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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

Iftach Hetsroni, MD, Associate Prof.
ISRAEL

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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

Iftach Hetsroni, MD, Associate Prof., ISRAEL Yakir Carmeli, B.Ed., ISRAEL Shiri Bretter, M.ed, ISRAEL Gabriel Marino, MD, ISRAEL Ayelet Gonen-Vonkler, BA, ISRAEL Altaieb Agbaria, MD, ISRAEL Gideon Mann, MD, Prof., ISRAEL Nissim Ohana, MD, ISRAEL Moshe Ayalon, PhD, ISRAEL

Sports Medicine Injuries Service, Orthopedic Department, Meir General Hospital and Wingate College for Sports Sciences at Netanya , Kfar Saba and Netanya, ISRAEL

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Sports Medicine

Orthopaedic Sports Medicine Outcome Studies

Diagnosis / Condition

Tears

Treatment / Technique

Arthroscopy Sutures / Knots / Anchors

Anatomic Location

Knee

Anatomic Structure

Meniscus Medial Lateral

Summary: Gold-standard inside-out meniscus repair technique results in overall 10% failure for lateral and 15% for medial meniscus. This finding, in addition to regaining closely preinjury activity levels and landing kinematics in the majority of the patients support the concept "Save the meniscus".

Objective

To identify prognostic factors and improve decision-making for meniscus repair.

Methods

During a decade (2013-2022), a gold-standard inside-out meniscus suture technique with posteromedial and posterolateral protective windows was adopted for all meniscus tears involving the peripheral half-width and requiring 3 or more sutures (i.e. tear length > 10mm). Short tears requiring 1-2 sutures and repair of radial tears were excluded from this analysis. Data collected included patient and injury characteristics and intraoperative findings and procedures. Outcomes at minimum 2 year follow-up included activity level scores, IKDC-subjective, KOOS, and knee motion and laxity. In men with healthy contralateral limb, motion-analysis laboratory setup was used to measure hopping, drop jump kinematics, and knee muscle torque.

Results

Between 2013 and 2020, 81 menisci (59 medial and 22 lateral) in 79 patients (69 male and 12 female) underwent inside-out repair using 3-13 sutures, of which 34 had concomitant ACL reconstruction (ACLR). Seven patients (7 menisci repair, 2 lateral and 5 medial) were not available for follow-up examination. Delay injury-surgery ranged 2 weeks - 36 months. Age at operation ranged 14 - 55 years. Follow-up was 2 - 8 years. Ten patients (10 menisci) of which 8 were medial and 2 lateral underwent re-arthroscopy for resection of the repaired fragment (accounting for 15% of the medial and 10% of the lateral menisci repaired), and these cases did not differ in patient age or tear chronicity compared to patients who did not undergo repeated arthroscopy for meniscus resection. In cases of concomitant ACLR, failure of the meniscus repair was dramatically lower compared to isolated meniscus repair (3% vs. 27%, p=0.03). Smoking and articular cartilage lesions (Grade II-III) did not affect the repair. At follow-up, Tegner was median 6 (range 4-10) compared to 7 (range 5-10) at preinjury. IKDC-subjective was 92±7 and slightly lower in females than males (88±9 vs. 93±6, p=0.05). KOOS-ADL, KOOS-Pain, and KOOS-Sports were inversely associated with chronicity of the tear (r=-0.3, p=0.05) but not with number of sutures. Motion analysis showed closely symmetric landing kinematics and knee muscle torques.
*Comment: Minimum 2 year follow-up in this study will eventually evaluate over a hundred patients and menisci operated between 2013 and 2022.

Conclusions

Gold-standard inside-out meniscus repair technique results in overall 10% re-arthroscopy to meniscectomize unhealed repaired fragment for lateral and 15% for medial meniscus. Lower failure rates are observed in concomitant ACLR, while isolated long meniscus repair can result in over 20% failure rates, particularly for medial meniscus. These findings in addition to regaining closely preinjury activity levels, functional scores, and objective landing kinematics after this operation in the majority of the patients can justify the concept "Save the meniscus", and this principle is applicable also to populations over 40 and 50 years of age when handling long peripheral meniscus tears with repairable meniscus tissue of good quality, particularly with concomitant ACLR. Regression analyses or machine-learning algorithms at the completion of this study may enable elaborating patient-specific decision-making protocol which can be presented not only to recreational but also to professional athletes where "Time is money" concept should as well be accounted for.

