Description
Objective
The role and importance of meniscus integrity is well established nowadays. It is known that meniscectomy, no matter how small, leads to early development of osteoarthritis. Hence, the ultimate goal of meniscal surgery is to preserve as much as possible viable tissue. This conjecture forms the basis of the current paper, which primarily aims to assess the success rate following meniscal repair.
Matherials
We designed a retrospective study including all patients submitted to meniscal repair between 2019 and 2022, with a minimum of one-year follow-up. Demographic and clinical data was collected, namely age, gender, waiting for surgery, location, zone and type of lesion, type of repair, augmentation techniques and associated lesions. Rehabilitation protocol was adjusted to tear pattern, with 6 weeks of protected weight bearing. Meniscal repair failure was suspected according to clinical presentation, such as pain, catching and tenderness on the joint line. If the suspicion was high, a control magnetic resonance image (MRI) was requested.
Results
Data from 33 cases was gathered. 82% were male, with a median age of 28 with an interquartile range (IQR) of 28-42 years. The median waiting time for surgery was 132 days with an IQR of 70 to 346 days. No correlation was found between this and the rate of failure. Most of the lesions were on the medial meniscus (60%), mainly on the posterior horn and meniscocapsular zone. In the lateral meniscus, the distribution between zones was more homogeneous. The lesions were mainly located in the red-red and white-red zone. Around 40% of the tears were vertical, 27% bucket handle and the remaining RAMP, horizontal or complex.
Most of the cases (63,6%) were treated with an all-inside repair, including RAMP lesions, which are repaired with a suturelasso® device. Around 15,6% were treated with an outside in repair. Reducible bucket handle tears were treated with a combined technique, according to the affected zone.
Around 60% of the cases evolved uneventfully. In almost 40%, there was a clinical suspicion of possible suture failure, so a MRI was ordered. We had an imagological healing rate of around 85%[HN1] , which means that we had 2 cases of failure. One was a bucket handle tear, that had a new torsional event and the other was a longitudinal tear that waited more than 400 days for surgery.
Associated lesions were present in 85% of the patients, with the most prevalent being anterior cruciate ligament rupture.
Chondral injuries did not seem to have impact on the clinical results.
Conclusions
Success of repairing peripheral tears in the vascularized zone is already recognized. Currently, there is a trend towards broadening the indications for suture, even for tears located in the white zone or bucket handle lesions with a long time of evolution. The findings of our study support this statement.
Our rate of failure was around 6%, which is inferior to what is reported in literature, and independent of the technique used. As potential risk factors, we can point out: patient-dependent factors that impair adherence to rehabilitation protocol, advanced age, poor tissue quality, and long waiting time for surgery.
[HN1]Este valor não faz sentido… Se tens menos de 30% de cicatrização na rmn, só temos 2 falências!?!?!
