2015 ISAKOS Biennial Congress ePoster #1360

Lateral Meniscus Repair for its Complex Tears Combined with ACL Reconstruction: A Second-Look Arthroscopic Evaluation

Ryo Iuchi, MD, Osaka, Osaka JAPAN
Konsei Shino, MD, PhD, Osaka, Osaka JAPAN
Shigeto Nakagawa, MD, Osaka, Osaka JAPAN
Take Yasuhiro, MD, PhD, Osaka, Osaka JAPAN
Shinichiro Okimura, MD, Osaka JAPAN
Tatsuo Mae, MD, PhD, Suita, Osaka JAPAN
yukioka hospital, Osaka, Osaka, JAPAN

FDA Status Cleared

Summary: Second-look arthroscopic evaluation after lateral meniscus repair of its complex tears associated with ACL injury showed excellent /good in 81%, while repairs for tears in the posterior segment was more successful than those including middle segment.

Abstract:

Introduction

Complex meniscal tears including radial / multiple ones associated with ACL injury are generally treated by meniscectomy or leaving alone during ACL reconstruction. We have been trying to meticulously repair such meniscal tears to save function of the meniscus as early as possible, while second-look arthroscopy has routinely been performed to trim unhealed portion before returning to sports activity. The purpose of this study was to evaluate the meniscus healing at the time of second-look arthroscopy after meniscal repair for those complex tears of the lateral meniscus.

Materials And Methods

From June 2005 to December 2014, 275 ACL reconstruction(ACLR)s were combined with lateral meniscus surgery. Of them, 16 cases had complex lateral meniscus tears and underwent repair at the time of ACLR. There were 11 males and 5 females with a mean age of 21 years ranging from 17 to 36. The mean period from injury to the surgery was 33 days ranging from 8 to 56. Eleven meniscal tears were located only in the posterior segment (Group P: radial tear 5, flap tear 2, complex tear 4), while 5 were extended from the middle to the posterior segment (Group MP: flap tear 1, complex tear 4). While anatomic ACLR was performed using autogenous bone-patellar tendon-bone graft (13cases) or semitendinosus tendon graft (3cases), meniscal repairs were performed with inside-out Henning suturing technique. The average number of sutures used was 6.5 ranging from 2 to 15. Postoperatively, range of motion exercise was started after 1 to 2-week immobilization. Full weight bearing was allowed at 5 to 8 weeks and running was permitted at 3-4 months. The mean interval between the repair and second-look arthroscopy was 4.9 months ranging from 3 to 8 months. For those patients, physical examinations including swelling, joint line tenderness, range of motion, McMurray test and Lachman test and the repaired menisci were performed just before the second-look arthroscopy. The healing status at the second-look arthroscopy was classified into the four categories; “excellent”, “good”, “fair” and “poor” based on the arthroscopic findings. Mann-Whitney U test to detect difference in the healing status. A value of p< 0.05 was considered statistically significant.

Results

No cases showed swelling, joint line tenderness, loss of motion, positive McMurray test and positive Lachman test. The second-look arthroscopic evaluation showed 8 menisci (50%) as excellent results, 5 (31%) as good and 3 (19%)as fair of the 16 cases. The repaired menisci in Group P presented excellent or good in 91%, while excellent or good finding was obtained in only 40% in Group MP, showing a significant difference.

Discussion

It was found that meniscus repair for its complex tears could be a strong option to save the meniscus, as our second-look evaluation showed excellent or good in 81% of the repaired menisci.
However, 60% of the repaired menisci which had involved middle segment showed fair or poor results. Thus meniscus repair for its tears extending to middle segment may need more careful postoperative management for further improvement in results, as the middle segment had lesser blood supply and greater contact stress.

Conclusion

Second-look evaluation after lateral meniscal repair associated with ACL injury showed excellent in 50% and good in 31% on the radial / multiple meniscal tears, while the meniscus repaired in the posterior segment was superior to those repaired from the middle to the posterior segment.