Arthroscopic repair of radial lateral menicus tear by double horizontal sutures with inside–outside technique
Introduction
An intact meniscus is crucial for maintaining normal knee function, as it performs shock absorption, joint lubrication, and force transmission across the knee joint. The meniscus increases contact area and thereby decreases contact stress on the articular cartilage [1], [2], [3]. A total or partial loss of meniscus affects this function, and can eventually lead to degenerative arthritis. It is therefore necessary to preserve the meniscus wherever possible [3], [4], [5].
Radial meniscal injuries in young patients are demanding problems due to the concern about future degenerative disease. Preservation of meniscal tissue whenever possible can result in a better clinical outcome [6], [7], [8]. Longitudinal meniscus tears at zone 1 have good healing potential, therefore they are commonly repaired with successful results [6], [7]. Radial tears can be difficult to repair and often lack the vascular supply necessary for healing [6], [7]. This is particularly a concern after total lateral meniscectomy in the young athletic patient as there is more risk of arthritic changes.
Meniscal repair has become popular over the past two decades among those who perform arthroscopic surgery. In recent years, arthroscopic repair has evolved from inside-out and outside-in techniques to the all-inside meniscal repair. Meniscal suturing may stabilise the tear and stimulate cell proliferation for healing [8], [9].
According to our knowledge, there are three studies reporting the repair of lateral radial meniscus tears. In all studies, all patients had promising results with healed menisci at Cooper zone 1 [10], [11], [12]. We report five cases of a tear at the junction of the anterior horn and body of the lateral meniscus. All patients had a complete radial tear that extended to the joint capsule. In all cases, the repair was performed by double horizontal sutures with inside-out technique, using zone-specific curved cannulae and Nos. 0 and 2 ethibond sutures without the use of any technique to enhance the repair.
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Material and methods
A prospective case study was performed on five patients who underwent lateral radial meniscal repair using inside-out technique by the same senior surgeon. Five patients with an average age of 28.6 years (range: 17 to 35, SD: 7.5) were treated (Table 1). All patients had a history of pain and occasional swelling of the knee following a traumatic injury. All patients presented with lateral-based knee pain, swelling and catching. Symptoms were exacerbated by exercise and had started a mean of
Results
All patients were able to return to their former levels of activity. All patients agreed to have MRI for the re-evaluation of their knee, despite the fact that they were clinically asymptomatic. MRI showed a fully healed meniscus at the repair sites in all cases, with no further disruption to the debrided area (Fig. 5a and b). All patients were followed up for an average of 31 months (range: 12 to 46, SD:15.5). There was also no adjacent articular cartilage damage in any of the cases. Mean
Discussion
Radial tears of the lateral meniscus were generally seen in stable knees. If such a tear reaches the periphery, it transects the meniscus and renders the hoop stress-distributing capacity of the meniscus useless [1], [2], [3]. Several authors have suggested that such a tear is the functional equivalent of a total meniscectomy and traditionally it is deemed inappropriate to repair such cases [1], [2], [3].
To our knowledge, there have been three studies on the repair of lateral radial meniscus
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