Document Type: RESEARCH PAPER
Shahid Beheshti University of medical sciences
Guillan University of medical sciences
Despite the introduction of different techniques for meniscal repair, no single procedure is superior in all situations. The new method for meniscal repair named “ modified outside-in technique ” aims to achieve higher primary fixation strength by an alternative suture technique as well as avoid disadvantages of outside-in, inside-out, and all-inside suture procedures. Additionally, the mid-term results of surgically treated patients with eniscal injuries by our new technique were evaluated.
The current prospective study included 66 patients who underwent meniscal repair by the modified outside-in technique. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form was completed pre- and post-operatively. At final follow-up, Lysholm score was completed and patients were questioned about their return to previous sport activities. Clinical success was defined as lack of swelling and joint line tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients’ satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months.
Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair in 12 (19.7%).
Patients’ satisfaction averaged at 8.35±1 (6-10). Neurovascular injury, synovitis and other knot-related complications were not reported.
The modified outside-in technique has satisfactory functional and clinical outcomes. We believe that this procedure is associated with better clinical and biomechanical results; however, complementary studies should be performed to draw a firm conclusion in this regard.
- Ikeuchi H. Trial and error in the development of instruments for endoscopic knee surgery. Orthop Clin North Am. 1982;13(2):255.
- DeHaven KE. Meniscus repair: open versus arthroscopic. Arthroscopy. 1985;1(3):173-4.
- Henning CE. Arthroscopic repair of meniscus tears. Orthopedics. 1983;6(9):1130-32.
- Phillips BB. Arthroscopy of the lower extremity. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopedics. 11th edition. Philadelphia: Mosby Elsevier; 2008:2832-42.
- Morgan CD, Casscells W. Arthroscopic meniscus repair: a safe approach to the posterior horns. Arthroscopy. 1986;2(1):3-12.
- Reigel CA, Mulhollan JS, Morgan CD. Arthroscopic all-inside meniscus repair. Clin Sports Med. 1996;15(3):483-98.
- Forster MC, Aster AS. Arthroscopic meniscal repair. Surgeon. 2003;1(6):323-7.
- Muriuki MG, Tuason DA, Tucker BG, Harner CD. Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. J Bone Joint Surg Am. 2011;93(12):1089-95.
- Rodeo SA. Arthroscopic meniscal repair with use of the outside-in technique. Instr Course Lect. 2000;49:195-206.
- Laprell H, Stein V, Petersen W. Arthroscopic all-inside meniscus repair using a new reﬁxation device: A prospective study. Arthroscopy. 2002;18(4):387–93.
- Tsai AM, McAllister DR, Chow S, Young CR, Hame SL. Results of meniscal repair using a bioabsorbable screw. Arthroscopy. 2004; 20(6):586-90.
- Jones HP, Lemos MJ, Wilk RM, Smiley PM, Gutierrez R, Schepsis AA. Two-year follow-up of meniscal repair using a bioabsorbable arrow. Arthroscopy. 2002;18(1):64-9.
- Fok AW, Yau WP. Early results of all-inside meniscal repairs using a pre-loaded suture anchor. Hong Kong Med J. 2013;19(2):124-8.
- Quinby JS, Golish SR, Hart JA, Diduch DR. All-inside meniscal repair using a new flexible, tensionable device. Am J Sports Med. 2006;34(8):1281-6.
- Billante MJ, Diduch DR, Lunardini DJ, Treme GP, Miller MD, Hart JM. Meniscal repair using an all-inside, rapidly absorbing, tensionable device. Arthroscopy. 2008;24(7):779-85.
- Kalliakmanis A, Zourntos S, Bousgas D, Nikolaou P. Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients. Arthroscopy. 2008;24(7):810-6.
- Miller MD, Kline AJ, Jepsen KG. All-inside meniscal repair devices: an experimental study in the goat model. Am J Sports Med. 2004;32(4):858-62.
- Hospodar SJ, Schmitz MR, Golish SR, Ruder CR, Miller MD. FasT-Fix versus inside-out suture meniscal repair in the goat model. Am J Sports Med. 2009;37(2):330-3.
- Seil R, Rupp S, Jurecka C, Georg T, Kohn D. Biodegradable meniscus fixations: a comparative biomechanical study. Rev Chir Orthop Reparatrice Appar Mot. 2003; 89(1):35-43.
- Hantes ME, Zachos VC, Varitimidis SE, Dailiana ZH, Karachalios T, Malizos KN. Arthroscopic meniscal repair: a comparative study between three different surgical techniques. Knee Surg Sports TraumatolArthrosc. 2006;14(12):1232-7.