Arthroscopic meniscus repair: A safe approach to the posterior horns

doi:10.1016/S0749-8063(86)80003-2

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 2, Issue 1, 1986, Pages 3-12

https://doi.org/10.1016/S0749-8063(86)80003-2 Get rights and content

Abstract

Seventy arthroscopic meniscus repairs were performed using a technique that places posterior horn sutures through spinal needles from safe posterior corner punctures, thus avoiding injury to the posterior neurovascular structures. Follow-up averaged 18 months, with a range from 12 to 28 months. Associated anterior cruciate ligament instability (31%) was either stabilized surgically (13%) or braced postoperatively for pivoting activity (18%). Clinical results were excellent in 98.6% of patients, with only one second tear (1.5%) occurring 2 months postoperatively. Complications (2.8%) included one transient saphenous nerve irritation and one case of pyarthrosis. No major neurovascular complications occurred.

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Cited by (146)

Outside-in Continuous Meniscal Suture Technique of the Knee
2020, Arthroscopy Techniques
Citation Excerpt :
These variations are correlated with the method used to evaluate the healing, with some studies performing a second arthroscopic look and other studies using clinical scores.13-15 In the pioneering study by Morgan and Casscells,16 the authors found 98% good results in 70 patients who underwent this surgical technique used in the posterior horn of the meniscus. Recently, Joshi et al.17 described a new surgical technique for outside-in meniscal suture for the treatment of longitudinal lesions of the posterior horn of the medial meniscus.
The meniscus is largely responsible for the health and longevity of the knee. It has diverse functions, being fundamental in load absorption and distribution and even in joint stability. To preserve meniscal functions and prevent the occurrence of osteoarthritis after meniscectomy, several meniscal repair techniques have been developed. To perform meniscal repair in anterior horn, the outside-in technique is the most used. There are few devices for performing them, with most of the surgical techniques described using needles. Our group uses a device capable of performing meniscal repair in different ways. Our objective is to describe a continuous outside-in meniscal repair technique, especially indicated for anterior horn and meniscus body tears, with the “Meniscus 4-All suture device.” The continuous outside-in meniscal suture technique using this device is easy to perform, inexpensive, fast, and reproducible, minimizing the risk of soft-tissue entrapment. In addition, it allows the surgeon to perform meniscal repair in the posterior horn in extensive injuries with the same repair device, just switching to inside-out technique.
Meniscus Repair of the Anterior Third: The Outside-In Option
2018, Operative Techniques in Sports Medicine
Citation Excerpt :
When the knee is flexed (90°), this nerve lies posterior to the joint line and is deep to the biceps tendon. Keeping the knee flexed and placing the spinal needle well anterior to the biceps tendon will avoid injury to the peroneal nerve when performing lateral meniscus repair.9 As long as the knee is flexed, needle and suture placement should be well away from the peroneal nerve when addressing anterior one-third tears.
Outside-in meniscal repair is an effective and often most optimal technique for addressing tears involving the anterior one-third of the meniscus. It can be performed without an assistant with standard arthroscopy instrumentation. Although the technique may be used for tears in the anterior two-thirds of both the lateral and medial meniscus, it is most commonly utilized for anterior one-third tears, which are not often accessible with other techniques. Knowledge of the anatomy of the saphenous and peroneal nerves in relation to flexion of the knee is paramount to avoiding iatrogenic injury. The technique involves passing sutures through spinal needles that are placed percutaneously from outside-in across the meniscal tear. There are various modifications of the basic technique that may be performed depending on available instrumentation and surgeon preference. Although repairable anterior one-third tears are not as common as posterior horn tears, proficiency with the outside-in technique can be quite valuable and often ideal in this setting. Multiple authors have reported excellent healing rates. With proper attention to needle placement, complications are rare.
Meniscal Repair with the Newest Fixators-Which are Best?
2012, Clinics in Sports Medicine
Meniscal Repair-Outside-In Repair
2012, Clinics in Sports Medicine
Clinical and radiological results 21years following successful, isolated, open meniscal repair in stable knee joints
2011, Knee
Citation Excerpt :
Technical issues such as suture or suture-anchor systems may be biomechanically equivalent in vitro [43], but may also influence the clinical results. In our study, a high incidence of neurological skin sensations at the site of the surgical approach for outside-in knotting could be found, which has been also described in the literature [44,45]. In fact, open meniscal repair appears to be associated with a higher level of postoperative dysesthesia around the knee (39%) which may favor arthroscopic repair with only 11% of dysesthesia [46].
The long-term results over 20 years following meniscal repair in stable knees have not been described yet. The objective was therefore to analyze the clinical and radiological outcomes of successful, isolated, open meniscal repairs with an intact ACL after a mean follow-up of 20.6 years (range, 16–25) retrospectively in 26 patients.
Clinical evaluation included objective (Lysholm, IKDC, Tegner) and subjective scores. Standard radiological assessment according to Ahlbäck's osteoarthritis classification and weight-bearing full-leg radiography for alignment were performed. Eight patients were excluded due to a re-rupture of the meniscus.
In the 18 remaining patients (12 male, 6 female), the mean Lysholm and IKDC score was 97.8 points (range, 85–100) and 93% (range, 77–100) at the most recent follow-up, respectively. The Tegner activity scale averaged 4.2 (range, 3–7). Subjectively, 13 patients rated their outcome excellent, 4 good, and 1 fair. The radiological evaluation demonstrated an average development of “+1” grade (range, 0–“+2”) osteoarthritic changes versus preoperatively; however, the contralateral healthy knee also revealed comparable (on average “+1” grade) degenerative changes reflecting natural history. The alignment was not significantly different between the operated and the contralateral leg.
Overall, isolated open meniscal repair in stableness has the potential of a successful surgery with good to excellent long-term results. The development of osteoarthritic changes within the femorotibial compartments is mild and comparable to contralateral and the alignment of the axis is preserved. Therefore, repair of a ruptured meniscus is recommended whenever possible, even in isolated meniscal tears. However, a re-rupture rate of approximately 30% in isolated meniscal tears has to be acknowledged, which still reflects the need for biological enhancement of meniscal healing.
Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta-analysis
2023, Knee Surgery, Sports Traumatology, Arthroscopy

