posterior half of medial and lateral menisci. Multiple all-inside meniscal repairs were performed on 7 knees to determine an alternate measure of capsular thickness (X2) and compared with the digitized results. RESULTS In the digitized group, the distance (X1) from the capsular junction to the posterior capsular wall was averaged in both menisci for 3 regions using anteromedial and anterolateral portals. Mean distances of 6.4 to 8.8 mm were found for the lateral meniscus and 6.5 to 9.1 mm for the medial meniscus. The actual penetration depth was determined in the repair group and labeled X2. It showed a similar pattern to the variation seen in X1 by region, although it exceeded predicted distances an average 1.7 mm in the medial and 1.5 mm in the lateral meniscus owing to visible deformation of the capsule as it pierced. CONCLUSIONS Capsular thickness during arthroscopic repair measures approximately 6 to 9 mm (X1), with 1.5 to 2 mm additional depth needed to ensure penetration rather than bulging of the posterior capsule (X2), resulting in 8 to 10 mm minimum penetration depth range. Surgeons can add desired distance away from the meniscocapsular junction (L) at device implantation, finding optimal minimal setting for penetration depth (X2 + L), which for most repairable tears may be as short as 8 mm and not likely to be greater than 16 mm. CLINICAL RELEVANCE Minimum depth setting for optimal placement of all-inside meniscal suture anchors when performing all-inside repair of the medial or lateral meniscus reduces risk of harming adjacent structures secondary to overpenetration and underpenetration of the posterior capsule.
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Affiliation(s)
| | - Hugh L Jones
- Institute of Orthopedic Research & Education, Houston, Texas, U.S.A
| | - Jeffrey Lue
- Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Jesal N Parekh
- Institute of Orthopedic Research & Education, Houston, Texas, U.S.A
| | - Philip C Noble
- Institute of Orthopedic Research & Education, Houston, Texas, U.S.A
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Pareek A, O'Malley MP, Levy BA, Stuart MJ, Krych AJ. Inside-Out Repair for Radial Meniscus Tears. Arthrosc Tech 2016; 5:e793-e797. [PMID: 27709039 PMCID: PMC5040169 DOI: 10.1016/j.eats.2016.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 03/16/2016] [Indexed: 02/03/2023] Open
Abstract
Understanding of meniscal function through basic science, natural history, and biomechanics has highlighted the importance of preserving the meniscus to maintain normal knee biomechanics. Tears that may alter these biomechanics can contribute to the progressive nature of degenerative joint disease in the knee. Radial tears result in the disruption of the circumferential fibers causing inability of the native meniscus to resist normal hoop stresses, thereby leading to increased focal areas of pressure that cause complications such as early onset arthrosis. In this technical note, we describe our preferred operative technique to repair radial meniscal tears using an arthroscopic inside-out approach with satisfactory clinical outcomes and healing response.
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Affiliation(s)
| | | | | | | | - Aaron J. Krych
- Address correspondence to Aaron J. Krych, M.D., Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A.Department of Orthopedic Surgery and Sports MedicineMayo Clinic200 First Street SWRochesterMN55905U.S.A.
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Cuéllar A, Cuéllar R, Cuéllar A, Garcia-Alonso I, Ruiz-Ibán MA. The Effect of Knee Flexion Angle on the Neurovascular Safety of All-Inside Lateral Meniscus Repair: A Cadaveric Study. Arthroscopy 2015; 31:2138-44. [PMID: 26163307 DOI: 10.1016/j.arthro.2015.04.100] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 04/26/2015] [Accepted: 04/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate if different knee flexion angles can modify the neurovascular injury risk during lateral meniscus repair. METHODS Twenty cadaveric knees were studied. An all-inside suture device (FasT-Fix; Smith & Nephew, Andover, MA) was placed at the posterior horn and at the medial and lateral limits of the popliteal hiatus. The minimal distances between the device and the popliteal artery and peroneal nerve were measured with the knee at 90°, 45°, and 0° of flexion through a limited posterolateral arthrotomy. RESULTS The distance between the device when inserted at the lateral edge of the popliteal hiatus and the peroneal nerve decreased from a median of 26 mm (interquartile range [IQR], 3.5 mm; range, 19 to 29 mm) at 90° to 21.5 mm (IQR, 4.5 mm; range, 14 to 25 mm) at 45° and 15.5 mm (IQR, 6.5 mm; range, 4 to 20 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the peroneal nerve decreased from 16 mm (IQR, 3.3 mm; range, 9 to 21 mm) at 90° to 12 mm (IQR, 4.3 mm; range, 9 to 16 mm) at 45° and 7 mm (IQR, 4.0; range, 4 to 15 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the popliteal artery decreased from 21 mm (IQR, 5.0 mm; range, 11 to 27 mm) at 90° to 19 mm (IQR, 5.0 mm; range, 10 to 23 mm) at 45° and 16 mm (IQR, 7.5 mm; range, 10 to 23 mm) at 0° (significant differences, P < .001). The distance between the device when inserted 5 mm lateral to the posterior root of the lateral meniscus and the popliteal artery decreased from 13 mm (IQR, 4.3 mm; range, 7 to 27 mm) at 90° to 10.5 mm (IQR, 4.3 mm; range, 4 to 19 mm) at 45° and 5.5 mm (IQR, 4.0 mm; range, 0 to 14 mm) at 0° (significant differences, P < .001). CONCLUSIONS The risk of injury to the popliteal artery or to the peroneal nerve during all-inside repair of the posterior half of the lateral meniscus is lower at 90° of flexion and increases with knee extension to 45° and 0°. CLINICAL RELEVANCE All-inside meniscal repair of the lateral meniscus is safer with the knee at 90° of flexion.
