Purpose: Despite a number of recently published reports on the success of meniscal repair devices, there are no anatomic studies documenting their safety. The purpose of this cadaveric and radiographic study was to anatomically determine the proximity of a common commercially available meniscal repair device to the popliteal neurovascular structures

Methods: Five human cadaveric knees were obtained and procured from the medical school anatomy lab. Two Biostingers (Linvatec) measuring 16mm in length were placed in the posterior one third of the medial meniscus. Each specimen was then placed prone with the knee extended to expose the posterior aspect of the knee. The distance to the neurovascular bundle for each device was then measured with a ruler calibrated to the nearest 0.1cm. To validate our anatomic dissection results, fifty calibrated human knee MRI scans were reviewed by two independent radiologists. The distances measured were from the popliteal artery to the closest point at the lateral meniscus periphery/capsule and the medial meniscus periphery/capsule. The average distance as measured by the two radiologists was calculated as was the average for the entire population of fifty subjects

Results: The mean distance in the cadaveric study was 15.6mm (14.0–18.0mm) between the tip of the repair device needle and the neurovascular bundle. The mean distance on MRI from the popliteal neurovascular bundle to the closest point in the posterior medial meniscus was 20.0 mm (13.0 mm–28.7 mm). The mean distance from the popliteal structures to the posterior lateral meniscus was 9.4 mm (3.2 mm–16.5 mm).

Conclusions: Considering the potential for significant morbidity, we recommend medial meniscal repair should be performed carefully with repair devices. Specifically, one should limit posterior capsule penetrations to less than 15 mm based on these findings.

Purpose: There is increasing evidence that surgical reconstruction of the ACL deficient knee in active patients over the age of 40 is the treatment of choice. The purpose of this study was to compare the objective and subjective outcomes of patients over 40 years old with those of a group of younger patients, all of whom underwent arthroscopic ACL reconstruction with quadruple hamstring autograft.

Methods: Forty patients were enrolled in this retrospective case-control study. Twenty patients over 40 years of age were compared to twenty patients under the age of 40 from our database. Both groups underwent single incision ACL reconstruction using hamstrings autograft and had a minimum of one year followup. Each patient underwent subjective questioning, radiographic and physical examination by 2 independent clinical reviewers. Subjectively, the groups were then compared using the IKDC (International Knee Documentation Committee) subjective questionnaire, Lysholm Knee score, Tegner activity level, and SF-36 general health survey. Objectively, they were compared using the IKDC objective questionnaire and KT-1000 arthrometry.

Results: The average age of the older group was 50 while the younger group age was 28. The two groups were also similar in terms of sex distribution, follow-up, and meniscal injury at reconstruction. Two patients in the over 40 group had postoperative infection. One patient in the under 40 group suffered a deep abrasion secondary to the tourniquet.|We found no significant difference between the 2 groups in regards to IKDC Subjective score, Lysholm Knee Score, Tegner Activity Level, and SF-36 General Health Survey. Also we found no significant difference between the groups objectively with IKDC scores, KT-1000 measurement and complication rates.

Conclusions: These results indicate that ACL reconstruction using hamstrings tendon autograft in patients older than 40 years old is comparable with that of a younger cohort. Age alone should not be used to determine whether surgical management of patients with ACL deficiency is necessary.