Akira Tsujii1, Hiroshi Amano2, Yoshinari Tanaka3, Keisuke Kita4, Ryohei Uchida5, Yoshiki Shiozaki6, Shuji Horibe7. 1. Department of Orthopedic Surgery, Yao Municipal Hospital, 1-3-1 Ryugecho, Yao, Osaka 581-0069, Japan. Electronic address: a-tsujii@umin.ac.jp. 2. Department of Sports Orthopedics, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kitaku, Sakai, Osaka 591-8025, Japan. Electronic address: h-amano@umin.ac.jp. 3. Department of Sports Orthopedics, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kitaku, Sakai, Osaka 591-8025, Japan. Electronic address: yoshi-tanaka@iris.eonet.ne.jp. 4. Department of Sports Orthopedics, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kitaku, Sakai, Osaka 591-8025, Japan. Electronic address: keikita@hera.eonet.ne.jp. 5. Department of Orthopedic Surgery, Seifu Hospital, 5-1-3 Shinkanaokacho, Kitaku, Sakai, Osaka 591-8021, Japan. Electronic address: uchida3847@gmail.com. 6. Department of Orthopedic Surgery, Seifu Hospital, 5-1-3 Shinkanaokacho, Kitaku, Sakai, Osaka 591-8021, Japan. Electronic address: yks@ares.eonet.ne.jp. 7. Faculty of Comprehensive Rehabilitation, Osaka Prefectural University, 3-7-30 Habikino, Habikino, Osaka 583-8555, Japan. Electronic address: s-horibe@rehab.osakafu-u.ac.jp.
Abstract
BACKGROUND: Radial/oblique tears of the midbody of the lateral meniscus significantly impair the ability of the meniscus to withstand the tibiofemoral load, requiring meniscal repair. However, healing status after meniscal repair has not been fully elucidated. This study aimed to evaluate arthroscopic findings after inside-out suture repair for isolated radial/oblique tears of the midbody of the lateral meniscus. METHODS: From 2011 to 2015, 18 consecutive patients with isolated radial/oblique tears of the midbody of the lateral meniscus underwent arthroscopic inside-out repair with the tie-grip suture technique. All knees were stable with no previous surgery. All patients were evaluated by second-look arthroscopy at six months postoperatively. Activities including jogging were not allowed until meniscal status was evaluated arthroscopically. To analyze factors associated with healing rates, age, time from injury to initial surgery, and tear zone were compared. RESULTS: Second-look arthroscopy revealed complete healing in four (22%) patients, partial healing in seven (39%), and failure to heal in seven (39%). Significant differences were observed for tear zone (p < 0.0001), but not for age and timing of repair. CONCLUSIONS: Arthroscopic evaluation revealed that inside-out repair with the tie-grip suture technique for isolated radial/oblique tears of the midbody of the lateral meniscus achieved complete or partial healing only in 61% of patients. Satisfactory results were observed particularly in patients with tears extending to the vascular zone, whereas those with tears in the avascular zone failed to achieve healing. Therefore, the operative indication of inside-out repair for radial/oblique tears of the midbody of the lateral meniscus might be limited to tears extending into the vascular zone. Given that 39% of cases were arthroscopically considered a failure even if patients complained of no symptoms in daily life, decisions should be made carefully to allow patients to return to sports activities.
BACKGROUND: Radial/oblique tears of the midbody of the lateral meniscus significantly impair the ability of the meniscus to withstand the tibiofemoral load, requiring meniscal repair. However, healing status after meniscal repair has not been fully elucidated. This study aimed to evaluate arthroscopic findings after inside-out suture repair for isolated radial/oblique tears of the midbody of the lateral meniscus. METHODS: From 2011 to 2015, 18 consecutive patients with isolated radial/oblique tears of the midbody of the lateral meniscus underwent arthroscopic inside-out repair with the tie-grip suture technique. All knees were stable with no previous surgery. All patients were evaluated by second-look arthroscopy at six months postoperatively. Activities including jogging were not allowed until meniscal status was evaluated arthroscopically. To analyze factors associated with healing rates, age, time from injury to initial surgery, and tear zone were compared. RESULTS: Second-look arthroscopy revealed complete healing in four (22%) patients, partial healing in seven (39%), and failure to heal in seven (39%). Significant differences were observed for tear zone (p < 0.0001), but not for age and timing of repair. CONCLUSIONS: Arthroscopic evaluation revealed that inside-out repair with the tie-grip suture technique for isolated radial/oblique tears of the midbody of the lateral meniscus achieved complete or partial healing only in 61% of patients. Satisfactory results were observed particularly in patients with tears extending to the vascular zone, whereas those with tears in the avascular zone failed to achieve healing. Therefore, the operative indication of inside-out repair for radial/oblique tears of the midbody of the lateral meniscus might be limited to tears extending into the vascular zone. Given that 39% of cases were arthroscopically considered a failure even if patients complained of no symptoms in daily life, decisions should be made carefully to allow patients to return to sports activities.