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Philippe Beaufils - One of the best experts on this subject based on the ideXlab platform.
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Meniscal Repair technique
Orthopaedics & Traumatology-surgery & Research, 2017Co-Authors: Philippe Beaufils, Nicolas PujolAbstract:Meniscal Repair aims to achieve Meniscal healing, avoiding the adverse effects of meniscectomy. Longitudinal vertical tears in a vascularized area are the reference indication. The technique generally uses hybrid all-inside implants. The outside-in technique has other indications in more anterior tears. Healing has been demonstrated on CT-arthrography and arthroscopy. Specific techniques have been developed for other pathological situations. Posterior meniscosynovial lesions in a context of chronic anterior laxity are identified by exploration of the posterior compartment, and fixed by all-inside hook suture. Horizontal lesions in young athletes can be treated by open Meniscal suture. Radial tears, when deep, can be Repaired. Root tears, when traumatic, can be treated by transosseous pullout reinsertion.
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long term outcomes of all inside Meniscal Repair
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Nicolas Pujol, P Boisrenoult, Nicolas Tardy, Philippe BeaufilsAbstract:Purpose The mean reported healing rate after Meniscal Repair is 60 % of complete healing, 25 % of partial healing and 15 % of failure. However, partially or incompletely healed menisci are often asymptomatic in the short term. It is unknown whether the function of the knee with a partially or incompletely healed meniscus is disturbed in the long term. The purpose of this study was to assess the long-term outcomes of Meniscal Repairs according to the initial rate of healing.
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platelet rich plasma for open Meniscal Repair in young patients any benefit
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Nicolas Pujol, P Boisrenoult, Etienne Salle De Chou, Philippe BeaufilsAbstract:Many studies have demonstrated that injection of various growth factors including platelet-derived growth factor could increase Meniscal cell activity and stimulate Repair. The purpose of this study was to augment Repair and promote Meniscal healing by the use of platelet-rich plasma (PRP) within horizontal cleavage Meniscal tears Repaired via an open approach. The hypothesis was that the clinical outcomes and healing process would be improved using this Meniscal healing augmentation technique. In this case–control study, 34 consecutive young patients underwent an open Meniscal Repair to treat symptomatic Grade 2 or Grade 3 horizontal Meniscal tears [median age 28 years (13–40)]. The median time between the onset of symptoms and surgery was 11.5 months (6–50). In the first group (17 consecutive patients, Group 1), a standard open Meniscal Repair was performed. In the second group (17 consecutive patients, Group 2), the same surgical Repair was performed, but platelet-rich plasma was introduced into the lesion at the end of the procedure. Clinical outcomes were evaluated using KOOS and IKDC 2000 scores. MRI was performed at 1 year after surgery for objective evaluation. At a minimum of 24 months postoperatively (mean 32.2 months, 24–40), three patients underwent subsequent meniscectomy (two in Group 1, one in Group 2). The mean KOOS distribution (pain, symptoms, daily activities, sports, quality of life) was 78.4, 86.1, 93.8, 74.4, 74.6 in Group 1, and 93.3, 90.7, 97.1, 88.8, 78.3 in Group 2 (p < 0.05 for pain and sports parameters). MRI revealed five cases with the complete disappearance of any hypersignal within the Repaired meniscus in Group 2, and none in Group 1 (p < 0.01). Open Meniscal Repair of horizontal tears extending into the avascular zone was effective at midterm follow-up in young patients. Clinical outcomes were slightly improved by the addition of PRP in this case–control study. III.
