Results Meniscal Repair

Repair v Meniscectomy

 

Stein et al Am J Sports Med 2010

- follow up of repair v partial meniscectomy for 8 years

- repair group: 96% return to preinjury activity, 20% develop OA

- partial meniscetomy: 50% return to preinjury activity, 50% develop OA

 

Shelbourne et al Am J Sports Med 2003

- repair v partial meniscectomy in ACLR

- equal results in each group

- 90% good outcome in each group

 

Outcome Repair Combined ACL / Meniscal Repair

 

Symptomatic / Clinical Failure and Meniscectomy

 

Kalliakmanis et al Arthroscopy 2008

- 280 meniscal repairs with ACLR with 2 year follow up

- 92% success FasT-Fix based on symptomatic failure / excision

- 86% RapidLoc

 

Toman et al Am J Sports Med 2009

- 77 mensical repairs combined with ACLR

- 96% success rate

- 3/77 (4%) failure at 2 years as defined by symptomatic failure / excision

 

Second Look Arthroscopy

 

Tachibana et al Am J Sports Med 2010

- second look arthroscopy after ACLR and meniscal repair in 46 patients

- 83% patients symptom free

- 74% healed, 15% incompletely healed and 11% failed

- 3/9 incomplete healing had vague knee pain

- 1/7 failed meniscus had symptoms

 

Ahn et al Am J Sports Med 2010

- ACLR + medial meniscus tear in 140 patients

- second look arthroscopy at average 3 years

- 84% complete healing

- 12.1% incomplete healing with no symptoms

- 3.6% (5/77) failed to heal and were failures

 

Feng et al Arthroscopy 2008

- ACLR + BH meniscal repair in 64 patients

- relook arthroscopy

- 90% success rate

- 82% completely healed

- 7.5% incompletely healed with joint line tenderness but otherwise asymptomatic

- 10% failed with locking symptoms (7/64)

- 4/7 failures occured in failed ACLR

 

Outcome Mensical Repair ACL Deficient Knee

 

Steenbrugge et al Int Orthop 2005

- 23 meniscal repair in ACL intact knee v 22 meniscal repair in ACL deficient knee

- 1 failure in the ACL intact group

- 4 failures in the ACL deficient group (18%)

 

Hanks et al Am J Sports Med 1990

- meniscal repair in 22 patients who were ACL deficient

- 3 failures (13%)

 

Outcome Repair Isolated Meniscal Repair in Stable Knee

 

Majewski et al Am J Sports Med 2006

- 88 isolated meniscal repairs in stable knees

- 21 clinical failures requiring partial meniscectomy (24%)

 

Eggli et al Am J Sports Med 1995

- 52 isolated meniscal repairs in ACL stable knee

- follow up 7 years

- 14/52 failed (27%)

- significantly more failures in group with resorbable sutures

 

Bak et al Acta Orthop Scand 1993

- 27 isolated bucket handle tears in ACL stable knees

- failure 10 / 27 (37%)

 

Tear Type

 

Krych et al Am J Sports Med 2010

- medial meniscal repair with ACL reconstruction 18 years or younger

- successful 84% with simple tears

- 57 - 59% success for displaced bucket handle or complex tears

 

Krych et al Am J Sports Med 2008

- isolated meniscal repair in patients 18 years or younger

- successful 80% with simple tears

- successful 68% in displaced bucket handle tears

- 13% complex tear

 

Noyes et al Am J Sports Med 2002

- 71 patients < 20 with complex avascular zone tears in patients

- meticulous inside out vertical repair

- 75% success rate

 

All Inside Implant

 

Seibold et al Arthroscopy 2007

- 113 patients with the meniscal arrow

- combined isolated and meniscal repairs with ACLR

- 28% retear requiring repeat arthroscopy and partial meniscectomy

 

Gifstad et al Am J Sports Med 2006

- 41% failure rate with Biofix Arrow

 

Barber et al Arthroscopy 2006

- success 87.5% with RapidLoc device

 

Barber et al Arthroscopy 2006

- 95% success with Biostinger

 

Kotsovolos et al Am J Sports Med 2006

- 9.8% failure rate with FasT-Fix

 

All Inside v Inside Out

 

Bryant et al Am J Sports Med 2007

- RCT of arrows v inside out suturing

- isolated repair and meniscal repairs with ACLR

- 11% failure rate in each group

- 2 arrows required surgical removal because of subcutaneous position

 

Spindler et al Am J Sports Med 2003

- prospective comparison of arrows v inside out suturing

- all in ACLR

- 88 and 89% success rates in each group

 

Failed Repair

 

Mensicus Failed Repair MRI0001Mensicus Failed Repair MRI0002

 

Miao et al Am J Sports Med 2011

- follow up of 89 repaired meniscal tears

- used arthroscopy as gold standard to see if healed or failed repair

- overall healing rate 86%

- clinical examination limited

- MRI 90% sensitive, but up to 98% specific

 

Re- repair

 

Voloshin et al Am J Sports Med 2003

- re-repair in 14 patients

- 72% survival rate