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Affiliation(s)
- Adrián Cuéllar
- Department of Surgery and Radiology, University of Basque Country, Vizcaya, Spain.
| | - Ricardo Cuéllar
- Department of Surgery and Radiology, University of Basque Country, Vizcaya, Spain
| | - Asier Cuéllar
- Department of Surgery and Radiology, University of Basque Country, Vizcaya, Spain
| | | | - Miguel Angel Ruiz-Ibán
- Department of Traumatology and Orthopaedic Surgery, Ramon and Cajal Hospital, Madrid, Spain
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Ambrosia J, Qazi Z, Shuler FD, Giangarra C. Delayed Pseudoaneurysm of the Popliteal Artery Following ACL Reconstruction. Orthopedics 2015; 38:e543-6. [PMID: 26091231 DOI: 10.3928/01477447-20150603-93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/10/2014] [Indexed: 02/03/2023]
Abstract
Arterial complications following arthroscopic anterior cruciate ligament (ACL) reconstruction of the knee are rare. Injuries to vascular structures around the knee have historically been reported more commonly, with reconstructive procedures occurring more posteriorly, such as posterior cruciate ligament (PCL) reconstruction. The authors present a report of sequelae following a postoperative popliteal artery spasm in an 18-year-old female soccer player who underwent ACL reconstruction using an ipsilateral autologous hamstring graft along with a medial meniscal repair and developed immediate spasm of the popliteal artery responding to sustained balloon angioplasty. Seven weeks postoperatively, she developed foot paresthesias and was noted to have a 3.5×3.1×1.3-cm pseudoaneurysm of her popliteal artery. She underwent popliteal artery bypass with reverse saphenous vein autograft and had an uneventful recovery. This case highlights the importance of prolonged follow-up and maintaining a high degree of suspicion for further arterial complications, even after routine arthroscopic knee procedures. In addition to maintaining close and extended follow-up, the authors agree with other authors' suggestions that urgent computed tomography angiogram be obtained to evaluate the vascular tree in a patient presenting with a cold, pulseless extremity after routine arthroscopic knee procedures. In this particular case, angiography of the uninvolved side also proved useful in identifying the patient's aberrant vascular anatomy and may be useful in patients with bilateral aberrant vascular anatomy to better facilitate interpretation of the injured side. To the author's knowledge, this is the first case of popliteal artery spasm initially responding to sustained angioplasty with the delayed development of a pseudoaneurysm.
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Sanz-Pérez M, García-Germán D, Ruiz-Díaz J, Navas-Pernía I, Campo-Loarte J. Location of the popliteal artery and its relationship with the vascular risk in the suture of the posterior horn of the lateral meniscus. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Nishimura A, Fukuda A, Kato K, Fujisawa K, Uchida A, Sudo A. Vascular safety during arthroscopic all-inside meniscus suture. Knee Surg Sports Traumatol Arthrosc 2015; 23:975-80. [PMID: 24253374 DOI: 10.1007/s00167-013-2774-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of the study is to assess the orientation and distance of the popliteal artery (PA) from both the anteromedial and anterolateral portals. METHODS The records of 97 patients (100 knees) who underwent knee arthroscopy were reviewed. The shortest distance from the posterior tibial cortex to the PA on the lines from both the medial and lateral borders of the patellar tendon to the PA was evaluated by magnetic resonance imaging at full knee extension. The figure-of-four position was compared between patients with intact and deficient anterior cruciate ligaments (ACLs). The shortest distances from the posterior cruciate ligament (PCL) to the lines running from the medial and lateral borders of the patellar tendon to the PA were also measured. RESULTS The shortest distances from the posterior tibial cortex to the PA were significantly longer in the figure-of-four position than at full knee extension and during extension in the ACL-deficient than intact group. Distances did not significantly differ in the figure-of-four position. The PA was hidden from the anteromedial portal by the PCL, but remained vulnerable from the anterolateral portal. CONCLUSIONS All-inside meniscus suturing of the posterior horn of the lateral meniscus inserted through the anteromedial portal is safer when the knee is in the figure-of-four position than fully extended. Meniscus repairs should be completed before ACL reconstruction due to vascular positions and the ease of approach. LEVEL OF EVIDENCE Prospective correlation study, Level IV.
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Affiliation(s)
- Akinobu Nishimura
- Department of Orthopaedic and Sports Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan,
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Sanz-Pérez M, García-Germán D, Ruiz-Díaz J, Navas-Pernía I, Campo-Loarte J. Location of the popliteal artery and its relationship with the vascular risk in the suture of the posterior horn of the lateral meniscus. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 59:165-71. [PMID: 25445122 DOI: 10.1016/j.recot.2014.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/27/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The proximity of the posterior horn of the lateral meniscus to the popliteal artery determines a risk of vascular injury in its suture. The aim of this study is to determine the location of the popliteal artery, and to establish the minimal distance from the posterior wall of the lateral meniscus to the artery, the common peroneal nerve (CPN), and its correlation to other variables. MATERIAL AND METHODS A total of 102 magnetic resonance studies were retrospectively reviewed from patients undergoing surgery at our institution. The axial section where the lateral meniscus could be clearly defined was selected, and the measurements were performed. RESULTS The artery lay laterally to the midline in 94% of the cases. The minimal mean distance from the posterior wall of the lateral meniscus to the popliteal artery was 1.01cm. (0.32-1.74, SD: 0.304). The minimal mean distance to the CPN was 1.74cm. (0.75-2.87, SD: 0.374). No association was found between the minimal mean distance from the posterior wall to the popliteal artery with the height, weight, BMI, the lateral meniscus diameter, or the tibial plateau diameter. An association was found between the distance from the posterior wall to the CPN with the weight and the BMI. CONCLUSIONS The proximity of the posterior horn to the popliteal artery should be considered when performing sutures. This distance is within the recommended depth for all-inside meniscus repair devices. This distance is not related to height, weight, BMI, lateral meniscus nor tibial plateau diameters.