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clinical outcomes of open Meniscal Repair of horizontal Meniscal tears in young patients
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Nicolas Pujol, P Boisrenoult, Yohann Bohu, Ali Macdes, Philippe BeaufilsAbstract:Symptomatic horizontal Meniscal tears in young patients are a singular entity. The extent of the lesion is often large, without any injury to the knee. The Meniscal tissue might be degenerative. However, a complete resection of the lesion would result in a subtotal meniscectomy. The purpose of this study was to consider the use of a Meniscal Repair in such patients in order to close the horizontal cleavage extending up to the avascular zone. The hypothesis was that the clinical outcomes after open Meniscal Repair of horizontal tears are good with a low rate of secondary meniscectomy. Between 1998 and 2006, 28 patients (30 knees) underwent an open Meniscal Repair to treat symptomatic horizontal Meniscal tears [6 women and 22 men, median age 25 years (16–44 years)]. The duration of symptoms was at least 12 weeks (12–72 weeks). Open Meniscal Repair was performed following arthroscopy. There were 14 medial and 7 lateral menisci, 10 grade 3 tears, and 11 grade 2 tears. If present (15 cases), Meniscal cysts were removed using the same approach. Clinical outcomes were evaluated using KOOS and IKDC scores. The return to sporting activities and the need for a secondary meniscectomy were also assessed. Twenty-one patients were evaluated at a median follow-up of 40 months (24–101 months). Twenty returned to their preinjury level of sporting activity. The median KOOS score was 92 ± 12.9. The median subjective IKDC score was 89 ± 14.1. There were four secondary meniscectomies. Open Meniscal Repair of complex horizontal tears extending into the avascular zone was effective at midterm follow-up in young and active patients. The meniscus was preserved in 80 % of cases. Functional results deteriorated in those older than 30 years. This entity should be differentiated from degenerative Meniscal tears that often occur in patients over 50, which may be associated with osteoarthritis. Retrospective study, Level IV.
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amount of Meniscal resection after failed Meniscal Repair
American Journal of Sports Medicine, 2011Co-Authors: Nicolas Pujol, Olivier Barbier, P Boisrenoult, Philippe BeaufilsAbstract:BackgroundThe failure rate after arthroscopic Meniscal Repair ranges from 5% to 43.5% (mean, 15%) in the literature. But little is known about the amount of Meniscal tissue removed after failed Meniscal Repair.HypothesisThe volume of subsequent meniscectomy after failed Meniscal Repair is not increased when compared with the volume of meniscectomy that would have been performed if not initially Repaired.Study DesignCase series; Level of evidence, 4.MethodsFrom January 2000 to December 2009, 295 knees underwent arthroscopic Meniscal Repair for unstable peripheral vertical tears. When present (219 cases), all anterior cruciate ligament (ACL) tears underwent reconstruction. Patients with multiple ligament injuries and posterior cruciate ligament injuries were excluded from the analysis. Thirty-two medial and 5 lateral menisci underwent subsequent meniscectomy after failed Repair at a mean of 26 months postoperatively (range, 3-114 months). Five parameters were specifically evaluated: the amount of meniscecto...
Toshifumi Ozaki - One of the best experts on this subject based on the ideXlab platform.
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Meniscal Repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee flexed position
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Yoshiki Okazaki, Shin Masuda, Takayuki Furumatsu, Yusuke Kamatsuki, Yuya Kodama, Shinichi Miyazawa, Tomohito Hino, Toshifumi OzakiAbstract:The purpose of this study was to evaluate the shape and shift of the medial meniscus before and after Meniscal Repair concurrent with anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI) at 90° of knee flexion. This study included 18 patients with ACL-deficient knees without meniscus tears (group A), 11 patients with medial meniscus tears alone (group M), and 15 patients with ACL-deficient knees complicated with medial meniscus tears (group AM). The posterior segment shape was evaluated using open MRI at 90° of knee flexion preoperatively and at 3 months postoperatively. The length, height, width, and posterior extrusion of the medial meniscus and posterior tibiofemoral distance were measured. These measurements were compared between the three groups. On preoperative MRI, a significant difference was observed in the posterior extrusion of the medial meniscus (group A, 1.2 ± 0.5 mm; group M, 1.7 ± 0.3 mm; group AM, 4.1 ± 1.5 mm, p < 0.001). All parameters did not differ between the three groups on postoperative MRI. In addition, the posterior width and extrusion of the medial meniscus were decreased significantly after Meniscal Repair concurrent with ACL reconstruction. This study demonstrated that the medial meniscus shifted posteriorly at 90° of knee flexion in ACL-deficient knees complicated with medial meniscus tears. Medial Meniscal Repair concurrent with ACL reconstruction improved the deformed morphology and posterior extrusion. MRI measurements of the posterior extrusion at the knee-flexed position may be clinically useful to assess the functional improvement of the medial meniscus following Meniscal Repair combined with ACL reconstruction. III.
