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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

Images of the knee with complete healing. (A) T2-coronal magnetic resonance image showing a root tear of the posterior horn of the medial meniscus in the left knee. (B) Arthroscopic photograph showing the complete root tear of the posterior horn of the medial meniscus. (C) Arthroscopic photograph showing firm reattachment of the posterior root of the medial meniscus to the tibial tunnel site. (D) Second look arthroscopic photograph showing complete healing of the root tear site of the medial meniscus.
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Figure 5: Images of the knee with complete healing. (A) T2-coronal magnetic resonance image showing a root tear of the posterior horn of the medial meniscus in the left knee. (B) Arthroscopic photograph showing the complete root tear of the posterior horn of the medial meniscus. (C) Arthroscopic photograph showing firm reattachment of the posterior root of the medial meniscus to the tibial tunnel site. (D) Second look arthroscopic photograph showing complete healing of the root tear site of the medial meniscus.

Mentions: Among the 20 patients who underwent root repair, 13 were available for second-look arthroscopy performed by one orthopaedic surgeon at our hospital. The healing status of the repaired meniscus was classified according to the method of Seo et al.5) (complete healing, lax healing, scar tissue healing, and failed healing). Complete healing was defined as meniscal continuity with no cleft, no lifting on probing, and normal meniscal tension at the repair site (Fig. 5). Lax healing was defined as apparent increase in meniscus lifting and mobility on probing with good meniscal continuity (Fig. 6). Scar tissue healing was defined as a meniscus that could be easily raised on probing and showed no true meniscal continuity except for some connecting scar tissue fibers between the tibial attachment site and the posterior horn of the medial meniscus (Fig. 7). Finally, failed healing was defined as no continuity and no evidence of meniscal healing at the repair site (Fig. 8). In addition, chondral lesions were evaluated during second-look arthroscopy using arthroscopic photographs and described according to ICRS grade7).


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)

Images of the knee with complete healing. (A) T2-coronal magnetic resonance image showing a root tear of the posterior horn of the medial meniscus in the left knee. (B) Arthroscopic photograph showing the complete root tear of the posterior horn of the medial meniscus. (C) Arthroscopic photograph showing firm reattachment of the posterior root of the medial meniscus to the tibial tunnel site. (D) Second look arthroscopic photograph showing complete healing of the root tear site of the medial meniscus.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Images of the knee with complete healing. (A) T2-coronal magnetic resonance image showing a root tear of the posterior horn of the medial meniscus in the left knee. (B) Arthroscopic photograph showing the complete root tear of the posterior horn of the medial meniscus. (C) Arthroscopic photograph showing firm reattachment of the posterior root of the medial meniscus to the tibial tunnel site. (D) Second look arthroscopic photograph showing complete healing of the root tear site of the medial meniscus.
Mentions: Among the 20 patients who underwent root repair, 13 were available for second-look arthroscopy performed by one orthopaedic surgeon at our hospital. The healing status of the repaired meniscus was classified according to the method of Seo et al.5) (complete healing, lax healing, scar tissue healing, and failed healing). Complete healing was defined as meniscal continuity with no cleft, no lifting on probing, and normal meniscal tension at the repair site (Fig. 5). Lax healing was defined as apparent increase in meniscus lifting and mobility on probing with good meniscal continuity (Fig. 6). Scar tissue healing was defined as a meniscus that could be easily raised on probing and showed no true meniscal continuity except for some connecting scar tissue fibers between the tibial attachment site and the posterior horn of the medial meniscus (Fig. 7). Finally, failed healing was defined as no continuity and no evidence of meniscal healing at the repair site (Fig. 8). In addition, chondral lesions were evaluated during second-look arthroscopy using arthroscopic photographs and described according to ICRS grade7).

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