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Meniscal Suture: Is Debridement Necessary?
2017 ISAKOS ABSTRACTS
Category: Knee - Meniscus Paper #4: Meniscal Suture: Is Debridement Necessary? NICOLAE HAZAPARU, MD, FRANCE SIRIPONG TAHWANG, MD, THAILAND JONGKOLNEE SETTAKORN, MD, THAILAND University Hospital Strasbourg, Strasbourg, FRANCE
SUMMARY Debridement of the suture zone may have little impact on meniscal healing after suture. ABSTRACT DATA Introduction: Suture of meniscal lesions is currently recommended because meniscal healing allows better knee function and protects against post-meniscectomy osteoarthritis. The debridement of the suture zone prior to performing suture is generally recommended to enhance vascularization and increase the healing potential. However, this procedure has never been formally validated. The hypothesis of this study was the lack of meniscus debridement did not increase the risk of reoperation for meniscus injury when compared to the figures published in the literature. Material: 72 patients were operated by two senior surgeons experienced in arthroscopic knee surgery for suture of a meniscal lesion, either isolated (44 cases) or during reconstruction of the anterior cruciate ligament (ACL) (28 cases). These were 61 men and 11 women with an average age of 29 years. The sutures were performed from inside to outside with a specific material (FastFix Ò, Smith-Nephew, London, United Kingdom) by simple suture of the lesion without debridement with a stitch every 5 to 10 mm. When indicated, ACL reconstruction was performed with a 4-fold semitendinosus autograft. Methods: Patients were re-interviewed by telephone or mail about the need for a subsequent reoperation for treatment of a lesion of the same meniscus. The IKDC, Lysholm and Tegner questionnaires were also filled up. The survival rate of the repaired meniscus was calculated using the actuarial method and compared with the rates reported in the literature. Results: 2 patients were lost of follow-up before one year. All other patients were followed for at least one year, and 52 could be re-interviewed for this study. Follow-up time was 1 to 5 years. 12 patients underwent reoperation for meniscus injury after a period of 6 months to 4 years. The survival rate of meniscal repair at 4 years was 81%. It was not possible, due to lack of power, to detect an influence of the medial or lateral location of the repair or the influence of concomitant ACL reconstruction. Discussion: The absence of debridement of the meniscal suture zone did not seem to have a negative influence on the meniscal healing appreciated by the reoperation rate. The failure rate of the present study does not seem to be different from previous studies where debridement was performed prior to meniscal suture. The debridement of the meniscal suture zone is justified by theoretical considerations that may not be confirmed if in clinical practice.
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Conclusion: The completion of a validation on a larger scale of the interest of the debridement of lesion prior to meniscal suture is desirable.
Category: Knee - Meniscus Paper #5: Treatment of Painful Irreparable Partial Meniscal Defects With a Polyurethane Scaffold: Mid-term Clinical Outcome and Survival Analysis AAD ALFONS DHOLLANDER, MD, PT, PHD, BELGIUM NATHANIEL LUNDY, BS, UNITED STATES SCOTT SHEMORY, UNITED STATES MICHAEL STIJGEN, BS, UNITED STATES DAVID C. FLANIGAN, MD, UNITED STATES Ghent University Hospital, Ghent, OVL, BELGIUM SUMMARY A biodegradable, polyurethane scaffold was designed to fulfill a challenging clinical need in the treatment of patients with painful irreparable partial meniscal defects. ABSTRACT DATA Background: A biodegradable, polyurethane scaffold was designed to fulfill a challenging clinical need in the treatment of patients with painful irreparable partial meniscal defects. Hypothesis: The use of an acellular polyurethane scaffold for new tissue generation in irreparable partial meniscal defects provides both mid-term pain relief and improved functionality. Study design: Case series; Level of evidence, 4. Methods: Fourty-four patients with irreparable partial meniscal defects (29 medial and 15 lateral) were implanted with a polyurethane scaffold (Actifit, Orteq Ltd) in a prospective, single-arm, proof-of-principle study with a minimal 5-years follow-up. Clinical outcomes were measured with visual analog scale (VAS), International Knee Documentation Committee and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and at 24 and 60 months of follow-up. MRI was used to evaluate the meniscal implant and cartilage status of index compartment. Kaplan-Meier time to treatment failure distributions were also performed. Removal of the scaffold, conversion towards meniscal transplant or unicompartimental/total knee arthroplasty were used as end points. Results: The patients who participated in this study showed significant clinical improvement after surgery (mean SD, baseline / 24months / 60 months): VAS (56.2 21.6 / 24.6 22.7 / 19.3 26.9) and total KOOS (206.5 79.7 / 329.8 108.9 / 333.6 112.2). MRI evaluation of the scaffolds showed a smaller-sized implant when compared to the native meniscus with an irregular surface at 24 and 60 months of follow-up. Stable cartilage status of the index compartment at 60 months of follow-up was demonstrated in 46.7% of patients compared with baseline status. During the follow-up period 62,2% of implants survived. At final follow-up, 66.7% of the medial scaffolds were still functioning