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Affiliation(s)
- M Sanz-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, España
| | - D García-Germán
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario HM de Madrid-Torrelodones, Madrid, España; Universidad San Pablo CEU, Madrid, España.
| | - J Ruiz-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, España
| | - I Navas-Pernía
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, España
| | - J Campo-Loarte
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, España
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Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based approach. World J Orthop 2014; 5:233-241. [PMID: 25035825 PMCID: PMC4095015 DOI: 10.5312/wjo.v5.i3.233] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/05/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.
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Abstract
Meniscus repair over resection, when feasible, should be strongly considered in an effort to preserve meniscus integrity and function, especially in younger patients. Currently, a number of techniques and implants may be used to achieve a successful result. Although all-inside meniscus repair devices have evolved significantly since their introduction and have become the repair technique of choice for many surgeons, the classic inside-out repair technique is still very useful to have in one's armamentarium. Though less popular because of the ease of current-generation fixators, the inside-out technique can still offer advantages for those surgeons who are proficient. With the versatility to address most tear patterns, the ability to deliver sutures with smaller needle diameters, and proven long-term results, it has been considered the gold standard in meniscus repair. We review the inside-out repair technique for both a medial and lateral meniscus tear with some helpful tips when performing the technique, and we present a video demonstration of the lateral meniscus repair technique.
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Tuman J, Haro MS, Foley S, Diduch D. All-inside meniscal repair devices and techniques. Expert Rev Med Devices 2012; 9:147-57. [PMID: 22404776 DOI: 10.1586/erd.11.74] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Techniques and devices for meniscal repair are evolving, including for all-inside meniscal repair. The first-generation all-inside meniscal repair devices were simplistic in design, but their technical difficulties and risks led to the development of second-generation devices. These devices employed the suture anchor concept for repair and confirmed the safety of use through standard anterior arthroscopic portals. Third-generation devices introduced the idea of rigid, bioabsorbable materials; unfortunately, these demonstrated higher failure and complication rates compared with other repair techniques. They were also limited in their ability to adjust compression and tension across the repair. Now, fourth-generation devices have been developed that are flexible, suture-based, and allow for variable compression and retensioning across the tear. Each device has its own specifications and technical nuances. With a comprehensive understanding of the current devices available, the industry and surgeons may continue in the development of safer, more successful, user-friendly and cost-effective all-inside devices.
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Affiliation(s)
- Jeff Tuman
- UVA Department of Orthopedic Surgery, 500 Ray C Hunt Drive, Box 800159, Charlottesville, VA 22908, USA
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Abouheif MM, Shibuya H, Niimoto T, Kongcharoensombat W, Deie M, Adachi N, Ochi M. Determination of the safe penetration depth during all-inside meniscal repair of the posterior part of the lateral meniscus using the FasT-Fix suture repair system. Knee Surg Sports Traumatol Arthrosc 2011; 19:1868-75. [PMID: 21468617 DOI: 10.1007/s00167-011-1489-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective of this study was to determine the safe penetration depth of the FasT-Fix meniscal suture repair system during all-inside repair of the posterior part of the lateral meniscus. METHODS Thirty-one knees from 17 embalmed and formalin-fixed cadavers (11 women, 6 men) were used. In each case, the circumference of the cadaver knee was measured before dissection. After dissection, 41 Fast-Fix meniscal repair devices were used in different predetermined penetration depths ranging from 8 to 16 mm. In this study, non-involvement of the popliteal neurovascular bundle, common peroneal nerve or the inferior lateral genicular vessels by either needle penetration or affixment by the suture bar anchors was considered to be a safe trial. RESULTS Out of the 41 FasT-Fix devices used in this study, only one device bent during introduction and was excluded from the study. For the remaining 40 trials, 27 of them were considered safe, while 13 trials were considered unsafe. The ratio of the average penetration depth to the average circumference of the cadaver knee was found to be >0.05 for the unsafe penetrations, and this was statistically significant P < 0.05. Additionally, for the first point, which is more central, there was a trend for the straight needles through the direct lateral approach to be less safe, and this was found to be statistically significant P < 0.05. CONCLUSIONS Correlating the needle-penetration depth to the measured circumference of the cadaver knee may be an important clinical predictor of safety whereby a ratio of less than 0.05 might be useful as a guide to determine the safe penetration depth of the FasT-Fix suture repair needle during repair of the posterior horn lateral meniscus. Also, it is better to avoid using straight needles through the direct lateral approach during repair of the more central portion of the posterior horn lateral meniscus.
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Affiliation(s)
- Mohamed Mahmoud Abouheif
- Department of Orthopedic Surgery and Traumatology, El Hadra University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
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Likes RL, Julka A, Aros BC, Pedroza AD, Kaeding CC, Jones GL, Flanigan DC. Meniscal repair with the MaxFire device: a cadaveric study. Orthop Surg 2011; 3:259-64. [PMID: 22021143 DOI: 10.1111/j.1757-7861.2011.00151.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To use a cadaver model to evaluate an all-inside meniscal repair device (MaxFire). METHODS Six fresh-frozen cadaveric knees (ages 30-84 years) without evidence of prior surgery were used for this study. The knees were rigidly mounted and arthroscopy performed using standard anteromedial and anterolateral portals. Four MaxFire devices were placed into the medial and lateral meniscus according to the technique provided by the manufacturer. The devices were placed in a vertical or horizontal mattress fashion systematically from posterior to anterior. Implants were placed from either the ipsilateral- or contralateral-portal at the discretion of each surgeon. Placement into the medial meniscus was performed with the knee in approximately 10° of flexion and into the lateral meniscus in 45° of flexion. RESULTS In all, 54 MaxFire devices were placed. Twenty-six devices were used medially, and 28 laterally. Forty-five (83%) were placed successfully. Of those, 3 (7%) were placed in a "top hat" fashion. The nine failures (17%) were related to final device tensioning. Three of the sutures broke, one suture would not reduce, and three implants pulled out of the meniscus. The devices were successfully removed arthroscopically with a grasper or oscillating shaver. Pulling of implants out of menisci occurred in degenerative knees with degenerative meniscal tissue and did not occur with healthy appearing menisci. CONCLUSION The MaxFire device is easy to use, has a low risk of complications, and can be inserted expeditiously by arthroscopy.