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Meniscal Repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee flexed position
Knee Surgery Sports Traumatology Arthroscopy, 2019Co-Authors: Yoshiki Okazaki, Shin Masuda, Takayuki Furumatsu, Yusuke Kamatsuki, Yuya Kodama, Shinichi Miyazawa, Tomohito Hino, Toshifumi OzakiAbstract:PURPOSE: The purpose of this study was to evaluate the shape and shift of the medial meniscus before and after Meniscal Repair concurrent with anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI) at 90° of knee flexion. METHODS: This study included 18 patients with ACL-deficient knees without meniscus tears (group A), 11 patients with medial meniscus tears alone (group M), and 15 patients with ACL-deficient knees complicated with medial meniscus tears (group AM). The posterior segment shape was evaluated using open MRI at 90° of knee flexion preoperatively and at 3 months postoperatively. The length, height, width, and posterior extrusion of the medial meniscus and posterior tibiofemoral distance were measured. These measurements were compared between the three groups. RESULTS: On preoperative MRI, a significant difference was observed in the posterior extrusion of the medial meniscus (group A, 1.2 ± 0.5 mm; group M, 1.7 ± 0.3 mm; group AM, 4.1 ± 1.5 mm, p CONCLUSIONS: This study demonstrated that the medial meniscus shifted posteriorly at 90° of knee flexion in ACL-deficient knees complicated with medial meniscus tears. Medial Meniscal Repair concurrent with ACL reconstruction improved the deformed morphology and posterior extrusion. MRI measurements of the posterior extrusion at the knee-flexed position may be clinically useful to assess the functional improvement of the medial meniscus following Meniscal Repair combined with ACL reconstruction.
Robert F Laprade - One of the best experts on this subject based on the ideXlab platform.
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Meniscal Repair the current state and recent advances in augmentation
Journal of Orthopaedic Research, 2021Co-Authors: Sonia Bansal, Jorge Chahla, Robert F Laprade, Edward R Floyd, Michael A Kowalski, Elizabeth Aikman, Philip Elrod, Kyley Burkey, Suzanne A Maher, Jennifer L RobinsonAbstract:Meniscal injuries represent one of the most common orthopaedic injuries. The most frequent treatment is partial resection of the meniscus, or meniscectomy, which can affect joint mechanics and health. For this reason, the field has shifted gradually towards suture Repair, with the intent of preservation of the tissue. "Save the Meniscus" is now a prolific theme in the field; however, Meniscal Repair can be challenging and ineffective in many scenarios. The objectives of this review are to present the current state of surgical management of Meniscal injuries and to explore current approaches being developed to enhance Meniscal Repair. Through a systematic literature review, we identified Meniscal tear classifications and prevalence, approaches being used to improve Meniscal Repair, and biological- and material- based systems being developed to promote Meniscal healing. We found that biologic augmentation typically aims to improve cellular incorporation to the wound site, vascularization in the inner zones, matrix deposition, and inflammatory relief. Furthermore, materials can be used, both with and without contained biologics, to further support matrix deposition and tear integration, and novel tissue adhesives may provide the mechanical integrity that the meniscus requires. Altogether, evaluation of these approaches in relevant in vitro and in vivo models provides new insights into the mechanisms needed to salvage Meniscal tissue, and along with regulatory considerations, may justify translation to the clinic. With the need to restore long-term function to injured menisci, biologists, engineers, and clinicians are developing novel approaches to enhance the future of robust and consistent Meniscal reparative techniques. This article is protected by copyright. All rights reserved.
