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Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients

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Abstract

Purpose

Menisco-capsular separation (MCS) is an avulsion type of injury of the medial and/or lateral meniscus and is defined as detachment of the meniscus from its capsular attachment. The aims of this study were to show the results of arthroscopic all-inside menisco-capsular repair in a large number of consecutive patients with acute or chronic MCS, emphasise the advantages of this safe treatment option and stress the superiority of the treatment on the basis of thorough physical examination of the knee joint over magnetic resonance imaging (MRI) diagnosis in MCS.

Methods

We evaluated data of patients treated between October 2011 and July 2012. Inclusion and exclusion criteria were defined and demographic variables evaluated. All patients were examined physically and with MRI. Knee arthroscopy was performed and the MCS repaired through all-inside menisco-capsular repair. Postoperative treatment was standardised. Patients were followed up for at least 24 weeks.

Results

Thirty-seven athletes (12 women, 25 men) were evaluated. Only in six patients was MCS detected on MRI. In all patients, MCS was diagnosed via physical examination. Arthroscopic treatment led to significant (p < 0.01) improvement. There were no complications reported postoperatively.

Conclusion

Isolated MCS is not as rare a meniscus pathology after trauma in young athletes as could be expected after reviewing current literature. It is occult on MRI scans in most of the cases and should therefor be taken into consideration in patients with acute or chronic tenderness at the level of the joint line and negative MRI scans. Thorough physical examination has higher diagnostic value than MRI alone, as shown in this study. Treatment of MCS using all-inside nonabsorbable sutures, as described in this study using Ultra FasT Fix®, is effective if performed by an experienced surgeon.

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References

  1. Al-Othman AA (2002) Biodegradable arrows for arthroscopic repair of meniscal tears. Int Orthop 26(4):247–249. doi:10.1007/s00264-002-0359-z

    Article  PubMed Central  PubMed  Google Scholar 

  2. Beltran J, Matityahu A, Hwang K, Jbara M, Maimon R, Padron M, Mota J, Beltran L, Sundaram M (2003) The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology. Skelet Radiol 32(8):435–445. doi:10.1007/s00256-003-0641-1

    Article  Google Scholar 

  3. De Maeseneer M, Lenchik L, Starok M, Pedowitz R, Trudell D, Resnick D (1998) Normal and abnormal medial meniscocapsular structures: MR imaging and sonography in cadavers. AJR Am J Roentgenol 171(4):969–976. doi:10.2214/ajr.171.4.9762977

    Article  PubMed  Google Scholar 

  4. De Maeseneer M, Shahabpour M, Vanderdood K, Van Roy F, Osteaux M (2002) Medial meniscocapsular separation: MR imaging criteria and diagnostic pitfalls. Eur J Radiol 41(3):242–252

    Article  PubMed  Google Scholar 

  5. El-Khoury GY, Usta HY, Berger RA (1984) Meniscotibial (coronary) ligament tears. Skelet Radiol 11(3):191–196

    Article  CAS  Google Scholar 

  6. Forster BB, Helms CA (1993) Importance of routine T2-weighted or T2*-weighted coronal images in magnetic resonance imaging of the knee. Can Assoc Radiol J 44(5):396–398

    CAS  PubMed  Google Scholar 

  7. Frizziero A, Ferrari R, Giannotti E, Ferroni C, Poli P, Masiero S (2012) The meniscus tear. State of the art of rehabilitation protocols related to surgical procedures. Muscles Ligaments Tendons J 2(4):295–301

    PubMed Central  PubMed  Google Scholar 

  8. Furumatsu T, Miyazawa S, Tanaka T, Okada Y, Fujii M, Ozaki T (2014) Postoperative change in medial meniscal length in concurrent all-inside meniscus repair with anterior cruciate ligament reconstruction. Int Orthop 38(7):1393–1399. doi:10.1007/s00264-013-2238-1

    Article  PubMed  Google Scholar 

  9. George J, Saw KY, Ramlan AA, Packya N, Tan AH, Paul G (2000) Radiological classification of meniscocapsular tears of the anterolateral portion of the lateral meniscus of the knee. Australas Radiol 44(1):19–22

    Article  CAS  PubMed  Google Scholar 

  10. Haas AL, Schepsis AA, Hornstein J, Edgar CM (2005) Meniscal repair using the FasT-Fix all-inside meniscal repair device. Arthrosc: J Arthrosc Relat Surg : Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 21(2):167–175. doi:10.1016/j.arthro.2004.10.012

    Article  Google Scholar 

  11. Hamberg P, Gillquist J, Lysholm J (1983) Suture of new and old peripheral meniscus tears. J Bone Joint Surg Am 65(2):193–197

    CAS  PubMed  Google Scholar 

  12. Hefti F, Muller W (1993) Current state of evaluation of knee ligament lesions. The new IKDC knee evaluation form. Orthopade 22(6):351–362

    CAS  PubMed  Google Scholar 

  13. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc : Off J ESSKA 1(3–4):226–234

    Article  CAS  Google Scholar 

  14. Hein CN, Deperio JG, Ehrensberger MT, Marzo JM (2011) Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee 18(3):189–192. doi:10.1016/j.knee.2010.04.006