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Clinical Outcomes Of Lateral Meniscus Posterior Root Repair In The Acl-Reconstructed Knees ePoster Presentation Lika Dzidzishvili, MD, SPAIN Irene Isabel López-Torres, MD, PhD, SPAIN David Sáez, MD, SPAIN Antonio Hernández Diez, MD, SPAIN Emilio Calvo, MD, PhD, MBA, SPAIN
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Large Posterolateral Cartilage Slope Is a Risk Factor for Noncontact ACL Injury ePoster Presentation Kensuke Hotta, MD, JAPAN Mitsuru Hanada, MD, PhD, JAPAN Kazuki Nomoto, MD, JAPAN Yukihiro Matsuyama, MD, PhD, Prof., JAPAN
Evolution in the Indication of Surgical Treatment on Repairable Meniscal Tears and Their Treatment in the Last 20 Years ePoster Presentation Alejandro Espejo-Reina, MD, MSc, SPAIN Enrique Sevillano-Perez, MD, SPAIN María Josea Espejo-Reina, MD, SPAIN Maximiano Lombardo-Torre, SPAIN Miguel Verdejo-Parrilla, MD, MSc, SPAIN Alejandro Espejo-Baena, MD, SPAIN
Predictors of The Ten-Year Patient-Reported Outcome Measures After Collagen Meniscus Implant (CMI) For Partial Meniscus Deficiency ePoster Presentation Alberto Grassi, PhD, ITALY Gian Andrea Lucidi, MD, ITALY Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, ITALY Giacomo Dal Fabbro, ITALY Nicola Pizza, MD, ITALY Marianna Viotto, ITALY Luca Ambrosini, MD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Clinical Result of the Two Stage ACL Reconstruction and Meniscus Allograft Transplantation, Is It Comparable To The Meniscus Allograft Transplantation Alone? ePoster Presentation S. Ali Ghasemi, MD, UNITED STATES Shervin Rashidinia, MD, IRAN, ISLAMIC REPUBLIC OF Adel Mahjoub, MD, UNITED STATES Lawrence S. Miller, UNITED STATES
Evolution in the Indication of Surgical Treatment on Degenerative Meniscal Tears In the Last 20 Years ePoster Presentation Alejandro Espejo-Reina, MD, MSc, SPAIN Enrique Sevillano-Perez, MD, SPAIN María Josea Espejo-Reina, MD, SPAIN Maximiano Lombardo-Torre, SPAIN Miguel Verdejo-Parrilla, MD, MSc, SPAIN Alejandro Espejo-Baena, MD, SPAIN
Good Clinical Results And Patient Satisfaction After Arthroscopic Repair of Large Meniscus Bucket Handle Tears of the Knee ePoster Presentation Johannes Pawelczyk, cand. med., GERMANY Rainer Siebold, Prof. Dr. med., GERMANY
Do All Meniscal Ramp Lesions Require Repair? A Prospective Study Of Ramp Lesions with Concomitant ACL Injury? ePoster Presentation Silvampatti Ramasamy Sundararajan, MS(Orth), INDIA Meet Mehta, MD orthopaedics, INDIA Terence Dsouza, MS, DNB, FNB, INDIA Ramakanth Rajagopalakrishnan, D.ortho, DNB(ortho).D.SICOT, INDIA S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, INDIA
No Dynamic Extrusion of the Medial Meniscus in Ultrasound Examination in Patients with Confirmed Root Tear Lesion ePoster Presentation Katrin Karpinski, MD, GERMANY Theresa Diermeier, MD, GERMANY Lukas Willinger, MD, GERMANY Andreas B. Imhoff, MD, Prof. Emeritus, GERMANY Andrea E. Achtnich, Assoc. Prof., GERMANY Wolf Petersen, MD, Prof, GERMANY
Meniscal Repair Is A Solution In “Older” Patients: A Systematic Literature Review with Meta-Analysis ePoster Presentation Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, CANADA Chris Saunders, PhD MBChB BMedSci (Hons), UNITED KINGDOM Matthew Sedgwick, Ph.D., UNITED KINGDOM
Cross-Sectional Effects of Isolated Meniscal Tears on In Vivo Biomechanics of the Knee: A Systematic Review Of Motion Analysis Studies ePoster Presentation Enzo Salviato Mameri, MD, MSc, BRAZIL Garrett Jackson, MD, UNITED STATES Harkirat Jawanda, BS, UNITED STATES Jonathan A Gustafson, PhD, UNITED STATES Leonardo Metsavaht, MD PhD, BRAZIL Jorge Chahla, MD, PhD, UNITED STATES
Meniscal Ramp Lesion, A Contact Characteristic Analysis In Cadaver ePoster Presentation Artit Boonrod, MD, THAILAND Khananut Jaruwanneechai, MD, THAILAND Sermsak Sumanont, MD, THAILAND Nadhaporn Saengpetch, THAILAND
Lateral Meniscal Posterior Root Repair with Concurrent ACL Reconstruction: Patient-Report Outcomes and Risk Factors for Failure ePoster Presentation Evan W. James, MD, UNITED STATES Per-Henrik Randsborg, MD, PhD, NORWAY Joseph T. Nguyen, MPH, UNITED STATES Anil S. Ranawat, MD, UNITED STATES Answorth A. Allen, MD, UNITED STATES Scott A. Rodeo, MD, UNITED STATES Robert G. Marx, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Clinical Outcomes with Meniscal Repair, Between 2019-2020, Viña del Mar, Chile (Preliminary Study) ePoster Presentation Sergio Patricio González Rouse, MD, MSc, MBA, CHILE Raul Roz, MD, CHILE Horacio Alejandro Carvajal Araya, MD, CHILE
Anatomical Survival of the Graft After Medial Meniscal Allograft Transplantation is Better in Patients with Lower-Grade ICRS Lesions: MRI-Based Objective Evaluation ePoster Presentation Seong-Il Bin, MD, PhD, KOREA, REPUBLIC OF Jong-Min Kim, MD, PhD, KOREA, REPUBLIC OF Bum-Sik Lee, MD, KOREA, REPUBLIC OF seonjong Lee, MD, KOREA, REPUBLIC OF Ju-Ho Song, MD, KOREA, REPUBLIC OF Ho Yeon Kim, MD, KOREA, REPUBLIC OF Jaejung Ryu, MD, KOREA, REPUBLIC OF
Polyurethane Meniscal Scaffold In Postmeniscectomy Syndrome Presented Good Clinical Results At Minimum 10-Years Of Follow-Up ePoster Presentation Maximiliano Ibañez, MD, SPAIN Raúl Torres-Claramunt, PhD, SPAIN Pablo E. Gelber, MD, PhD, SPAIN Simone Perelli, MD,PhD, SPAIN Daniel Pérez-Prieto, MD, SPAIN Àngel Masferrer-Pino, MD PhD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN

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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

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"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

"Repair Or Resect? That Is The Question!" Inside-Out Repair Of Long Meniscus Tears Is Used to Identify Prognostic Factors and Improve Decision-Making

Objective

Methods

Results

Conclusions

More 2023 ISAKOS Congress Content