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Affiliation(s)
- Rickland L Likes
- Sports Medicine Center, Department of Orthopaedics, Ohio State University, Columbus, Ohio 43221-3502, USA
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Hoffelner T, Resch H, Forstner R, Michael M, Minnich B, Tauber M. Arthroscopic all-inside meniscal repair--Does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skeletal Radiol 2011; 40:181-7. [PMID: 20589497 DOI: 10.1007/s00256-010-0965-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/18/2010] [Accepted: 05/06/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to correlate clinical and radiological results using a 3-T MRI to verify meniscal healing after arthroscopic all-inside meniscus repair. MATERIALS AND METHODS We selected 27 patients (14 men and 13 women) with an average age of 31 ± 9 years and retrospective clinical examinations and radiological assessments using a 3-T MRI after all-inside arthroscopic meniscal repair were conducted. Repair of the medial meniscus was performed in 19 patients and of the lateral meniscus in eight. In 17 patients (63%), we performed concomitant anterior cruciate ligament reconstruction. The mean follow-up period was 4.5 ± 1.7 years. The Lysholm score and Tegner activity index were used for clinical evaluation. Four grades were used to classify the radiological signal alterations within the meniscus: central globular (grade 1); linear horizontal or band-like (grade 2); intrameniscal alterations and linear signal alterations communicating with the articular surface (grade 3); and complex tears (grade 4). RESULTS At follow-up, the average Lysholm score was 76 ± 15 points, with ten of the patients placed in group 6 based on the Tegner activity index. MRI examinations revealed no signal alteration in three patients, grade 1 in 0, grade 2 in five, grade 3 in 13, and grade 4 in six. The MRI findings correlated positively with the clinical scores in 21 patients (78%). CONCLUSIONS Correlation of clinical and radiological examination was performed using 3-T MRI. In spite of satisfactory clinical outcomes at follow-up, a radiological signal alteration may still be visible on MRI, which was believed to be scar tissue, but could not be proven definitively. Imaging with a 3-Tesla MRI after meniscal suture surgery provides good but no definitive reliability on meniscus healing and therefore gives no advantage compared to 1.5-T MRI, with good clinical outcome using an all-inside arthroscopic meniscal repair. CLINICAL RELEVANCE 3T-MRI can not substitute diagnostic arthroscopy in patients with persistent complaints after arthroscopic all-inside meniscal repair.
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Affiliation(s)
- Thomas Hoffelner
- Department of Traumatology and Sports Injuries, 5020, Muellner Hauptstrasse 48, Salzburg, Austria.
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Aros BC, Pedroza A, Vasileff WK, Litsky AS, Flanigan DC. Mechanical comparison of meniscal repair devices with mattress suture devices in vitro. Knee Surg Sports Traumatol Arthrosc 2010; 18:1594-8. [PMID: 20532866 DOI: 10.1007/s00167-010-1188-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 05/25/2010] [Indexed: 01/14/2023]
Abstract
We report the load to failure in tensile testing of the MaxFire™ meniscal repair system (Biomet Inc, Warsaw, IN) and compare it to other current meniscal repair devices and mattress suture techniques. After creating a longitudinal tear in 42 one-year-old bovine menisci, 7 specimen groups defined by the meniscal repair device, suture, and/or mattress technique used for meniscal repair were randomly established: (Group 1: Fiberwire™ vertical mattress (VM), Group 2: Fiberwire™ horizontal mattress (HM), Group 3: FasT-Fix™ VM, Group 4: FasT-Fix™ HM, Group 5: RapidLoc™, Group 6: MaxFire™ VM, Group 7: MaxFire™ HM). After completing the repairs, the meniscal specimens were cyclically pre-loaded before load to failure testing was performed. The mean load to failure for each group was: Fiberwire VM (185 ± 41 N), Fiberwire HM (183 ± 36 N), FasT-Fix VM (125 ± 8 N), FasT-Fix HM (107 ± 29 N), RapidLoc (70 ± 12 N), MaxFire VM (145 ± 44 N), MaxFire HM (139 ± 50 N). An analysis of variance demonstrated a significant difference in the mean load to failure (F = 8.31 P < 0.01). Statistically significant differences were seen between both Fiberwire groups verses FasT-Fix HM and Rapid-Loc (P < 0.05). Three modes of failure were observed: suture breakage (17/42, 40.5%), tissue failure (18/42, 42.9%), and knot failure (7/42, 16.7%). 2-0 Fiberwire™ VM and HM repairs had the highest load to failure of all groups tested. The load to failure for the MaxFire™ meniscal repair system is comparable to other available all-inside meniscal repair systems.
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Affiliation(s)
- Brian C Aros
- Green Mountain Orthopaedic Surgery, Berlin, VT, USA
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Monllau JC, Leal J, Voss C, Pelfort X, Tey M, Pavlovich RI. Good outcome after meniscal repair using an all-inside suturing system in combination with high-frequency biostimulation. Orthopedics 2010; 33:407-12. [PMID: 20806749 DOI: 10.3928/01477447-20100429-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Joan C Monllau
- Hospital de la Sta Creu i Sant Pau, Universitat Autònoma de Barcelona, St Antoni M. Claret 167, 08025 Barcelona, Spain.
