DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20201485

Evaluation of functional outcome of bucket handle medial meniscus repair along with anterior cruciate ligament reconstruction

Akshay Jain, Adhir Jain, Manjeet Singh, Prateek Pathak

Abstract


Background: Bucket-handle meniscus tears (BHMT) are often displaced and unstable and comprise nearly 10% of all meniscus tears and commonly affect the young male population. Displacement of the free segment can lead to significant pain and disability, necessitating reduction and surgical treatment. The aim of present prospective longitudinal cohort study was to evaluate the functional outcomes of bucket handle medial meniscus repair along with anterior cruciate ligament (ACL) reconstruction at 2 years follow up.

Methods: Between January 2017 to December 2018, 30 patients who underwent ACL reconstruction along with bucket handle medial meniscus repair were included in the study. Meniscus repair was done using the all inside, outside in, inside out or hybrid techniques. All patients were evaluated clinically at pre op and at 2 year follow up using knee injury and osteoarthritis outcome score and compared. Meniscal healing was assessed clinically using Barrett’s criteria.

Results: The study comprised 30 patients with a mean age of 27.47 years (range from 13 to 49 years) with 66.67% males. According to clinical examination and Barrett criteria’s the clinical failure rate was 6.67% (2 out of 30 patients) who underwent partial menisectomy later. We also compared functional outcomes of sedentary and active peoplesand also between meniscal repair of less than 3 cm and more than 3 cm’s. There was no statistically significant difference in the functional outcomes in both the groups; however range of motion was significantly higher in tear length 3 cm or less compared to more than 3 cm.

Conclusions: Meniscal repair should be aggressively considered in young pa­tients to enhance functional recovery and durability of the knee joint, if the meniscus is reparable.


Keywords


Bucket handle medial meniscus tear, Knee joint, Meniscus repair, Fast fix, Knee injury and osteoarthritis outcome score, Barrett criteria

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References


Miller MD, Thompson SR. Miller’s review of orthopaedics. 7th ed. Philadelphia: Elsevier; 2016: 341-342.

Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee. A study of normal and os¬teoarthrotic knee joints. Acta Orthop Scand. 1980;51:871-9.

Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of menisectomy and of repair on intraarticular contact areas and stress in the human knee: a preliminary report. Am J Sports Med. 1986;14:270-5.

Ode GE, Van Thiel GS, McArthur SA, Dishkin-Paset J, Leurgans SE, Shewman EF, et al. Effects of serial sectioning and repair of radial tears in the lateral meniscus. Am J Sports Med. 2012;40:1863-70.

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;93:1089-95.

DeHaven KE. Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med. 1980;8(1):9-14.

Warren RF, Marshall JL. Injuries of the anterior cruciate and medial collateral ligaments of the knee: a long-term follow-up of 86 cases: part II. Clin Orthop Relat Res. 1978;(136):198-211.

De Girolamo L, Galliera E, Volpi P, Denti M, Dogliotti G, Quaglia A, et al. Why menisci show higher healing rate when repaired during ACL reconstruction? Growth factors release can be the explanation. Knee Surg Sports Traumatol Arthrosc. 2015;23(1):90-6.

Cannon Jr WD. Arthroscopic meniscal repair. Inside-out technique and results. Am J Knee Surg. 1996;9:137-43.

Dean CS, Chahla J, Matheny LM, Mitchell JJ, La Prade RF. Outcomes after biologically augmented isolated meniscal repair with marrow venting are comparable with those after meniscal repair with concomitant anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45(6):1341-8.

Freedman KB, Nho SJ, Cole BJ. Marrow stimulating technique to augment meniscus repair. Arthroscopy. 2003;19(7):794-8.

Mariani PP, Santori N, Adriani E, Mastantuono M. Acceler¬ated rehabilitation after arthroscopic meniscal repair: a clinical and magnetic resonance imaging evaluation. Arthroscopy. 1996;12:680-6.

Vander Schilden JL. Improvements in rehabilitation of the post menisectomized or meniscal-repaired patient. Clin Orthop Relat Res. 1990;(252):73-9.

