Elsevier

The Knee

Volume 15, Issue 5, October 2008, Pages 355-359
The Knee

Arthroscopic repair of radial lateral menicus tear by double horizontal sutures with inside–outside technique

https://doi.org/10.1016/j.knee.2008.05.012Get rights and content

Abstract

The purpose of this prospective study is to report the outcome of arthroscopic repair of radial lateral menicus tears at the junction of the anterior horn and body. Five patients with an average age of 27 years were treated. The repair was performed with double horizontal sutures by inside-out technique, using zone-specific, curved cannulae with no enhancement technique. A mean of 2.4 superior and 2.8 inferior stitches were performed. Reduction was obtained in all cases. Patients were evaluated using Lysholm functional knee scores. All patients were clinically and radiologically examined using MRI to assess meniscus integrity at the repair site, over an average follow-up period of 31 months. All patients were able to return to their former level of activity. In all cases, MRI showed a fully healed meniscus at the repair sites, with no further disruption of the debrided area. The mean Lysholm scores improved from 62 preoperatively to 94 postoperatively. The difference between preoperative and postoperative values was found to be statistically significant (p = 0.029). No cases of postoperative extra or intra-articular complications were encountered. We found that repairing rather than resecting radial lateral menicus tears that extend into capsular zone, improves activity level.

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.

Section snippets

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

References (18)

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