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Abstract
All-inside meniscal repair has gained widespread popularity over recent years. The devices and techniques have rapidly evolved, resulting in increased ease of use and reduced surgical times and risk to the neurovascular structures. Despite these advances, inside-out suture repairs remain the current gold standard, with proven long-term results. All-inside techniques must continue to be compared to inside-out meniscal repair.
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Hospodar SJ, Schmitz MR, Golish SR, Ruder CR, Miller MD. FasT-Fix versus inside-out suture meniscal repair in the goat model. Am J Sports Med 2009; 37:330-3. [PMID: 19029315 DOI: 10.1177/0363546508325667] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent all-inside meniscal repair devices are available, but in vivo studies with these devices are sparse. HYPOTHESIS The FasT-Fix has inferior meniscal healing compared with the inside-out suture technique in the goat model. STUDY DESIGN Controlled laboratory study. METHODS After Institutional Review Board approval, 73 male castrated goats (Capra hircus) underwent a 2-cm meniscal incision and subsequent repair with the FasT-Fix device on one knee and inside-out meniscal repair on the contralateral knee. Both repairs used a vertical mattress suture technique. Access to the menisci was via an open technique with an extra-articular osteotomy of the medial collateral ligament origin on the femur. The animals were then allowed to ambulate unrestricted in a pasture after a 7-day stay in cages. Necropsy was carried out 6 months postoperatively, and the menisci and articular cartilage were studied with gross and microscopic inspection. RESULTS Nine of the 73 animals were excluded before necropsy. A total of 64 animals underwent necropsy, gross measurement of residual lesions, gross evaluation for chondral damage, histologic evaluation of meniscal repair, histologic evaluation of any adjacent inflammatory reaction to implants, and data analysis. Compared with the inside-out group, the FasT-Fix group had longer residual full-thickness defects (1.2 +/- 2.9 mm vs 0.2 +/- 1.1 mm; P = .011) and longer residual partial-thickness defects (8.4 +/- 6.3 mm vs 3.6 +/- 5.5 mm; P < .001). A total of 148 FasT-Fix devices were placed for 73 knees. Two devices were replaced for improper deployment. The device deployed and attached correctly 146 of 148 times for a success rate of 98.6%. There was no gross chondral damage and no histologic findings of inflammatory reaction to the implants with either technique. CONCLUSIONS The FasT-Fix meniscal repair had inferior meniscal healing results in this animal model. Previous studies using this animal model have paralleled clinical outcomes. Implantation of the FasT-Fix device does not damage adjacent femoral or tibial cartilage. The deployment of the FasT-Fix implant was simple and reproducible. There was no inflammatory reaction to the FasT-Fix implant. CLINICAL RELEVANCE The FasT-Fix meniscal repair has inferior meniscal healing results compared with the inside-out meniscal repair technique in the goat model. The clinical significance of this finding is not known. Further clinical study of the FasT-Fix implant is warranted.
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Affiliation(s)
- Steven J Hospodar
- Department of Orthopaedics, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
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Barber FA, Schroeder FA, Oro FB, Beavis RC. FasT-Fix meniscal repair: mid-term results. Arthroscopy 2008; 24:1342-8. [PMID: 19038704 DOI: 10.1016/j.arthro.2008.08.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 08/09/2008] [Accepted: 08/13/2008] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical success of the FasT-Fix meniscal repair device (Smith & Nephew Endoscopy, Andover, MA) associated with an accelerated rehabilitation program. METHODS A prospectively collected consecutive series of meniscal repairs performed with the FasT-Fix device was studied. The Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee activity scores, along with the clinical examination findings and adverse events, were recorded for all patients. Associated procedures were recorded. An accelerated postoperative rehabilitation program was followed, independent of concurrent anterior cruciate ligament surgery. RESULTS Forty-one meniscal repairs were performed, with an average follow-up of 30.7 months (range, 12 to 58 months). Twenty-nine of 41 repairs were performed in conjunction with anterior cruciate ligment reconstruction. The other repairs were in stable knees. There were 26 medial and 15 lateral meniscus repairs. Both menisci were repaired in 5 knees. Repeat arthroscopies were performed for 12 repairs and 7 (17%) were found to have failed. The preoperative and postoperative Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee activity scores were 47.3 and 87.4, 3.4 and 7.2, 38.7 and 82.8, and 2.3 and 3.4, respectively. CONCLUSIONS The FasT-Fix meniscal repair associated with an accelerated rehabilitation program resulted in clinically effective meniscal repair in 83% at the time of follow-up. Clinical outcome measures all improved. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas, USA
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Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients. Arthroscopy 2008; 24:810-6. [PMID: 18589270 DOI: 10.1016/j.arthro.2008.03.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 03/02/2008] [Accepted: 03/03/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was the clinical evaluation of arthroscopic meniscal repair results with the use of 3 different repair devices. METHODS From 2001 to 2006, 265 patients underwent 280 meniscal repairs (RapidLoc [DePuy Mitek, Raynham, MA] in 88 patients, T-Fix [Acufex Microsurgical, Mansfield, MA] in 85 patients, and FasT-Fix [Smith & Nephew Endoscopy, Andover, MA] in 92 patients). There were 181 medial and 99 lateral tears; 174 tears were located in Cooper radial zone 1, and 106 tears were in Cooper radial zone 2. All patients had associated anterior cruciate ligament reconstructions. Follow-up assessment included clinical examination, arthrometry (KT-1000; MEDmetric, San Diego, CA), International Knee Documentation Committee scores, and scores on Lysholm functional questionnaires. Clinical criteria for a successful result included the absence of joint line tenderness, swelling, and blocking and the presence of a negative McMurray test. RESULTS The mean follow-up was 24.5 months (range, 20 to 26 months). Tear length averaged 3.17 cm (range, 1.4 to 4 cm). A mean of 2.4 suture devices was used. On the basis of our criteria, 28 meniscus repairs were considered to be failures (success rates of 92.4% for FasT-Fix, 87% for T-Fix, and 86.5% for RapidLoc). There were 16 relook arthroscopies for device removal and partial meniscectomy, with 11 patients (68.7%) having failure of the meniscal repair in zone 2. Both the Lysholm and International Knee Documentation Committee scores were significantly improved. Chronicity or location of the tear, length of the tear, and patient age did not affect the clinical outcome. CONCLUSIONS The compared meniscal repair systems showed comparable clinical results. These meniscal repair systems appeared to be safe and effective, providing a high rate of meniscal healing both in patients with complex tears and in patients with tears located in Cooper radial zone 2. LEVEL OF EVIDENCE Level III, therapeutic retrospective comparative study.
