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Clinical outcome and failure analysis of medial meniscus bucket-handle tear repair: a series of 96 patients with a minimum 2 year follow-up

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The failure rate of meniscal repair remains significant, especially for bucket-handle tears. This study aimed to evaluate the clinical outcomes, failure rate and risk factors for failure of bucket-handle medial meniscal tear repairs performed during ACL reconstruction.

Materials and methods

A retrospective analysis of prospectively collected data was performed on a consecutive series of 96 ACL reconstructions with meniscal arthroscopic suture of a bucket-handle tear of the medial meniscus with a minimum 2 year follow-up. Preoperative and postoperative evaluation at last follow-up included objective IKDC rating, instrumented differential laxity and Tegner activity level. Functional outcome was evaluated with Lysholm score at last follow-up. Failure rate, survival curves and risk factor analysis using Cox proportional hazard ratio models were performed to analyze suture repair failure.

Results

At IKDC rating, all patients were C or D preoperatively, whereas they where all A or B at last follow-up. Instrumented differential laxity improved from 6.77 mm (1.57) to 1.02 mm (1.15) mm at last follow-up (p = 1.9 E−18). The mean Tegner score before injury was 6.79 (± 1.47) and 6.11 (± 1.75) at last follow-up (p = 0.0011). Mean Lyholm score at last follow-up was 91.53 (± 11.6). The average entire cohort failure rate was 19% at final follow-up of 35.2 ± 9.8 months. Kaplan–Meier survival analysis demonstrated that the probability of the absence of failure decreased constantly over time. No significant difference in the objective IKDC, Lysholm or Tegner scores was observed between the failure group and the success group. Multivariate analysis revealed that younger patients and a procedure of ACL revision are more at risk for suture repair failure. In the majority of cases, the meniscal lesion observed at revision was equivalent or less extensive than the initial lesion.

Conclusion

Despite the fact that failure rate remains high for medial meniscus bucket-handle tears, suture repair of bucket-handle tears should be encouraged taking into account the long-term consequences of menisectomy.

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Authors and Affiliations

  1. Ramsay Générale de Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, 24, Avenue Paul Santy, 69008, Lyon, France

    Mathieu Thaunat, Gaspard Fournier, Biova Teko Kouevidjin, Gilles Clowez, Matteo Borella, Jean-Marie Fayard & Bertrand Sonnery-Cottet

  2. Mater Private Cork, City Gate, Mahon, Cork, Ireland

    Padhraig O’Loughlin

Authors
  1. Mathieu Thaunat
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  2. Gaspard Fournier
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  3. Padhraig O’Loughlin
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  4. Biova Teko Kouevidjin
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  5. Gilles Clowez
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  8. Bertrand Sonnery-Cottet
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Correspondence to Mathieu Thaunat.

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Conflict of interest

Mathieu Thaunat, and Bertrand Sonnery-Cottet are consultant for Arthrex company; Jean-Marie Fayard is consultant for Arthrex and New Clip Technics.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of Ramsay Générale de Santé n° IRB COS-RGDS-2019-05-006-THAUNAT-M and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Thaunat, M., Fournier, G., O’Loughlin, P. et al. Clinical outcome and failure analysis of medial meniscus bucket-handle tear repair: a series of 96 patients with a minimum 2 year follow-up. Arch Orthop Trauma Surg 140, 1649–1654 (2020). https://doi.org/10.1007/s00402-020-03346-1

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