Abstract
Introduction: Meniscal tears are common in young athletes, usually result from a twisting injury during sport and may occur in the anterior or posterior horns. Injured menisci may be treated arthroscopically by excision of the torn fragments. However, in patients with peripheral meniscal detachment, located at the “vascular zone”, operative repair is feasible and usually successful. Meniscal repair may be done by open direct suture of peripheral tears or by arthroscopic techniques as “Outside-In”, “Inside-Out” or “All-Inside”. We present our experience with arthroscopic suture of completely detached menisci.
Patients & Methods: This study consisted of 33 male patients (14-48Y; mean 25Y; Follow-up: 2-6Y; mean 3.5Y). Inside-Out technique was used in 31 patients and Outside-In technique in two patients. 16/33 patients had detachment of the peripheral half of the meniscus (14-medial; 2-lateral); 13/33 patients had peripheral detachment of almost two thirds of meniscus (10-medial; 3-lateral) and 4/33 patients had detachment of one third of the meniscus (3-lateral; 1-medial injuries; all combined with fractures of the tibial plateau). 15 patients with medial meniscus detachment had complete (5 Pts) or partial (10 Pts) tear of ACL. Two other patients with medial meniscus detachment had associated small radial tears of the affected meniscus. Two of the patients with complete ACL tear had later been operated upon for reconstruction of ACL. Results were assessed by the Knee Society Knee score and by Lysholm Scoring Scale.
Results: 25/33 patients (76%) had good and excellent results. Four of them developed re-tear and detachment of medial meniscus during other later additional sport injuries, usually between 1–2 years following initial treatment. Four other patients had a “second” arthroscopic look 1–2 years later following another sport twisting injury and in all of them a stable peripheral attachment of the sutured menisci was observed. Results were better in patients who had ACL reconstruction a few months following meniscal repair. 5 patients had fair results (15%) and 3 patients had poor results (9%).
Conclusions: Based on this study it is suggested that meniscal suturing for peripheral tears is a satisfactory procedure. Meniscal tears suitable for repairs are those within the vascular zones (the outer third of the menis-cus), unstable on probing, are longer than 7mm and without major surgical damaging. Tears of posterior segments are the most difficult to suture and often require open arthrotomy. ACL reconstruction combined with meniscal repair appears to increase the healing rate of the meniscus. There are also adjuvant techniques for meniscal repair such as: fibrin clot or laser (both are weaker than suture alone) and adhesives. However, there is still not enough data.
The abstracts were prepared by Orah Naor, IOA Co-ordinator and Secretary. Correspondence should be addressed to Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
