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Second-look arthroscopic assessment and clinical results of modified pull-out suture for posterior root tear of the medial meniscus.

Cho JH, Song JG - Knee Surg Relat Res (2014)

Bottom Line: The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration.The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2.Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.

ABSTRACT

Purpose: To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings.

Materials and methods: From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores.

Results: There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2.

Conclusions: We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

No MeSH data available.


Related in: MedlinePlus

Arthroscopic image showing a complete root tear of the posterior horn of the medial meniscus (MM) through the anterolateral portal in the left knee. MFC: medial femoral condyle.
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Figure 1: Arthroscopic image showing a complete root tear of the posterior horn of the medial meniscus (MM) through the anterolateral portal in the left knee. MFC: medial femoral condyle.

Mentions: Modified pull-out suture repair was performed using a technique described by Cho6). After routine arthroscopic examination of the knee joint, a posteromedial portal was established using the transillumination technique. After identifying the location of a lesion (Fig. 1), the footprint was confirmed by removing the cartilage of the tibial plateau that was attached to the posterior root of the medial meniscus, using a curette and a round bur inserted through the posteromedial portal. Under arthroscopic visualization through the anterolateral portal, the anterior cruciate ligament tibial drilling guide (Linvatec, Largo, FL, USA) was introduced through the posteromedial portal. The tip of the guide was placed at the decorticated footprint of the posterior root of the medial meniscus. After making a 2-cm vertical incision on the anteromedial cortex of the proximal tibia, the sleeve of the guide with 40°-45° was fixed. The entry point at the tibial anteromedial cortex was aimed at the midportion of the tibial shaft and approximately 2-3 cm anterior to the medial collateral ligament insertion. A guide pin was drilled through the sleeve from the anteromedial cortex of the proximal tibia to the posterior root tear site of the medial meniscus. A tibial tunnel was made using a 6 mm reamer (Linvatec) to extend from the anteromedial cortex of the proximal tibia to the footprint of the posterior root of the medial meniscus. While visualizing from the anterolateral portal, a crescent-shaped suture hook (Linvatec) loaded with a No. 0 PDS (Ethicon, Somerville, NJ, USA) suture material was inserted through the posteromedial portal (Fig. 2). The detached root portion of the medial meniscus posterior horn was penetrated by the sharp tip of the crescent-shaped suture hook from the femoral surface to the tibial surface of the meniscus in a vertical direction. Then, some portion of the total length of the PDS was advanced through the suture hook into the intra-articular space through the tibial tunnel with a grasper. At the same time, the one end of the suture was retrieved through the tibia using the already inserted grasper (Fig. 3), and the suture hook was withdrawn upward. Subsequently, the other end of the PDS strand was retrieved through the tibial tunnel with a grasper. In the same manner, additional 1 PDS suture strand was advanced through the posterior horn of the medial meniscus into the tibial tunnel with a grasper. By pulling the ends of the suture under adequate tension, the posterior root of the medial meniscus could be reduced and stabilized under adequate tension (Fig. 4). Subsequently, the suture strands were post-tied and fixed with a 6.5 mm a cancellous bone screw and a smooth washer to the anterior cortex of the tibia.


Second-look arthroscopic assessment and clinical results of modified pull-out suture for posterior root tear of the medial meniscus.

Cho JH, Song JG - Knee Surg Relat Res (2014)

Arthroscopic image showing a complete root tear of the posterior horn of the medial meniscus (MM) through the anterolateral portal in the left knee. MFC: medial femoral condyle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061404&req=5

Figure 1: Arthroscopic image showing a complete root tear of the posterior horn of the medial meniscus (MM) through the anterolateral portal in the left knee. MFC: medial femoral condyle.
Mentions: Modified pull-out suture repair was performed using a technique described by Cho6). After routine arthroscopic examination of the knee joint, a posteromedial portal was established using the transillumination technique. After identifying the location of a lesion (Fig. 1), the footprint was confirmed by removing the cartilage of the tibial plateau that was attached to the posterior root of the medial meniscus, using a curette and a round bur inserted through the posteromedial portal. Under arthroscopic visualization through the anterolateral portal, the anterior cruciate ligament tibial drilling guide (Linvatec, Largo, FL, USA) was introduced through the posteromedial portal. The tip of the guide was placed at the decorticated footprint of the posterior root of the medial meniscus. After making a 2-cm vertical incision on the anteromedial cortex of the proximal tibia, the sleeve of the guide with 40°-45° was fixed. The entry point at the tibial anteromedial cortex was aimed at the midportion of the tibial shaft and approximately 2-3 cm anterior to the medial collateral ligament insertion. A guide pin was drilled through the sleeve from the anteromedial cortex of the proximal tibia to the posterior root tear site of the medial meniscus. A tibial tunnel was made using a 6 mm reamer (Linvatec) to extend from the anteromedial cortex of the proximal tibia to the footprint of the posterior root of the medial meniscus. While visualizing from the anterolateral portal, a crescent-shaped suture hook (Linvatec) loaded with a No. 0 PDS (Ethicon, Somerville, NJ, USA) suture material was inserted through the posteromedial portal (Fig. 2). The detached root portion of the medial meniscus posterior horn was penetrated by the sharp tip of the crescent-shaped suture hook from the femoral surface to the tibial surface of the meniscus in a vertical direction. Then, some portion of the total length of the PDS was advanced through the suture hook into the intra-articular space through the tibial tunnel with a grasper. At the same time, the one end of the suture was retrieved through the tibia using the already inserted grasper (Fig. 3), and the suture hook was withdrawn upward. Subsequently, the other end of the PDS strand was retrieved through the tibial tunnel with a grasper. In the same manner, additional 1 PDS suture strand was advanced through the posterior horn of the medial meniscus into the tibial tunnel with a grasper. By pulling the ends of the suture under adequate tension, the posterior root of the medial meniscus could be reduced and stabilized under adequate tension (Fig. 4). Subsequently, the suture strands were post-tied and fixed with a 6.5 mm a cancellous bone screw and a smooth washer to the anterior cortex of the tibia.

Bottom Line: The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration.The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2.Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.

ABSTRACT

Purpose: To identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings.

Materials and methods: From January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores.

Results: There were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2.

Conclusions: We achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.

No MeSH data available.


Related in: MedlinePlus