2015 ISAKOS Biennial Congress ePoster #1615
Second-Look Arthroscopic Results of Meniscal Repair for Longitudinal Tear in Poor Blood Supply Area With Free Synovial Graft
Akihiro Tsuchiya, MD, Funabashi, Chiba JAPAN
Izumi Kanisawa, MD, Chiba, Chiba JAPAN
Kenji Takahashi, MD, PhD, Funabashi, Chiba JAPAN
Hiroki Sakai, MD, Funabashi-City, Chiba JAPAN
Shigehiro Asai, MD, Tokyo JAPAN
Funabashi Orthopedic Hospital Sports Medicine Ceter, Funabashi, Chiba, JAPAN
FDA Status Cleared
Summary: Fifty seven meniscal longitudinal injuries in poor blood supply area have been sutured with endogenous free synovial graft that was taken from supra-patellar porch. The second-look arthroscopic assessments were done in 23cases with 25menisci. Nine menisci healed completely and 6 menisci healed incompletely. Nine menisci did not heal . The success rate of our procedure was 62.5%.
Meniscal suture is now ordinary procedure for meniscal injury. But results were not so good in poor blood supply area injury. Fibrin clot was used for as a stimulator for healing, therefor synovial graft was rarely reported as a stimulator. We have transplanted free synovial graft to injury part with meniscal suture. We introduce the procedure of free synovial graft transplantation and evaluated second-look arthroscopic results.
[Materials and method]
From 2012.6 till 2014.8, fifty seven meniscal longitudinal tear in poor blood supply area have been sutured with free synovial graft that was taken from supra-patellar porch. The width of synovial graft was 1 to 2cm and the length was as same as the length of meniscal tear. The absorbable threads were sutured in both end of the synovial graft. At first, 2 nylon loop sutures were passed through at the anterior and posterior end of the longitudinal tear, and the absorbable threads that had been sutured at the end of synovial graft were relayed. Then these sutures were tied to the meniscus. After that the ordinary inside-out or all- inside meniscal suture procedure were done. The second-look arthroscopic assessments were done in 22 cases with 24 menisci. Nine were male and 14 were female. The mean age at operation was 25.3 years old (14 to 45). The mean period between first surgery and second-look is 12.9 months (2.5 to 28). There were 18 medial meniscal tear and 6 lateral meniscal tear. In 19 cases meniscal sutures were done with ACL reconstruction simultaneously. Two menisci were done revision suture.
There was no complication during and after operation even at donor site. Nine menisci healed completely and 6 menisci healed incompletely. Nine menisci did not heal and were done re-suture or partial meniscectomy at second-look arthroscopy. The success rate of our procedure was 62.5%.
Discussion And Conclusion
The results of meniscal suture in poor blood supply area injury had been not so good. So fibrin clot was used as a stimulator for healing. But we have used free synovial graft that was taken from supra-patellar poach. Ghadially reported that a pedicle synovial flap sewn into the tear of a vascular zone and the results were good. Jitsuiki reported good healing results of meniscal lesions in the avascular portion using free synovial auto graft in rabbits. But there are no clinical results of meniscal suture in poor vascular area with free autologous synovial graft. The healing rate of meniscal suture with free synovial graft transplantation in poor blood supply area was relatively good. Endogenous synovial graft might plays as a stimulator for meniscal healing. As a treatment for meniscal tear in scares vascular area, free synovial graft transplantation must be valuable procedure.