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comparable outcomes after bucket handle Meniscal Repair and vertical Meniscal Repair can be achieved at a minimum 2 years follow up
American Journal of Sports Medicine, 2017Co-Authors: Jorge Chahla, Gilbert Moatshe, Mark E Cinque, Jonathan A Godin, Alexander R Vap, Robert F LapradeAbstract:Background:Meniscal tears can lead to significant pain and disability, necessitating surgical treatment. Nondisplaced vertical tears are usually smaller in size and can be Repaired in most cases; however, bucket-handle tears are usually larger and displaced, and the Repair of these tears can be challenging.Purpose/Hypothesis:The purpose was to report the outcomes after inside-out vertical mattress suture Meniscal Repair of bucket-handle tears and to compare these outcomes with those of patients who underwent Repair of nondisplaced vertical Meniscal tears with a minimum of 2 years’ follow-up. The hypothesis was that the outcomes of bucket-handle tear Repair would be comparable with those of nondisplaced vertical Meniscal tear Repair.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent inside-out Repair of a bucket-handle Meniscal tear or a nondisplaced vertical Meniscal tear with a minimum 2 years’ follow-up were included in this study. Patients were excluded if they had a diagnos...
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outcomes after biologically augmented isolated Meniscal Repair with marrow venting are comparable with those after Meniscal Repair with concomitant anterior cruciate ligament reconstruction
American Journal of Sports Medicine, 2017Co-Authors: Chase S Dean, Jorge Chahla, Lauren M Matheny, Justin J Mitchell, Robert F LapradeAbstract:Background:Meniscal Repair in the setting of anterior cruciate ligament (ACL) reconstruction has demonstrated superior outcomes compared with isolated Meniscal Repair. Limited evidence exists for t...
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inside out Meniscal Repair medial and lateral approach
Arthroscopy techniques, 2016Co-Authors: Jorge Chahla, Chase S Dean, Raphael Serra Cruz, Tyler R Cram, Robert F LapradeAbstract:Preservation of Meniscal tissue has been proven to be the best approach in most cases of Meniscal tears. Currently available techniques for treating a peripheral Meniscal tear include inside-out, outside-in, and all-inside techniques. Each of these techniques present potential advantages and disadvantages. Despite technologic advances in all-inside devices, because of implant-related complications, cost concerns, and device availability, the inside-out technique is still the preferred method among many surgeons. Although the inside-out Repair technique is considered more technically demanding and requires additional incisions, it has several advantages such as the possibility for an increased number of sutures, creating a stronger construct, and greater versatility in their placement. This article describes the inside-out Meniscal Repair technique with its corresponding posterolateral and posteromedial surgical approaches.
David R. Diduch - One of the best experts on this subject based on the ideXlab platform.
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platelet rich plasma in Meniscal Repair does augmentation improve surgical outcomes
Clinical Orthopaedics and Related Research, 2015Co-Authors: Justin W Griffin, David R. Diduch, Michael M Hadeed, Brian C Werner, Eric W Carson, Mark D MillerAbstract:Background Increased contact stresses after meniscectomy have led to an increased focus on Meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in Meniscal Repair.
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Meniscal Repair indications and techniques
Journal of Knee Surgery, 2010Co-Authors: Kimberly A Turman, David R. DiduchAbstract:Meniscal tears are exceedingly common. Because the meniscus serves many vital functions to the knee joint, the preservation of Meniscal tissue through Meniscal Repair is ideal. However, not all Meniscal tears are amenable to Repair, and each case must be critically assessed for Repair suitability. It has been well documented that Meniscal healing is enhanced in the setting of concurrent anterior cruciate ligament (ACL) reconstruction. This may influence the indications for Repair, as well as the Repair technique. Meniscal Repair techniques have evolved over time from initial open Repairs to inside-out and outside-in suture Repairs to newer all-inside Repair devices. The current gold standard remains inside-out vertical mattress suture Repairs. All-inside Repairs are best reserved for special circumstances, such as in the setting of concurrent ACL reconstruction.