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Staerke C, Kopf S, Becker R. The extent of laceration of circumferential fibers with suture repair of the knee meniscus. Winner of the AGA DonJoy award 2006. Arch Orthop Trauma Surg 2008; 128:525-30. [PMID: 18064476 DOI: 10.1007/s00402-007-0533-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cannulas used with suture based meniscal repair techniques can potentially injure the load transmitting fibers of the meniscus. The subject of this study was to quantify this effect in a porcine in vitro model. MATERIALS AND METHODS From fresh frozen medial porcine menisci tissue specimens were harvested following the course of the peripheral circumferential fibers bundles. In the first part of the study the tissue samples were perforated with the cannulas of either a Fast Fix or a Rapidloc device or with an 18-gauge needle. The specimens were then visually inspected for fiber damage using low power microscopy and the mean size of the laceration was measured. Finally, the extent of the tissue laceration was indirectly determined using non-contact strain measurements of the samples before and after puncture. RESULTS When advanced with the cutting edge perpendicular to the fibers, the cannulas consistently cut the fibers while those were rather separated with the opposite orientation. It could be shown that specimens with a mean width of 8.1 mm lost 25% of the load transmitting cross section when being perforated two times with a Fast Fix device (P < 0.001). This effect is negated when the cannula was oriented in line with the fibers. CONCLUSIONS Cannulas used for suture based meniscal repair can cause a substantial laceration of the meniscal tissue. The effect strongly depends on the orientation of the cutting edge of the cannula relative to the course of the fibers and can thus potentially be avoided by an appropriate handling and design.
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Affiliation(s)
- Christian Staerke
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
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Abstract
The human meniscus is important for normal knee function and distributes loads, aids in joint lubrication, congruence, stability, and proprioception. Repair of appropriate meniscal tears is possible and several methods exist to accomplish this including suture repairs and device repairs. Clinical evidence suggests that meniscal repairs can result in acceptable healing rates although adverse events have been reported for some devices. New self-adjusting suture devices have facilitated the accurate and effective repair of the torn meniscus. Technique descriptions for these devices are presented.
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Espejo-Baena A, Golano P, Meschian S, Garcia-Herrera JM, Serrano Jiménez JM. Complications in medial meniscus suture: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2007; 15:811-6. [PMID: 16758232 DOI: 10.1007/s00167-006-0096-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Accepted: 11/16/2005] [Indexed: 01/29/2023]
Abstract
The aim of this study was to examine the possibility of complications in medial meniscus repair using an inside-out suturing device. Anatomical cadaveric study. Six fresh frozen cadaveric lower limbs were used. The posterior horn of the medial meniscus was sutured using three vertical stitches. An anatomical dissection was subsequently performed to check for any possible effects upon the structures of the medial aspect of the knee. In addition, an incision was made in a safety zone in order to ascertain whether it was possible to carry out the suture without affecting the aforementioned structures. No vascular or nervous structures were pierced by the needle. On knotting, it was found that a number of different structures had become trapped: the sartorial tendon was affected in each of the specimens used. In four cases, the saphenous vein was trapped by some of the knots. The saphenous nerve was trapped in four instances. Once this had been established, a small accessory incision was made to provide access to a safety zone, where suture can be performed without affecting any neurovascular or tendinous structures. Inside-out suture of the posterior meniscal horn carries a high incidence of entrapment of the neurovascular structures of the medial aspect of the knee. The sartorial tendon is constantly affected. Such complications can easily be avoided by entering the safety zone via a small auxiliary incision. This study provides evidence that complications affecting the peripheral structures of the medial aspect of the knee may arise during inside-out suture of the posterior horn of the medial meniscus and proposes a simple method of averting them.
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Affiliation(s)
- Alejandro Espejo-Baena
- Hospital Clinico Universitario Virgen de la Victoria, Paseo Reding 9 - 1oC, 29016 Malaga, Spain.
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Abstract
Preservation of the menisci is increasingly emphasized in orthopedic care of the knee. Techniques are rapidly emerging that allow easier accomplishment of this goal. In particular, the development of all-inside arthroscopic meniscal repair devices has facilitated more ready repair. A number of laboratory and clinical studies have examined these devices and comparisons with more traditional techniques have been made. Numerous reports of potential complications from these new technologies have also been described in the literature. This review covers the current options for treatment of meniscal repair, laboratory and clinical data, and also potential complications.
