- Email: [email protected]
How Successful are the Results of Double-Vertical Meniscal Sutures?
2013 ISAKOS ABSTRACTS
SUMMARY Intraarticular contact pressures after anterior horn lateral meniscus tear, repair and meniscectomy ABSTRACT DATA Background: The purpose of this study was to describe the effect of anterior horn lateral meniscus (AHLM) tears on tibiofemoral contact forces and the ability to restore normal parameters with repair in contrast to meniscectomy. Hypothesis: We proposed that tears of the AHLM would cause a significant increase in peak contact force in the lateral compartment of the knee. We suspected that by repairing the meniscal tear, the peak contact forces would be restored to pre-tear levels and that partial meniscectomy would also be expected to increase peak contact forces and pressures. Study Design: Our study is a biomechanical controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees (49.1 years; +/- 5 years) were used. Two knees were used to finalize the test setup, leaving a total of eight knees. A Tekscan 4011 pressure sensor was sutured in the lateral and medial compartments of the knee joint. The specimens were fixed to an ElectroPuls E10000 test system (Instron, Norwood, MA) and subjected to a load of 1000 N at 0 and 30 of flexion. The test was repeated for the intact knee, simulated tear, repaired meniscus, and partial meniscectomy in that sequence. A 2-cm peripheral meniscal tear was simulated in the anterior horn of the lateral meniscus. Vertical tears were repaired in each knee using a knotless bony anchor device with a technique used by the senior author in practice. Data was analyzed by Student’s paired t-test (p<0.05). Peak pressure, peak force and contact area were recorded for each specimen in its various conditions. Results: Peak force in the lateral compartment was significantly increased at 0 of knee flexion from 37 N intact to 47 N after the tear (p¼0.046) and 56 N (p¼0.001) post meniscectomy. It was also increased at 30 flexion from 37 N intact to 55 N (p¼0.003) after meniscectomy. There was no significant difference in peak force between the intact and repaired states. That is, meniscal repair restored peak force to the intact state. At 0 of knee flexion, the peak pressure of the lateral meniscus was significantly increased from 1.1 Mpa in the intact state to 1.9 Mpa after meniscectomy (p¼0.022). Contact area was significantly decreased in both the repaired and meniscectomy groups (p<0.05). The peak force in the medial compartment was significantly increased at 0 of knee flexion from 29 N intact to 48 N after partial lateral meniscectomy (p¼0.041). Conclusions: This cadaveric study exhibited a significant increase in tibiofemoral peak forces with both AHLM tears as well as resection of the torn tissue. We also showed an increase in peak contact pressure after meniscectomy. An increase in peak contact pressure has been described as a likely cause of cartilage degeneration. With a knotless bony anchor repair technique, the pre-injury condition peak forces were restored to normal, suggesting the importance of repairing tears of the AHLM when possible.
e157
Paper #205: How Successful are the Results of Double-Vertical Meniscal Sutures? UGUR HAKLAR, PROF. M.D., TURKEY PRESENTING AUTHOR FERDI DONMEZ, MD, TURKEY $ Acibadem Kadikoy Hospital, Istanbul, Turkey
SUMMARY Results of Arthroscopic Repair of Longitudinal Medial Meniscal Tears by Vertical or Double Vertical Sutures with Inside-out Technique. ABSTRACT DATA Background: Although in the literature there are many articles about arthroscopic repair of meniscus tears, there are no articles about the results of double-vertical sutures. Purpose: To present the mid-long term results of medial meniscus tears repaired with double-vertical sutures. Study Design: Cohort study Level of evidence, 3. Methods: We evaluated the results of 112 longitudinal medial meniscal tears treated with inside-out vertical or double-vertical sutures, with or without ACL reconstruction, based on clinical resolution of symptoms, assesment of Lysholm’s knee functional score with Tegner’s activity score, and re-examination by magnetic resonance imaging (MRI) after the repair. All of 112 menisci were medial. The morphology of the meniscal tears included only longitudinal tears. 45 (40%) of them were extending both superior and inferior articular surfaces, 10 (9%) were extending only superior articular surface, 36 (32%) were extending only inferior articular surface and 21 of them were displaced buckethandle tears (18%). The length of the tears was evaluated arthroscopically. 85 tears out of 112 were more than 2 cm in length, and 27 were tears of 2 cm or less. 89 of the 112 repairs (79.4%) were performed in conjunction with ACL reconstructions; the remaining 23(20.6%) repairs were performed in ACL intact knees. Results: The cases were evaluated after a mean follow-up duration of 49.3 months (range 12 to 88 months). According to clinical and radiologic examination, we accepted 99 (89.4%) meniscal repairs as healed. The remaining 13 cases (10.6 %) were considered as failures. The Lysholm score improved significantly from the preoperative mean value of 63.8 to a postoperative mean value of 89.5 (P<0.001). Preoperatively the mean Tegner activity score was 3.3 whereas the postoperative mean value was 6.7 (P<0.001). We found concurrent ACL reconstruction, type of the tear, length of tear, and smoking as factors that can significantly effect the meniscal healing. Conclusion: Vertical or double vertical sutures with inside-out technique provides high rate of healing in longitudinal medial meniscal tears. Key Terms: Longitudinal medial meniscal tears, insideout e double vertical suture e meniscal repair. Paper #206: Horizontal and Vertical Suturing of Human Meniscus Lesions Display Different Shear Load Fixation Characteristics: An In Vitro Biomechanical Study YAVUZ KOCABEY, MD, TURKEY PRESENTING AUTHOR OMER FARUK TASER, MD, TURKEY