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deteriorating outcomes after Meniscal Repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction increased failure rate with long term follow up
American Journal of Sports Medicine, 2005Co-Authors: Gregory P Lee, David R. DiduchAbstract:BackgroundAn increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable Meniscal Repair and minimal invasiveness.HypothesisThe Meniscus Arrow is comparable to conventional inside-out suture Repair in accomplishing long-term healing of Meniscal tears.Study DesignCase series; Level of evidence, 4.MethodsThis study is an extended follow-up of an original series of 32 patients withoutcomes analysis. All patients underwent Meniscal Repair with exclusive use of the arrow. All Repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction. Follow-up assessment included physical examination, arthrometry, the International Knee Documentation Committee instrument, and the Knee Disorders Subjective History visual analog scale. Intermediate follow-up at a mean of 2.3 years yielded a success rate of 90.6%. The me...
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outcomes after Meniscal Repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction
Arthroscopy, 2002Co-Authors: Sanjitpal S Gill, David R. DiduchAbstract:Abstract Purpose: To determine the healing rate of Meniscal Repair using the Meniscus Arrow (Bionx, Blue Bell, PA) in patients undergoing concurrent anterior cruciate ligament (ACL) reconstruction and to evaluate patient outcomes with the International Knee Documentation Committee (IKDC) form and a visual analog scale (VAS). Type of Study: Case series with outcomes analysis. Methods: We retrospectively analyzed 38 consecutive patients with 39 Meniscal tears in knees undergoing concurrent endoscopic ACL reconstruction whose menisci were Repaired with the Meniscus Arrow system. All Meniscal tears were deemed amenable to Repair according to length, stability, morphology, and zone of tear. There were 31 medial and 8 lateral Meniscal tears, with an average tear length of 2.1 cm. An average of 2.5 arrows were used to Repair each tear. All 39 tears were located in the posterior horn of the meniscus or extending into the body of the meniscus from the posterior horn. Follow-up was assessed by clinical examination, the knee disorders subjective history, VAS, and the IKDC evaluation form. Reconstructed ACL laxity was assessed by KT-2000 arthrometry and clinical evaluation. Results: At an average follow-up of 2.3 years (range, 18-39 months), 32 patients have been surveyed to date. The success rate was 90.6% (29 of 32 patients) with 3 patients going on to arthroscopic partial meniscectomy. KT-2000 arthrometry showed that sagittal knee laxity was less than 3 mm in all reconstructed knees. Clinical criteria for success in the rest of the Repaired menisci included (1) the absence of locking, catching, or giving way; (2) no history of recurrent effusions; (3) no joint line tenderness; (4) a negative McMurray test; and (5) no subsequent surgical procedures on the Repaired meniscus. Additionally, the VAS showed the ability of these patients to return to a high level of activity, including competitive sports, without symptoms suggestive of a Meniscal tear. The IKDC showed normal or nearly normal function of all success knees. Conclusions: The study shows that a high rate of meniscus healing can be achieved by the all-inside, bioabsorbable Meniscus Arrow system in conjunction with ACL reconstruction. Also, patients have excellent function of their knee and are able to return to a high level of activity. Our healing rates are comparable to those previously reported with the inside-out suture techniques without the need for an additional posterior incision that would increase operative time and risk to neurovascular structures. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp 569–577
Nicolas Pujol - One of the best experts on this subject based on the ideXlab platform.