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Affiliation(s)
- Barton Harris
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22903, USA
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45
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Quinby JS, Golish SR, Hart JA, Diduch DR. All-inside meniscal repair using a new flexible, tensionable device. Am J Sports Med 2006; 34:1281-6. [PMID: 16493169 DOI: 10.1177/0363546505286143] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A new generation of flexible all-inside meniscal repair devices is available, but clinical studies with these devices are lacking. HYPOTHESIS The RapidLoc has an intermediate-term meniscal healing rate that is equivalent to literature reports of inside-out suture technique in patients undergoing concurrent anterior cruciate ligament reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS Retrospective analysis was performed for 75 meniscal tears in 66 consecutive patients undergoing anterior cruciate ligament reconstruction who underwent meniscal repair with the RapidLoc. Patients with at least 2 years' follow-up were evaluated for symptoms suggestive of a meniscal tear and were assessed with the International Knee Documentation Committee form and the Knee Disorders Subjective History visual analog scale. Subjects were asked to return for a clinical examination to include evaluation for an effusion and joint line tenderness as well as McMurray test and KT-1000 arthrometry readings. Patients with symptoms consistent with meniscal repair failure underwent magnetic resonance arthrography and repeat arthroscopy. RESULTS Twenty patients with 21 meniscal tears were excluded, resulting in 54 meniscal tears in 46 patients. At a mean follow-up of 34.8 months, the clinical success rate for meniscal repair was 90.7% (49/54), with 5 failures requiring meniscectomy. Univariate analysis revealed predictive variables for failure: bucket-handle configuration, multiplanar tears, tear length greater than 2 cm, and chronicity longer than 3 months. Non-predictive variables included compartment, zone, ligament graft choice, gender, age, follow-up, and visual analog scale score. Analysis of healed patients revealed a negative correlation between chronicity of tear and International Knee Documentation Committee score. CONCLUSIONS The RapidLoc has an acceptable intermediate-term clinical healing rate in patients undergoing concurrent anterior cruciate ligament reconstruction. Predictive variables for failure should be considered during operative decision making.
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Affiliation(s)
- J Scott Quinby
- Sports Medicine Clinic of North Texas, Dallas, Texas, USA
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Zantop T, Temmig K, Weimann A, Eggers AK, Raschke MJ, Petersen W. Elongation and structural properties of meniscal repair using suture techniques in distraction and shear force scenarios: biomechanical evaluation using a cyclic loading protocol. Am J Sports Med 2006; 34:799-805. [PMID: 16567460 DOI: 10.1177/0363546505285583] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most biomechanical studies on meniscal repairs have focused on testing distraction scenarios to evaluate structural properties of the repaired meniscus. An application of shear forces might replicate the in vivo situation more closely. HYPOTHESIS In the shear force scenario, meniscal repair using a vertical suture technique will result in significantly less elongation when subjected to a cyclic loading protocol than that resulting from a horizontal suture technique. STUDY DESIGN Controlled laboratory study. METHODS In fresh-frozen porcine menisci (n = 10 in each group), horizontal and vertical 2.0 Ethibond suturing techniques were tested in distraction and shear force scenarios. Elongation after 1000 cycles between 5 and 20 N and the structural properties such as stiffness, yield load, maximum load to failure, and failure mode were evaluated using a testing machine at a rate of 12.5 mm/s. RESULTS In the distraction force scenario, no statistically significant difference in elongation after cyclic loading was found between specimens repaired with vertical or horizontal suture techniques. After 1000 cycles of cyclic loading in the shear force scenario, the horizontal suturing revealed significantly less elongation (2.8 +/- 1.1 mm) than did the vertical suture technique (4.6 +/- 2.0 mm). No statistically significant difference in yield and maximum load was found (P > .05). CONCLUSION The results of the present study do not support the authors' hypothesis. In the shear force test, horizontal sutures were superior to vertical suture techniques. CLINICAL RELEVANCE Meniscal repair with horizontal suture techniques can withstand elongation due to shear forces more effectively than can vertical mattress sutures.
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Affiliation(s)
- Thore Zantop
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Waldeyerstr 1, D-48149 Muenster, Germany.
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Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH. Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy 2006; 22:3-9. [PMID: 16399454 DOI: 10.1016/j.arthro.2005.10.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair using the FasT-Fix repair system. TYPE OF STUDY Prospective case series. METHODS Sixty-one meniscal repairs with the FasT-Fix meniscal repair system in 58 patients with a mean age of 32.6 years were performed between 2001 and 2002. Concurrent anterior cruciate ligament reconstruction was performed in 36 patients (62%). All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation also included the Tegner and Lysholm knee scores, and KT-1000 arthrometry. In addition, all patients were evaluated preoperatively with magnetic resonance imaging. RESULTS The average follow-up was 18 months (range, 14 to 28 months). Six of 61 repaired menisci (9.8%) were considered failures according to our criteria. Therefore, the success rate was 90.2%. Time required for meniscal repair averaged 11 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. The mean Lysholm significantly improved from 43.6 preoperatively to 87.5 postoperatively (P < .001). Fifty-one patients (88%) had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in 1 of them. Analysis showed that age, length of tear, simultaneous anterior cruciate ligament reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome. CONCLUSIONS Our results show that arthroscopic meniscal repair with the FasT-Fix repair system provided a high rate of meniscus healing and appeared to be safe and effective in this group of patients. LEVEL OF EVIDENCE Level IV, therapeutic study, case series (no control group).
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Affiliation(s)
- Elias S Kotsovolos
- Center for Knee, Foot Surgery and Sports Trauma, ATOS Clinic, Heidelberg, Germany.