View all citing articles on Scopus

^*: This article was presented at the American Academy of Orthopaedic Surgeons Meeting (AAOSM), February 1986, New Orleans, Louisiana.

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Arthroscopic meniscus repair: A safe approach to the posterior horns*

Abstract

Arthroscopy

Arthroscopy

Medial meniscus injuries: mechanism, diagnosis, and treatment

Partial meniscectomy

The healing of semilunar cartilages

J Bone Joint Surgery

Mechanical changes in the knee after meniscectomy

J Bone Joint Surg [Am]

Load-bearing mode of the knee joint

Clin Orthop

The role of the menisci in force transmission across the knee

Clin Orthop

Ligamentous restraints to anterior-posterior drawer in the human knee

J Bone Joint Surg [Am]

The menisci and knee stability

The diagnosis of problems after meniscectomy

J Bone Joint Surg [Br]

Knee joint changes after meniscectomy

J Bone Joint Surg [Br]

Degenerative changes in the knee after meniscectomy

Br Med J

Factors affecting late results after meniscectomy

J Bone Joint Surg [Am]

Late results after meiniscectomy

J Bone Joint Surg [Am]

Acute anteromedial rotary instability: long-term results of surgical repair

J Bone Joint Surg [Am]

Knee joint surface changes: long term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstruction

Clin Orthop

The degenerative effects of medial meniscus tears in dog's knees

CORR

Partial or total meniscectomy

J Bone Joint Surg [Am]

Arthroscopic surgery: repair of peripheral detachment of the meniscus

Contemp Orthop