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Meniscal Repair technique
Orthopaedics & Traumatology-surgery & Research, 2017Co-Authors: Philippe Beaufils, Nicolas PujolAbstract:Meniscal Repair aims to achieve Meniscal healing, avoiding the adverse effects of meniscectomy. Longitudinal vertical tears in a vascularized area are the reference indication. The technique generally uses hybrid all-inside implants. The outside-in technique has other indications in more anterior tears. Healing has been demonstrated on CT-arthrography and arthroscopy. Specific techniques have been developed for other pathological situations. Posterior meniscosynovial lesions in a context of chronic anterior laxity are identified by exploration of the posterior compartment, and fixed by all-inside hook suture. Horizontal lesions in young athletes can be treated by open Meniscal suture. Radial tears, when deep, can be Repaired. Root tears, when traumatic, can be treated by transosseous pullout reinsertion.
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meniscectomy versus Meniscal Repair 10 years radiological and clinical results in vertical lesions in stable knee
Orthopaedics & Traumatology-surgery & Research, 2015Co-Authors: C Lutz, Nicolas Pujol, Francois Dalmay, F P Ehkirch, T Cucurulo, C Laporte, Le G Henaff, J F Potel, G Rochcongar, E SalledechouAbstract:Abstract Introduction Surgical management of Meniscal lesion consists of either a meniscectomy or Meniscal Repair. Although Repair offers immediate recovery after surgery, it is also associated with higher rates of revision. A meniscectomy, on the other hand is known to be associated with an early onset of osteoarthritis. The present study compared clinical and radiological results at 10 years between meniscectomy and Meniscal Repair in isolated vertical lesion in an otherwise stable knee. The hypothesis was that Repair shows functional and radiological benefit over meniscectomy. Patients and method A multi-centric retrospective comparative study of 32 patients (24 male, 8 female). Mean follow-up was 10.6 years (range, 10–13 years). There were 10 Meniscal Repairs (group R) and 22 meniscectomies (group M), in 17 right and 15 left knees. Mean age at surgery was 33.45 ± 12.3 years (range, 9–47 years). There were 28 medial and 4 lateral Meniscal lesions; 26 were in the red-red zone and 6 in red-white zone. Results Functional score: KOOS score was significantly higher in group R than M on almost all parameters: 98 ± 4.69 versus 77.38 ± 21.97 for symptoms (P = 0.0043), 96.89 ± 7.20 versus 78.57 ± 18.9 for pain (P = 0.0052), 99.89 ± 0.33 versus 80.88 ± 19.6 for daily life activities (P = 0.0002), 96.11 ± 9.83 versus 54.05 ± 32.85 for sport and leisure (P = 0.0005), but 91 ± 16.87 versus 68.15 ± 37.7 for quality of life (P = 0.1048). Radiology score: in group R, 7 patients had no features of osteoarthritis, and 2 had grade 1 osteoarthritis. In group M, 5 patients had grade 1 osteoarthritis, 10 grade 2, 3 grade 3 and 3 grade 4. Mean quantitative score was 0 (mean, 0.22 ± 0.44) in-group R and 2 (mean, 2.19 ± 0.98) in group M (P Discussion At more than 10 year's follow-up, functional scores were significantly better with Meniscal Repair than meniscectomy on all parameters of the KOOS scale except quality of life. Functional and radiological scores correlated closely. These results show that Meniscal Repair for vertical lesions in stable knees protects against osteoarthritis and is therefore strongly recommended. Level of evidence IV; retrospective study.
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long term outcomes of all inside Meniscal Repair
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Nicolas Pujol, P Boisrenoult, Nicolas Tardy, Philippe BeaufilsAbstract:Purpose The mean reported healing rate after Meniscal Repair is 60 % of complete healing, 25 % of partial healing and 15 % of failure. However, partially or incompletely healed menisci are often asymptomatic in the short term. It is unknown whether the function of the knee with a partially or incompletely healed meniscus is disturbed in the long term. The purpose of this study was to assess the long-term outcomes of Meniscal Repairs according to the initial rate of healing.