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Chang HC, Nyland J, Caborn DNM, Burden R. Biomechanical evaluation of meniscal repair systems: a comparison of the Meniscal Viper Repair System, the vertical mattress FasT-Fix Device, and vertical mattress ethibond sutures. Am J Sports Med 2005; 33:1846-52. [PMID: 16157854 DOI: 10.1177/0363546505278254] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The biomechanical characteristics of the Meniscal Viper Repair System have not been previously studied. HYPOTHESIS Comparable meniscal lesion fixation standards will exist among the Meniscal Viper Repair System, the vertical FasT-Fix device, and vertical mattress sutures. STUDY DESIGN Controlled laboratory study. METHODS Porcine menisci (3 groups of 7 menisci each) were repaired using different devices. A servohydraulic device cycled each construct between 5 N and 50 N for 500 cycles before load to failure (5 mm/min). Group differences were evaluated with 1-way analysis of variance and Tukey post hoc tests. RESULTS During cyclic testing, the vertical mattress suture group (2.3 +/- 0.2 mm) showed less mean displacement than did the vertical FasT-Fix or the Viper system groups (3.9 +/- 0.7 mm and 3.9 +/- 0.5 mm, respectively); the vertical mattress suture group (21.8 +/- 2 N/mm) also displayed superior mean stiffness to the vertical FasT-Fix or the Viper system groups (13.2 +/- 2 N/mm and 13.1 +/- 1.8 N/mm, respectively). During load-to-failure testing, the vertical FasT-Fix group (145.9 +/- 9 N) withstood greater mean loads than did the Viper system group (111.2 +/- 30 N), but it did not differ significantly from loads withstood by the vertical mattress suture group (133.4 +/- 10 N). The Viper system and vertical FasT-Fix groups (14.6 +/- 2 N/mm and 12.1 +/- 1 N/mm, respectively) displayed superior mean stiffness to the vertical mattress suture group (9.8 +/- 0.5 N/mm) during load-to-failure testing. CLINICAL RELEVANCE Standard vertical mattress sutures provided superior fixation during cyclic loading compared with the 2 all-inside methods of suture fixation, suggesting a potential for better meniscal lesion healing with vertical mattress sutures when confronted with the stresses associated with early, progressive rehabilitation activities. Stronger sutures and less meniscal segment purchase in tears located 3 to 4 mm from the periphery may contribute to the failure of the Viper repair system.
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Affiliation(s)
- Haw C Chang
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray Street, Suite 1003, Louisville, KY 40202, USA
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Frosch KH, Fuchs M, Losch A, Stürmer KM. Repair of meniscal tears with the absorbable Clearfix screw: results after 1-3 years. Arch Orthop Trauma Surg 2005; 125:585-91. [PMID: 15645274 DOI: 10.1007/s00402-004-0775-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Total meniscus resection usually leads to osteoarthritis of the knee joint. Preservation and refixation of the injured menisci are therefore of great clinical importance. MATERIALS AND METHODS The present study examines 40 meniscal injuries in 37 patients that were arthroscopically treated with Clearfix meniscal screws (Mitek, Norderstedt, Germany) in the period from August 1999 to December 2002. The mean patient age was 27.7 (range 16-62) years. Nine patients were female. A total of 24 patients (27 meniscal tears) also had an anterior cruciate ligament (ACL) lesion, and 5 patients had cartilage injuries. Twenty-two patients were treated within the first 2 weeks following the trauma, 10 patients within 8 weeks, and 5 patients after 8 weeks. The lesions were a bucket-handle tear of the medial meniscus in 11 cases and a bucket-handle tear of the lateral meniscus in 2 cases. The posterior horn of the medial meniscus was torn in 13 cases, and the pars intermedia in 3 cases. The posterior horn of the lateral meniscus was torn in 8 cases, and the pars intermedia in 3 cases. The mean tear length was 2.9 (+/- 1.5) cm and was fixed with an average of 1.8 (+/- 0.7) screws. In 7 cases, the anterior horn was treated with an additional meniscal suture. A total of 35 patients were examined after an average of 18 (range 7-45) months. RESULTS In the event of a moderate outcome, MRI was performed as part of the follow-up investigation. The average Lysholm score was 93 (+/- 7.4), the Tegner activity index was 6.3 (+/- 2.0) before the accident and 5.8 (+/- 2.0) at the follow-up, the Marshall knee score was 47 (+/- 3.8). The VAS pain assessment was 1.6 (+/- 1.3) and the VAS function assessment was 7.9 (+/- 1.6). Of the 7 patients with a moderate result, 2 patients without additional ligament lesions suffered re-ruptures after and 13 months, respectively. The other 5 patients with a moderate result each had multiple accompanying injuries or pre-existing damage to the affected knee joint. CONCLUSION The Clearfix screws achieved a clinical success rate of 82% in isolated meniscal tears in stable knee joints and a clinical success rate of 100% with additional ACL reconstruction. In view of the good clinical results and the simple procedure for use, the implant should be recommended for meniscal refixation.
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Affiliation(s)
- K H Frosch
- Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg August University Goettingen, Robert Koch Str. 40, 37075 Goettingen, Germany.
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Fukushima K, Okano T, Negishi S, Horaguchi T, Sato K, Saito A, Ryu J. New meniscus repair by an all-inside knot suture technique. Arthroscopy 2005; 21:768. [PMID: 15944646 DOI: 10.1016/j.arthro.2005.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The indications for the all-inside knot suture technique include tears in the red-red zone or red-white zone in the meniscus, and a horizontal tear, a vertical tear, and a peripheral tear. First, find an appropriate place for a suture insertion site with a Kateran needle or a spinal needle. Make sure it exits beyond the tear in the meniscus. Once the insertion site is chosen, a suture is passed into and through the joint. The suture is slowly pulled back. You should be able to feel the tip of the suture come out of the joint capsule. If you want to make a vertical suture to suture the tear, move the suture vertically apex. Then insert the suture back into the joint through the capsule. Make sure the suture stays inside the joint. Find and grab the suture with a punch inserted from the clear cannula. Pull the suture out of the joint through the clear cannula with the punch. Tighten the knot with a knot pusher. Then confirm the stability of the sutured site with the probe. Our all-inside knot suture technique can be performed arthroscopically, allowing reliable repair of the torn meniscus.
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Affiliation(s)
- Kazumasa Fukushima
- Verdy Clinic, Orthopaedic Surgery and Sports Medicine, Nihon University, Tokyo, Japan.
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