Clinical Orthopaedics and Related Research®

, Volume 468, Issue 5, pp 1209–1213 | Cite as

Outcomes of Meniscal Preservation Using All-inside Meniscus Repair Devices

Symposium: Current Issues in Knee Reconstruction

Abstract

Background

The thrust of meniscal surgery has now moved toward meniscal preservation. Repair is particularly indicated on the lateral side where the sequelae of resection are severe even in an older patient population.

Questions/purposes

The aim of this study was to analyze the success of all-inside meniscus repairs in a carefully selected patient population.

Methods

Three hundred twelve repairs were performed in 288 patients with a mean age of 32 years (range, 17–46 years). One hundred seventy-one lateral menisci and 141 medial menisci were repaired. The minimum followup was 12 months (mean, 18 months; range, 12–55 months). Medicolegal cases, major trauma, and knee dislocations were excluded. Failure was defined as persistent meniscal symptoms beyond 16 weeks, an MRI diagnosis of a nonhealed meniscal tear beyond 52 weeks, reoperation for the meniscal tear, and failure to return to the patient’s previous functional level.

Results

There were three painful capsular sutures that required removal, two cases of complex regional pain syndrome, and two deep venous thromboses. The repair failed in 6% of cases with associated ACL reconstruction and 14.1% of cases without ACL reconstruction. Repeat surgery was typically performed at a mean of 16 months (range, 1–44 months).