Fazalare JJ, McCormick KR, Babins DB. Meniscal repair of the knee. Orthopedics. 2009;32:199.

Canale ST, Beaty JH. Campbell’s operative orthopaedics. 12th ed. St Louis, MO: Mosby; 2012: 2075-8, 2014.

O’Shea JJ, Shelbourne KD. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. Am J Sports Med. 2003;31(2):216-20.

Metcalf MH, Barrett GR. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med. 2004;32:675-80.

U.S. Social Security Administration (1996): Policy interpretation ruling titles ii and xvi: determining capability to do other work--implications of a residual functional capacity for less than a full range of sedentary work. Federal Register, Vol. 61, No. 128, 1996.

Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am. 2004;86:670-9.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28:88-96.

Barrett GR, Field MH, Treacy SH, Ruff CG. Clinical results of meniscus repair in patients 40 years and older. Arthroscopy. 1998;14:824-9.

Fauno P, Nielsen AB. Arthroscopic partial menisectomy: a long-term follow-up. Arthroscopy 1992;8(3):345-9.

Salata MJ, Gibbs AE, Sekiya JK. A systematic review of clinical outcomes in patients undergoing menisectomy. Am J Sports Med. 2010;38(9):1907.

Johnson D, Weiss B. Meniscal repair using the inside-out suture technique. Sports Med Arthroscopy. 2012;20(2):68-76.

Miller DB Jr. Arthroscopic meniscus repair. Am J Sports Med. 1988;16(4):315-20.

O’Shea JJ, Shelbourne KD. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. Am J Sports Med. 2003;31(2):216-20.

Feng H, Hong L, Geng XS, Zhang H, Wang XS, Jiang XY. Second-look arthroscopic evaluation of bucket-handle meniscus tears repairs with anterior cruciate ligament reconstruction: 67 consecutive cases. Arthroscopy. 2008;24(12):1358-66.

Brown GC, Rosenberg TD, Deffner KT. Inside-out meniscal repair using zone¬-specific instruments. Am J Knee Surg. 1996;9(3):144-50.

Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic me¬niscal repair evaluated by second-look arthroscopy. Am J Sports Med. 1991;19(6):632-7.

Ryu RK, Dunbar WH 4th. Arthroscopic meniscal repair with two-year follow-up: a clinical review. Arthroscopy. 1988;4(3):168-73.

Venkatachalam S, Godsiff SP, Harding ML. Review of the clinical results of arthroscopic meniscal repair. Knee. 2001;8(2):129-33.

Barber FA, Herbert MA, Richards DP. Load to failure testing of new meniscal repair devices. Arthroscopy. 2004;20(1):45-50.

Bohnsack M, Rühmann O. Arthroscopic meniscal repair with bio resorbable implants. Oper Orthop Traumatol. 2006;18(5-6):425-52.

Borden P, Nyland J, Caborn DN, Pienkowski D. Biomechanical comparison of the Fast-Fix meniscal repair suture system with vertical mattress sutures and meniscus arrows. Am J Sports Med. 2003;31(3):374-8.

Ahn JH, Kim SH, Yoo JC, Wang JH. All-inside suture technique using two ¬posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy. 2004;20(1):101-8.

Espejo-Reina A, Serrano-Fernandez JM, Martin-Castilla B, Estades-Rubio FJ, Briggs KK, Espejo-Baena A. Outcomes after repair of chronic bucket¬-handle tears of medial meniscus. Arthroscopy. 2014;30(4):492-6.

Stone RG, Frewin PR, Gonzales S. Long-term assessment of arthroscopic meniscus repair: a two- to six-year follow-up study. Arthroscopy. 1990;6(2):73-8.

Paxton ES, Stock MV, Brophy RH. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011;27(9):1275-88.

Ahn JH, Lee YS, Yoo JC, Chang MJ, Koh KH, Kim MH. Clinical and second¬-look arthroscopic evaluation of repaired medial meniscus in anterior cruciate ligament-reconstructed knees. Am J Sports Med. 2010;8(3):472-7.