Category: Knee - Meniscus Paper #4: Meniscal Suture: Is Debridement Necessary? NICOLAE HAZAPARU, MD, FRANCE SIRIPONG TAHWANG, MD, THAILAND JONGKOLNEE SETTAKORN, MD, THAILAND University Hospital Strasbourg, Strasbourg, FRANCE
SUMMARY Debridement of the suture zone may have little impact on meniscal healing after suture. ABSTRACT DATA Introduction: Suture of meniscal lesions is currently recommended because meniscal healing allows better knee function and protects against post-meniscectomy osteoarthritis. The debridement of the suture zone prior to performing suture is generally recommended to enhance vascularization and increase the healing potential. However, this procedure has never been formally validated. The hypothesis of this study was the lack of meniscus debridement did not increase the risk of reoperation for meniscus injury when compared to the figures published in the literature. Material: 72 patients were operated by two senior surgeons experienced in arthroscopic knee surgery for suture of a meniscal lesion, either isolated (44 cases) or during reconstruction of the anterior cruciate ligament (ACL) (28 cases). These were 61 men and 11 women with an average age of 29 years. The sutures were performed from inside to outside with a specific material (FastFix Ò, Smith-Nephew, London, United Kingdom) by simple suture of the lesion without debridement with a stitch every 5 to 10 mm. When indicated, ACL reconstruction was performed with a 4-fold semitendinosus autograft. Methods: Patients were re-interviewed by telephone or mail about the need for a subsequent reoperation for treatment of a lesion of the same meniscus. The IKDC, Lysholm and Tegner questionnaires were also filled up. The survival rate of the repaired meniscus was calculated using the actuarial method and compared with the rates reported in the literature. Results: 2 patients were lost of follow-up before one year. All other patients were followed for at least one year, and 52 could be re-interviewed for this study. Follow-up time was 1 to 5 years. 12 patients underwent reoperation for meniscus injury after a period of 6 months to 4 years. The survival rate of meniscal repair at 4 years was 81%. It was not possible, due to lack of power, to detect an influence of the medial or lateral location of the repair or the influence of concomitant ACL reconstruction. Discussion: The absence of debridement of the meniscal suture zone did not seem to have a negative influence on the meniscal healing appreciated by the reoperation rate. The failure rate of the present study does not seem to be different from previous studies where debridement was performed prior to meniscal suture. The debridement of the meniscal suture zone is justified by theoretical considerations that may not be confirmed if in clinical practice.
e39
Conclusion: The completion of a validation on a larger scale of the interest of the debridement of lesion prior to meniscal suture is desirable.
Category: Knee - Meniscus Paper #5: Treatment of Painful Irreparable Partial Meniscal Defects With a Polyurethane Scaffold: Mid-term Clinical Outcome and Survival Analysis AAD ALFONS DHOLLANDER, MD, PT, PHD, BELGIUM NATHANIEL LUNDY, BS, UNITED STATES SCOTT SHEMORY, UNITED STATES MICHAEL STIJGEN, BS, UNITED STATES DAVID C. FLANIGAN, MD, UNITED STATES Ghent University Hospital, Ghent, OVL, BELGIUM SUMMARY A biodegradable, polyurethane scaffold was designed to fulfill a challenging clinical need in the treatment of patients with painful irreparable partial meniscal defects. ABSTRACT DATA Background: A biodegradable, polyurethane scaffold was designed to fulfill a challenging clinical need in the treatment of patients with painful irreparable partial meniscal defects. Hypothesis: The use of an acellular polyurethane scaffold for new tissue generation in irreparable partial meniscal defects provides both mid-term pain relief and improved functionality. Study design: Case series; Level of evidence, 4. Methods: Fourty-four patients with irreparable partial meniscal defects (29 medial and 15 lateral) were implanted with a polyurethane scaffold (Actifit, Orteq Ltd) in a prospective, single-arm, proof-of-principle study with a minimal 5-years follow-up. Clinical outcomes were measured with visual analog scale (VAS), International Knee Documentation Committee and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and at 24 and 60 months of follow-up. MRI was used to evaluate the meniscal implant and cartilage status of index compartment. Kaplan-Meier time to treatment failure distributions were also performed. Removal of the scaffold, conversion towards meniscal transplant or unicompartimental/total knee arthroplasty were used as end points. Results: The patients who participated in this study showed significant clinical improvement after surgery (mean SD, baseline / 24months / 60 months): VAS (56.2 21.6 / 24.6 22.7 / 19.3 26.9) and total KOOS (206.5 79.7 / 329.8 108.9 / 333.6 112.2). MRI evaluation of the scaffolds showed a smaller-sized implant when compared to the native meniscus with an irregular surface at 24 and 60 months of follow-up. Stable cartilage status of the index compartment at 60 months of follow-up was demonstrated in 46.7% of patients compared with baseline status. During the follow-up period 62,2% of implants survived. At final follow-up, 66.7% of the medial scaffolds were still functioning