Conclusions

At short-term followup, all-inside meniscus repairs have good outcomes in the majority of highly selected cases, although this was a very selected cohort with a large number of associated ACL reconstructions.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Ahn JH, Lee YS, Chang JY, Chang MJ, Eun SS, Kim SM. Arthroscopic all inside repair of the lateral meniscus root tear. Knee. 2009;16:77–80.CrossRefPubMedGoogle Scholar
  2. 2.
    Allen PR, Denham RA, Swan AV. Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br. 1984;66:666–671.PubMedGoogle Scholar
  3. 3.
    Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:90–95.CrossRefPubMedGoogle Scholar
  4. 4.
    Barber FA, Schroeder FA, Oro FB, Beavis RC. FasT-Fix meniscal repair: mid-term results. Arthroscopy. 2008;24:1342–1348.CrossRefPubMedGoogle Scholar
  5. 5.
    Bargar WL, Moreland JR, Markolf KL, Shoemaker SC, Amstutz HC, Grant TT. In vivo stability testing of post-meniscectomy knees. Clin Orthop Relat Res. 1980;150:247–252.PubMedGoogle Scholar
  6. 6.
    Barrett GR, Field MH, Treacy SH, Ruff CG. Clinical results of meniscus repair in patients 40 years and older. Arthroscopy. 1998;14:824–829.CrossRefPubMedGoogle Scholar
  7. 7.
    Belzer JP, Cannon WD Jr. Meniscus tears: treatment in the stable and unstable knee. J Am Acad Orthop Surg. 1993;1:41–47.PubMedGoogle Scholar
  8. 8.
    Cabaud H, Rodkey W, Fitzwater J. Medial meniscus repairs: an experimental and morphological study. Am J Sports Med. 1981;9:129–134.CrossRefPubMedGoogle Scholar
  9. 9.
    Cannon WJ, Vittori J. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med. 1992;20:176–181.CrossRefPubMedGoogle Scholar
  10. 10.
    Cassidy R, Shaffer A. Repair of peripheral meniscus tears: a preliminary report. Am J Sports Med. 1981;9:209–214.CrossRefPubMedGoogle Scholar
  11. 11.
    Cooper DE, Arnoczky SP, Warren RF. Arthroscopic meniscal repair. Clin Sports Med. 1990;9:589–607.PubMedGoogle Scholar
  12. 12.
    Cox JS, Cordell LD. The degenerative effects of medial meniscus tears in dogs’ knees. Clin Orthop Relat Res. 1977;125:236–242.PubMedGoogle Scholar
  13. 13.
    Dandy DJ, Jackson RW. Meniscectomy and chondromalacia of the femoral condyle. J Bone Joint Surg Am. 1975;57:1116–1119.PubMedGoogle Scholar
  14. 14.
    DeHaven KE. Decision-making factors in the treatment of meniscus lesions. Clin Orthop Relat Res. 1990;252:49–54.PubMedGoogle Scholar
  15. 15.
    Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30:664–670.Google Scholar
  16. 16.
    Hamberg P, Gillquist J, Lysholm J. Suture of new and old peripheral meniscus tears. J Bone Joint Surg Am. 1983;65:193–197.PubMedGoogle Scholar
  17. 17.
    Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. Arthroscopy. 1987;3:13–18.CrossRefPubMedGoogle Scholar
  18. 18.
    Higuchi H, Kimura M, Shirakura K, Terauchi M, Takagishi K. Factors affecting long-term results after arthroscopic partial meniscectomy. Clin Orthop Relat Res. 2000;377:161–168.CrossRefPubMedGoogle Scholar
  19. 19.
    Kurosawa H, Fukubayashi T, Nakajima H. Loadbearing mode of the knee joint. Physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res. 1980;149:283–290.PubMedGoogle Scholar
  20. 20.
    Levy IM, Torzilli PA, Gould JD, Warren RF. The effect of lateral meniscectomy on motion of the knee. J Bone Joint Surg Am. 1989;71:401–406.PubMedGoogle Scholar
  21. 21.
    Logan M, Watts M, Owen J, Myers P. Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med. 2009;37:1131–1134.CrossRefPubMedGoogle Scholar
  22. 22.
    Lozano J, Ma CB, Cannon WD. All-inside meniscus repair: a systematic review Clin Orthop Relat Res. 2007;455:134–141.CrossRefPubMedGoogle Scholar
  23. 23.
    Maitra RS, Miller MD, Johnson DL. Meniscal reconstruction: Part I: indications, techniques, and graft considerations. Am J Orthop. 1999;28:213–218.PubMedGoogle Scholar
  24. 24.
    Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee: the contributions of the supporting structures: a quantitative in vitro study. J Bone Joint Surg Am. 1976;58:583–594.PubMedGoogle Scholar
  25. 25.
    Marzo JM, Gurske-DePerio J. Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med. 2009;37:124–129.CrossRefPubMedGoogle Scholar
  26. 26.
    McDermott ID, Amis AA. The consequences of meniscectomy. J Bone Joint Surg Br. 2006;88:1549–1556.PubMedGoogle Scholar
  27. 27.
    McGinty JB, Geuss LF, Marvin RA. Partial or total meniscectomy. A comparative analysis. J Bone Joint Surg Am. 1977;59:763–766.Google Scholar
  28. 28.
    Miller MD, Ritchie JR, Gomez BA, Royster RM, DeLee JC. Meniscal repair: an experimental study in the goat. Am J Sports Med. 1995;23:124–128.CrossRefPubMedGoogle Scholar
  29. 29.
    Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic meniscal repair evaluated by second-look arthroscopy. Am J Sports Med. 1991;19:632–638.CrossRefPubMedGoogle Scholar
  30. 30.
    Newman AP, Anderson DR, Daniels AU, Dales MC. Mechanics of the healed meniscus in a canine model. Am J Sports Med. 1989;17:164–175.CrossRefPubMedGoogle Scholar
  31. 31.
    Scott G, Jolly B, Henning C. Combined posterior incision and arthroscopic intraarticular repair of the meniscus: an examination of factors affecting healing. J Bone Joint Surg Am. 1986;68:847–861.PubMedGoogle Scholar
  32. 32.
    Stone KR. Meniscus replacement. Clin Sports Med. 1996;15:557–571.PubMedGoogle Scholar
  33. 33.
    Tapper EM, Hoover NW. Late results after meniscectomy. J Bone Joint Surg Am. 1969;51:517–526.PubMedGoogle Scholar
  34. 34.
    Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Relat Res. 1975;109:184–192.CrossRefPubMedGoogle Scholar
  35. 35.
    Warren RF. Meniscectomy and repair in the anterior cruciate ligament-deficient patient. Clin Orthop Relat Res. 1990;252:55–63.PubMedGoogle Scholar
  36. 36.
    Wickiewicz TL. Meniscal injuries in the cruciate-deficient knee. Clin Sports Med. 1990;9:681–694.PubMedGoogle Scholar
  37. 37.
    Wirth C. Meniscus repair. Clin Orthop Relat Res. 1981;157:153–160.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  1. 1.University College HospitalLondonUK
  2. 2.Trauma & OrthopaedicsLondonUK

Personalised recommendations