Abstract
Purpose
Symptomatic horizontal meniscal tears in young patients are a singular entity. The extent of the lesion is often large, without any injury to the knee. The meniscal tissue might be degenerative. However, a complete resection of the lesion would result in a subtotal meniscectomy. The purpose of this study was to consider the use of a meniscal repair in such patients in order to close the horizontal cleavage extending up to the avascular zone. The hypothesis was that the clinical outcomes after open meniscal repair of horizontal tears are good with a low rate of secondary meniscectomy.
Methods
Between 1998 and 2006, 28 patients (30 knees) underwent an open meniscal repair to treat symptomatic horizontal meniscal tears [6 women and 22 men, median age 25 years (16–44 years)]. The duration of symptoms was at least 12 weeks (12–72 weeks). Open meniscal repair was performed following arthroscopy. There were 14 medial and 7 lateral menisci, 10 grade 3 tears, and 11 grade 2 tears. If present (15 cases), meniscal cysts were removed using the same approach. Clinical outcomes were evaluated using KOOS and IKDC scores. The return to sporting activities and the need for a secondary meniscectomy were also assessed.
Results
Twenty-one patients were evaluated at a median follow-up of 40 months (24–101 months). Twenty returned to their preinjury level of sporting activity. The median KOOS score was 92 ± 12.9. The median subjective IKDC score was 89 ± 14.1. There were four secondary meniscectomies.
Conclusions
Open meniscal repair of complex horizontal tears extending into the avascular zone was effective at midterm follow-up in young and active patients. The meniscus was preserved in 80 % of cases. Functional results deteriorated in those older than 30 years. This entity should be differentiated from degenerative meniscal tears that often occur in patients over 50, which may be associated with osteoarthritis.
Level of evidence
Retrospective study, Level IV.
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References
Arnoczky SP, Cooper TG, Stadelmaier DM, Hannafin JA (1994) Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy 10:552–557
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
Beaufils P, Hulet C, Dhenain M, Nizard R, Nourissat G, Pujol N (2009) Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthop Traumatol Surg Res 95:437–442
Biedert RM (1993) Intrasubstance meniscal tears. Clinical aspects and the role of MRI. Arch Orthop Trauma Surg 112:142–147
Biedert RM (2000) Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods. Knee Surg Sports Traumatol Arthrosc 8:104–108
Cassard X, Verdonk R, Almqvist KF, Nourrissat G, Thoreux P, Kerdiles N, Charrois O, Katabi M, Kelberine F, Candoni P, Ait Si Selmi T, Hulet C, Billot N, Beaufils P, Bamberg A, Pujol N, Gihr D, Accadbled F (2004) Meniscal repair. Rev Chir Orthop Reparatrice Appar Mot 90:3S49–3S75
Chatain F, Robinson AH, Adeleine P, Chambat P, Neyret P (2001) The natural history of the knee following arthroscopic medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 9:15–18
Crawford K, Briggs KK, Rodkey WG, Steadman JR (2007) Reliability, validity, and responsiveness of the IKDC score for meniscus injuries of the knee. Arthroscopy 23:839–844
Crues JV III, Mink J, Levy TL, Lotysch M, Stoller DW (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164:445–448
Hantes ME, Zachos VC, Zibis AH, Papanagiotou P, Karachalios T, Malizos KN, Karantanas AH (2004) Evaluation of meniscal repair with serial magnetic resonance imaging: a comparative study between conventional MRI and indirect MR arthrography. Eur J Radiol 50:231–237
Hulet C, Souquet D, Alexandre P, Locker B, Beguin J, Vielpeau C (2004) Arthroscopic treatment of 105 lateral meniscal cysts with 5-year average follow-up. Arthroscopy 20:831–836
Kamimura T, Kimura M (2011) Repair of horizontal meniscal cleavage tears with exogenous fibrin clots. Knee Surg Sports Traumatol Arthrosc 19:1154–1157
Kim JM, Bin SI, Kim E (2009) Inframeniscal portal for horizontal tears of the meniscus. Arthroscopy 25:269–273
Kohn D, Siebert W (1989) Meniscus suture techniques: a comparative biomechanical cadaver study. Arthroscopy 5:324–327
Lozano J, Ma CB, Cannon WD (2007) All-inside meniscus repair: a systematic review. Clin Orthop Relat Res 455:134–141
Lu KH (2006) Arthroscopic meniscal repair and needle aspiration for meniscal tear with meniscal cyst. Arthroscopy 22:1367 e1361–1364
Lu KH (2003) Unusual solitary ganglion cysts of the anterior segment of the lateral meniscus. Arthroscopy 19:E16
Noyes FR, Barber-Westin SD (2000) Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older. Arthroscopy 16:822–829
Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28:88–96
Rubman MH, Noyes FR, Barber-Westin SD (1998) Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears. Am J Sports Med 26:87–95
Sarimo J, Rainio P, Rantanen J, Orava S (2002) Comparison of two procedures for meniscal cysts. A report of 35 patients with a mean follow-up of 33 months. Am J Sports Med 30:704–707
Seil R, VanGiffen N, Pape D (2009) Thirty years of arthroscopic meniscal suture: what’s left to be done? Orthop Traumatol Surg Res 95:S85–S96
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Pujol, N., Bohu, Y., Boisrenoult, P. et al. Clinical outcomes of open meniscal repair of horizontal meniscal tears in young patients. Knee Surg Sports Traumatol Arthrosc 21, 1530–1533 (2013). https://doi.org/10.1007/s00167-012-2099-y
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DOI: https://doi.org/10.1007/s00167-012-2099-y