    Article  PubMed  Google Scholar 

  15. Hetsroni I, Lillemoe K, Marx RG (2011) Small medial meniscocapsular separations: a potential cause of chronic medial-side knee pain. Arthrosc: J Arthrosc Relat Surg: Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 27(11):1536–1542. doi:10.1016/j.arthro.2011.06.025

    Article  Google Scholar 

  16. House CV, Connell DA, Saifuddin A (2007) Posteromedial corner injuries of the knee. Clin Radiol 62(6):539–546. doi:10.1016/j.crad.2006.11.024

    Article  CAS  PubMed  Google Scholar 

  17. Kim SJ, Jung KA, Kim JM, Kwun JD, Baek SH, Han JN (2005) Arthroscopic all-inside repair of tears of the anterior horn of the lateral meniscus. Arthrosc :J Arthrosc Relat Surg : Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 21(11):1399. doi:10.1016/j.arthro.2005.08.027

    Google Scholar 

  18. Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH (2006) Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthrosc :J Arthrosc Relat Surg : Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 22(1):3–9. doi:10.1016/j.arthro.2005.10.017

    Article  Google Scholar 

  19. Leach WJ, King JB (1994) Posterior reattachment of the torn anterior cruciate ligament. J Bone Joint Surg Br 76(1):159–160

    CAS  PubMed  Google Scholar 

  20. Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13(3):184–188. doi:10.1016/j.knee.2006.01.005

    Article  CAS  PubMed  Google Scholar 

  21. Müller W (1982) The knee: form, function and ligamentous reconstruction surgery. Springer, Berlin

    Google Scholar 

  22. Padua DA, Marshall SW, Boling MC, Thigpen CA, Garrett WE Jr, Beutler AI (2009) The landing error scoring system (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: the JUMP-ACL study. Am J Sports Med 37(10):1996–2002. doi:10.1177/0363546509343200

    Article  PubMed  Google Scholar 

  23. Park HJ, Kim SS, Lee SY, Park NH, Ahn JH, Chung EC, Park JY, Kim MS (2014) Comparison between arthroscopic findings and 1.5-T and 3-T MRI of oblique coronal and sagittal planes of the knee for evaluation of selective bundle injury of the anterior cruciate ligament. AJR Am J Roentgenol 203(2):W199–W206. doi:10.2214/AJR.13.11571

    Article  PubMed  Google Scholar 

  24. Potter HG, Weinstein M, Allen AA, Wickiewicz TL, Helfet DL (2002) Magnetic resonance imaging of the multiple-ligament injured knee. J Orthop Trauma 16(5):330–339

    Article  PubMed  Google Scholar 

  25. Rubin DA, Britton CA, Towers JD, Harner CD (1996) Are MR imaging signs of meniscocapsular separation valid? Radiology 201(3):829–836. doi:10.1148/radiology.201.3.8939239

    Article  CAS  PubMed  Google Scholar 

  26. Snoeker BA, Bakker EW, Kegel CA, Lucas C (2013) Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Therapy 43(6):352–367. doi:10.2519/jospt.2013.4295

    Article  Google Scholar 

  27. Sommerlath KG (1991) Results of meniscal repair and partial meniscectomy in stable knees. Int Orthop 15(4):347–350

    Article  CAS  PubMed  Google Scholar 

  28. Steenbrugge F, Van Nieuwenhuyse W, Verdonk R, Verstraete K (2005) Arthroscopic meniscus repair in the ACL-deficient knee. Int Orthop 29(2):109–112. doi:10.1007/s00264-004-0616-4

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jager A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 38(8):1542–1548. doi:10.1177/0363546510364052

    Article  PubMed  Google Scholar 

  30. Stone RG (1979) Peripheral detachment of the menisci of the knee: a preliminary report. The Orthopedic clinics of North America 10(3):643–657

    CAS  PubMed  Google Scholar 

  31. Tsai KJ, Chiang H, Jiang CC (2004) Magnetic resonance imaging of anterior cruciate ligament rupture. BMC Musculoskelet Disord 5:21. doi:10.1186/1471-2474-5-21

    Article  PubMed Central  PubMed  Google Scholar 

  32. Van Dyck P, Gielen JL, Vanhoenacker FM, Wouters K, Dossche L, Parizel PM (2012) Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis? Skelet Radiol 41(3):273–280. doi:10.1007/s00256-011-1169-4

    Article  Google Scholar 

  33. Venkatachalam S, Godsiff SP, Harding ML (2001) Review of the clinical results of arthroscopic meniscal repair. Knee 8(2):129–133

    Article  CAS  PubMed  Google Scholar 

  34. Zanetti M, Pfirrmann CW (2006) Pitfalls in magnetic resonance imaging of the knee. Radiologe 46(1):71–77. doi:10.1007/s00117-005-1290-2

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Lena Hirtler.

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Hirtler, L., Unger, J. & Weninger, P. Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients. International Orthopaedics (SICOT) 39, 967–974 (2015). https://doi.org/10.1007/s00264-014-2657-7

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  • DOI: https://doi.org/10.1007/s00264-014-2657-7

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