SUMMARY Intraarticular contact pressures after anterior horn lateral meniscus tear, repair and meniscectomy ABSTRACT DATA Background: The purpose of this study was to describe the effect of anterior horn lateral meniscus (AHLM) tears on tibiofemoral contact forces and the ability to restore normal parameters with repair in contrast to meniscectomy. Hypothesis: We proposed that tears of the AHLM would cause a significant increase in peak contact force in the lateral compartment of the knee. We suspected that by repairing the meniscal tear, the peak contact forces would be restored to pre-tear levels and that partial meniscectomy would also be expected to increase peak contact forces and pressures. Study Design: Our study is a biomechanical controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees (49.1 years; +/- 5 years) were used. Two knees were used to finalize the test setup, leaving a total of eight knees. A Tekscan 4011 pressure sensor was sutured in the lateral and medial compartments of the knee joint. The specimens were fixed to an ElectroPuls E10000 test system (Instron, Norwood, MA) and subjected to a load of 1000 N at 0 and 30 of flexion. The test was repeated for the intact knee, simulated tear, repaired meniscus, and partial meniscectomy in that sequence. A 2-cm peripheral meniscal tear was simulated in the anterior horn of the lateral meniscus. Vertical tears were repaired in each knee using a knotless bony anchor device with a technique used by the senior author in practice. Data was analyzed by Student’s paired t-test (p<0.05). Peak pressure, peak force and contact area were recorded for each specimen in its various conditions. Results: Peak force in the lateral compartment was significantly increased at 0 of knee flexion from 37 N intact to 47 N after the tear (p¼0.046) and 56 N (p¼0.001) post meniscectomy. It was also increased at 30 flexion from 37 N intact to 55 N (p¼0.003) after meniscectomy. There was no significant difference in peak force between the intact and repaired states. That is, meniscal repair restored peak force to the intact state. At 0 of knee flexion, the peak pressure of the lateral meniscus was significantly increased from 1.1 Mpa in the intact state to 1.9 Mpa after meniscectomy (p¼0.022). Contact area was significantly decreased in both the repaired and meniscectomy groups (p<0.05). The peak force in the medial compartment was significantly increased at 0 of knee flexion from 29 N intact to 48 N after partial lateral meniscectomy (p¼0.041). Conclusions: This cadaveric study exhibited a significant increase in tibiofemoral peak forces with both AHLM tears as well as resection of the torn tissue. We also showed an increase in peak contact pressure after meniscectomy. An increase in peak contact pressure has been described as a likely cause of cartilage degeneration. With a knotless bony anchor repair technique, the pre-injury condition peak forces were restored to normal, suggesting the importance of repairing tears of the AHLM when possible.
e157
Paper #205: How Successful are the Results of Double-Vertical Meniscal Sutures? UGUR HAKLAR, PROF. M.D., TURKEY PRESENTING AUTHOR FERDI DONMEZ, MD, TURKEY $ Acibadem Kadikoy Hospital, Istanbul, Turkey
SUMMARY Results of Arthroscopic Repair of Longitudinal Medial Meniscal Tears by Vertical or Double Vertical Sutures with Inside-out Technique. ABSTRACT DATA Background: Although in the literature there are many articles about arthroscopic repair of meniscus tears, there are no articles about the results of double-vertical sutures. Purpose: To present the mid-long term results of medial meniscus tears repaired with double-vertical sutures. Study Design: Cohort study Level of evidence, 3. Methods: We evaluated the results of 112 longitudinal medial meniscal tears treated with inside-out vertical or double-vertical sutures, with or without ACL reconstruction, based on clinical resolution of symptoms, assesment of Lysholm’s knee functional score with Tegner’s activity score, and re-examination by magnetic resonance imaging (MRI) after the repair. All of 112 menisci were medial. The morphology of the meniscal tears included only longitudinal tears. 45 (40%) of them were extending both superior and inferior articular surfaces, 10 (9%) were extending only superior articular surface, 36 (32%) were extending only inferior articular surface and 21 of them were displaced buckethandle tears (18%). The length of the tears was evaluated arthroscopically. 85 tears out of 112 were more than 2 cm in length, and 27 were tears of 2 cm or less. 89 of the 112 repairs (79.4%) were performed in conjunction with ACL reconstructions; the remaining 23(20.6%) repairs were performed in ACL intact knees. Results: The cases were evaluated after a mean follow-up duration of 49.3 months (range 12 to 88 months). According to clinical and radiologic examination, we accepted 99 (89.4%) meniscal repairs as healed. The remaining 13 cases (10.6 %) were considered as failures. The Lysholm score improved significantly from the preoperative mean value of 63.8 to a postoperative mean value of 89.5 (P<0.001). Preoperatively the mean Tegner activity score was 3.3 whereas the postoperative mean value was 6.7 (P<0.001). We found concurrent ACL reconstruction, type of the tear, length of tear, and smoking as factors that can significantly effect the meniscal healing. Conclusion: Vertical or double vertical sutures with inside-out technique provides high rate of healing in longitudinal medial meniscal tears. Key Terms: Longitudinal medial meniscal tears, insideout e double vertical suture e meniscal repair. Paper #206: Horizontal and Vertical Suturing of Human Meniscus Lesions Display Different Shear Load Fixation Characteristics: An In Vitro Biomechanical Study YAVUZ KOCABEY, MD, TURKEY PRESENTING AUTHOR OMER FARUK TASER, MD, TURKEY