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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References
Abrams GD, Frank RM, Gupta AK et al (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41:2333–2339. https://doi.org/10.1177/0363546513495641
Mosich GM, Lieu V, Ebramzadeh E, Beck JJ (2018) Operative treatment of isolated meniscus injuries in adolescent patients: a meta-analysis and review. Sports Health 10:311–316. https://doi.org/10.1177/1941738118768201
Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 27:1275–1288. https://doi.org/10.1016/j.arthro.2011.03.088
Baratz ME, Fu FH, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 14:270–275. https://doi.org/10.1177/036354658601400405
Paradowski PT, Lohmander LS, Englund M (2016) Osteoarthritis of the knee after meniscal resection: long term radiographic evaluation of disease progression. Osteoarthr Cartil 24:794–800. https://doi.org/10.1016/j.joca.2015.12.002
Stein T, Mehling AP, Welsch F et al (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 38:1542–1548. https://doi.org/10.1177/0363546510364052
Thaunat M, Archbold P, Conteduca J et al (2014) Rapid chondrolysis following an unoperated lateral meniscus tear in a young professional rugby player. Orthop Traumatol Surg Res 100:445–448. https://doi.org/10.1016/j.otsr.2014.02.007
Elkousy H, Higgins LD (2005) Zone-specific inside-out meniscal repair: technical limitations of repair of posterior horns of medial and lateral menisci. Am J Orthop 34:29–34
Krych AJ, Wu IT, Desai VS et al (2018) High rate of missed lateral meniscus posterior root tears on preoperative magnetic resonance imaging. Orthop J Sports Med 6:2325967118765722. https://doi.org/10.1177/2325967118765722
Lecouvet F, Van Haver T, Acid S et al (2018) Magnetic resonance imaging (MRI) of the knee: identification of difficult-to-diagnose meniscal lesions. Diagn Interv Imaging 99:55–64. https://doi.org/10.1016/j.diii.2017.12.005
Henning CE, Lynch MA, Clark JR (1987) Vascularity for healing of meniscus repairs. Arthroscopy 3:13–18
Barber FA, Bava ED (2012) Meniscal repair: the newest fixators. Sports Med Arthrosc Rev 20:95–100. https://doi.org/10.1097/JSA.0b013e3182460d1f
Goodwillie AD, Myers K, Sgaglione NA (2014) Current strategies and approaches to meniscal repair. J Knee Surg 27:423–434. https://doi.org/10.1055/s-0034-1384673
Miller MD, Kline AJ, Gonzales J, Beach WR (2002) Pitfalls associated with FasT-Fix meniscal repair. Arthroscopy 18:939–943
Seo SS, Kim CW, Lee CR, Park DH, Kwon YU, Kim OG, Kim CK (2019) Second-look arthroscopic findings and clinical outcomes of meniscal repair with concomitant anterior cruciate ligament reconstruction: comparison of suture and meniscus fixation device. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-019-03323-3
Warth LC, Bollier MJ, Hoffman DF, Cummins JS, Hall MM (2016) New complication associated with all-inside meniscal repair device: ultrasound-aided diagnosis and operative localization of foreign body reaction. Orthop J Sports Med 4(9):2325967116664882. https://doi.org/10.1177/2325967116664882(eCollection 2016 Sep)
Westermann RW, Duchman KR, Amendola A et al (2017) All-inside versus inside-out meniscal repair with concurrent anterior cruciate ligament reconstruction: a meta-regression analysis. Am J Sports Med 45:719–724. https://doi.org/10.1177/0363546516642220
Terai S, Hashimoto Y, Yamasaki S, Takahashi S, Shimada N, Nakamura H (2019) Prevalence, development, and factors associated with cyst formation after meniscal repair with the all-inside suture device. Arch Orthop Trauma Surg 139(9):1261–1268. https://doi.org/10.1007/s00402-019-03176-w
Cuéllar A, Cuéllar R, Díaz Heredia J et al (2018) The all-inside meniscal repair technique has less risk of injury to the lateral geniculate artery than the inside-out repair technique when suturing the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 26:793–798. https://doi.org/10.1007/s00167-017-4490-1
Sanz-Pérez M, García-Germán D, Ruiz-Díaz J et al (2015) 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 59:165–171. https://doi.org/10.1016/j.recot.2014.08.003
Ahn JH, Kim K-I, Wang JH et al (2015) Arthroscopic repair of bucket-handle tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 23:205–210. https://doi.org/10.1007/s00167-013-2764-9
Ahn JH, Lee SH, Kim KI, Nam J (2018) Arthroscopic meniscus repair for recurrent subluxation of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 26:787–792. https://doi.org/10.1007/s00167-017-4420-2
Ahn JH, Oh I (2006) Arthroscopic all-inside lateral meniscus suture using posterolateral portal. Arthroscopy 22:572.e1–572.e4. https://doi.org/10.1016/j.arthro.2005.07.031
Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R (2014) Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 42(4):921–926. https://doi.org/10.1177/0363546514522394
Fillingham YA, Riboh JC, Erickson BJ et al (2017) Inside-out versus all-inside repair of isolated meniscal tears: an updated systematic review. Am J Sports Med 45:234–242. https://doi.org/10.1177/0363546516632504
Grant JA, Wilde J, Miller BS, Bedi A (2012) Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. Am J Sports Med 40:459–468. https://doi.org/10.1177/0363546511411701
Hupperich A, Salzmann GM, Niemeyer P, Feucht M, Eberbach H, Südkamp NP, Kühle J (2018) What are the factors to affect outcome and healing of meniscus bucket handle tears? Arch Orthop Trauma Surg 138(10):1365–1373. https://doi.org/10.1007/s00402-018-2989-7
Morgan CD (1991) The “all-inside” meniscus repair. Arthroscopy 7:120–125
Anderson AW, LaPrade RF (2009) Common peroneal nerve neuropraxia after arthroscopic inside-out lateral meniscus repair. J Knee Surg 22:27–29
Ishida K, Kuroda R, Sakai H et al (2006) Rapid chondrolysis after arthroscopic partial lateral meniscectomy in athletes: a case report. Knee Surg Sports Traumatol Arthrosc 14:1266–1269. https://doi.org/10.1007/s00167-006-0091-0
Mariani PP, Garofalo R, Margheritini F (2008) Chondrolysis after partial lateral meniscectomy in athletes. Knee Surg Sports Traumatol Arthrosc 16:574–580. https://doi.org/10.1007/s00167-008-0508-z
Sonnery-Cottet B, Archbold P, Thaunat M et al (2014) Rapid chondrolysis of the knee after partial lateral meniscectomy in professional athletes. Knee 21:504–508. https://doi.org/10.1016/j.knee.2014.01.001
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One or more of the authors has declared the following potential conflict of interest or source of funding: Bertrand Sonnery-Cottet is a paid consultant, receives royalties and research support, and has made presentations for Arthrex. Mathieu Thaunat is a Consultant for Arthrex.
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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 no. IRB COS-RGDS-2019-03-004-THAUNAT-M and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Investigation performed at Centre Orthopédique Santy, Hopital privé Jean Mermoz Ramsay Santé, FIFA Medical Centre of Excellence, Lyon, France.
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Thaunat, M., Ingale, P.S., Vieira, T.D. et al. Posterolateral approach for all-inside arthroscopic lateral meniscus repair in athletes: technique and outcomes. Arch Orthop Trauma Surg 141, 1101–1108 (2021). https://doi.org/10.1007/s00402-020-03504-5
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DOI: https://doi.org/10.1007/s00402-020-03504-5