5.4 TO 12.9 YEAR RESULTS OF MENISCAL REPAIR USING AN ARTHROSCOPIC ASSISTED INSIDE-OUT SUTURE TECHNIQUE.

Abstract

This study reports our long-term results of arthroscopically assisted meniscal suture using an inside-out technique.

Between January 1990 and July 1997, 112 patients underwent 121 meniscal repairs in 112 knees. The average follow-up is 8.7 years (range 5.4 to 12.9 years). Repairs consisted of interrupted sutures using 2.0 PDS. Sutures were placed arthroscopically using a suture shuttle system and tied behind the capsule after making a small postero-medial or posterolateral incision. The meniscus and bed was prepared using a Rasp or hand-held instruments. Fibrin clot techniques were not used. 79% of patients had associated ACL reconstruction in addition to meniscal suture. All surgery was carried out by our senior author (PTM). Rehabilitation involved non-weight-bearing in an extension splint for 3 weeks and partial weight-bearing for a further 3 weeks followed by a progressive rehabilitation programme.

The average age at surgery was 23.9 years (range 12.2 to 57.7 years). The average time from injury to surgery was 13.5 months (range 0 to 60 months). There were 74 males and 38 females. 51% of patients were professional or semi-professional athletes. Repair involved 79 medial menisci, 42 lateral menisci. The average number of sutures used was 3.8 (range 1 to 12). Operative findings and procedure were entered prospectively into a database. Patients were assessed clinically until recovery and long-term follow-up consisted of a detailed postal questionnaire.

The average Lysholm scores were 86.4, with 59% excellent, 16% good, 17% fair and 8% poor. IKDC subjective scores averaged 82.0, with 40% excellent, 21% good, 27% fair and 12% poor. Confirmed failure of meniscal repair (as indicated by MRI or re-arthros-copy) has been identified in 11.8% of patients. A further 10.8% have a probable failure based on a recurrence of mechanical symptoms. Of the failures 73% were professional or semi-professional sportsman. Their average return to sport after surgery was 9.5 months (range 3 to 18 months). Failure was reported at an average of 29.3 months after surgery (range 0 to 84 months).

With an aggressive approach towards meniscal preservation we have achieved a success rate of 77.4% at an average follow-up of 8.7 years.

The majority of these tears are vertical posterior horn or large bucket handle and associated with an ACL reconstruction. The majority of patients are young and involved in a high level of sporting activity.