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platelet rich plasma for open Meniscal Repair in young patients any benefit
Knee Surgery Sports Traumatology Arthroscopy, 2015Co-Authors: Nicolas Pujol, P Boisrenoult, Etienne Salle De Chou, Philippe BeaufilsAbstract:Many studies have demonstrated that injection of various growth factors including platelet-derived growth factor could increase Meniscal cell activity and stimulate Repair. The purpose of this study was to augment Repair and promote Meniscal healing by the use of platelet-rich plasma (PRP) within horizontal cleavage Meniscal tears Repaired via an open approach. The hypothesis was that the clinical outcomes and healing process would be improved using this Meniscal healing augmentation technique. In this case–control study, 34 consecutive young patients underwent an open Meniscal Repair to treat symptomatic Grade 2 or Grade 3 horizontal Meniscal tears [median age 28 years (13–40)]. The median time between the onset of symptoms and surgery was 11.5 months (6–50). In the first group (17 consecutive patients, Group 1), a standard open Meniscal Repair was performed. In the second group (17 consecutive patients, Group 2), the same surgical Repair was performed, but platelet-rich plasma was introduced into the lesion at the end of the procedure. Clinical outcomes were evaluated using KOOS and IKDC 2000 scores. MRI was performed at 1 year after surgery for objective evaluation. At a minimum of 24 months postoperatively (mean 32.2 months, 24–40), three patients underwent subsequent meniscectomy (two in Group 1, one in Group 2). The mean KOOS distribution (pain, symptoms, daily activities, sports, quality of life) was 78.4, 86.1, 93.8, 74.4, 74.6 in Group 1, and 93.3, 90.7, 97.1, 88.8, 78.3 in Group 2 (p < 0.05 for pain and sports parameters). MRI revealed five cases with the complete disappearance of any hypersignal within the Repaired meniscus in Group 2, and none in Group 1 (p < 0.01). Open Meniscal Repair of horizontal tears extending into the avascular zone was effective at midterm follow-up in young patients. Clinical outcomes were slightly improved by the addition of PRP in this case–control study. III.
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clinical outcomes of open Meniscal Repair of horizontal Meniscal tears in young patients
Knee Surgery Sports Traumatology Arthroscopy, 2013Co-Authors: Nicolas Pujol, P Boisrenoult, Yohann Bohu, Ali Macdes, Philippe BeaufilsAbstract:Symptomatic horizontal Meniscal tears in young patients are a singular entity. The extent of the lesion is often large, without any injury to the knee. The Meniscal tissue might be degenerative. However, a complete resection of the lesion would result in a subtotal meniscectomy. The purpose of this study was to consider the use of a Meniscal Repair in such patients in order to close the horizontal cleavage extending up to the avascular zone. The hypothesis was that the clinical outcomes after open Meniscal Repair of horizontal tears are good with a low rate of secondary meniscectomy. Between 1998 and 2006, 28 patients (30 knees) underwent an open Meniscal Repair to treat symptomatic horizontal Meniscal tears [6 women and 22 men, median age 25 years (16–44 years)]. The duration of symptoms was at least 12 weeks (12–72 weeks). Open Meniscal Repair was performed following arthroscopy. There were 14 medial and 7 lateral menisci, 10 grade 3 tears, and 11 grade 2 tears. If present (15 cases), Meniscal cysts were removed using the same approach. Clinical outcomes were evaluated using KOOS and IKDC scores. The return to sporting activities and the need for a secondary meniscectomy were also assessed. Twenty-one patients were evaluated at a median follow-up of 40 months (24–101 months). Twenty returned to their preinjury level of sporting activity. The median KOOS score was 92 ± 12.9. The median subjective IKDC score was 89 ± 14.1. There were four secondary meniscectomies. Open Meniscal Repair of complex horizontal tears extending into the avascular zone was effective at midterm follow-up in young and active patients. The meniscus was preserved in 80 % of cases. Functional results deteriorated in those older than 30 years. This entity should be differentiated from degenerative Meniscal tears that often occur in patients over 50, which may be associated with osteoarthritis. Retrospective study, Level IV.