The Role of the Pie-Crusting Technique of the Medial Collateral Ligament in the Arthroscopic Inside-out Technique for Medial Meniscal Repair With or Without Anterior Cruciate Ligament Reconstruction: A Satisfactory Repair Technique (original) (raw)
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Role of Age on Success of Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2021
To assess failure rates and patient-reported outcomes measures (PROMs) following arthroscopic primary ACL repair of proximal tears in different age groups. Methods: Between 2008 and 2017, the first 113 consecutive patients treated with repair were retrospectively reviewed at minimum of 2-years. Patients were stratified into three age groups: ≤21, 22-35, and >35 years. Primary outcomes were ipsilateral reinjury or reoperation, and contralateral injury rates, and secondary outcomes consisted of Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) subjective, pain, and satisfaction scores. Group differences were compared using chisquare tests and Mann-Whitney U tests. Results: Follow-up was obtained in 113 patients (100%). Median age was 35 years (IQR 23-43) and median follow-up was 2.2 years (IQR 2.0-2.8). Overall, ACL reinjury occurred in 13 patients (11.5%), reoperation in seven patients (6.2%), complications in two patients (1.8%) and contralateral ACL injury in four patients (3.5%). Overall, median Lysholm was 95 (IQR 89-100) and IKDC subjective 92 (IQR 84-99). Treatment failure was significantly higher in the youngest age group (37.0%) as compared to the middle and older groups (4.2% and 3.2%, both p<0.005). No significant differences were seen in reoperation, complication, or contralateral injury rates between groups (all p>0.2), nor in PROMs between the groups (all p>0.1). Conclusion: The failure rate of primary repair of proximal ACL tears is high in patients aged 21 or younger (37.0%), and this should be taken into account when discussing repair in this patient group. In patients older than 21, repair may be an excellent treatment with low failure (3.5%) and complication rates (1.2%) and good subjective scores.
Arthroscopy, Sports Medicine, and Rehabilitation, 2020
Purpose: To evaluate the outcomes of arthroscopic meniscal repair performed in combination with anterior cruciate ligament (ACL) repair. Methods: This study presents a case series of 34 patients who underwent repair of meniscal tears along with ACL reconstruction from 2014 to 2016. Cases of discoid meniscal lesions and combined or ligament injuries other than ACL injuries were excluded. Patients were followed up periodically, at 3, 6, 9, 12, and 24 months. Preoperative and postoperative functional evaluations were performed using visual analog scale, International Knee Documentation Committee, and Lysholm knee scores. Results: The mean age of the patients was 29.1 years (range, 17-44 years). The mean follow-up period was 18 AE 7.8 months (range, 6-24 months). Among the 34 individual knees, 1 patient (3%) underwent both medial and lateral meniscal repairs. Medial meniscal repair was performed in 20 knees (59%), whereas the lateral meniscus was repaired in 13 knees (38%). A longitudinal tear was the most common type of tear pattern, followed by radial (6 patients) and complex (3 patients) tear patterns. The radial and complex tears were treated with an additional partial meniscectomy. The mean International Knee Documentation Committee score was 38.46 preoperatively and improved to 80.30 at final postoperative follow-up (statistically significant difference, P < .01). The mean Lysholm score was 50.30 preoperatively and improved to 91.40 at final postoperative follow-up (statistically significant difference, P < .01). According to the Lysholm knee score, 31 patients (89%) had excellent or good results. The mean visual analog scale score decreased from 7.3 preoperatively to 2 postoperatively. The clinical success rate of the repairs was 89%. Of 35 repairs, 4 (11%) had retears. Conclusions: Arthroscopic meniscal repair along with ACL reconstruction provided predictable high rates of meniscal healing and yielded favorable functional and clinical results. Patient selection remains one of the most important prognostic factors. Level of Evidence: Level IV, therapeutic case series.
Knee Surgery, Sports Traumatology, Arthroscopy
Purpose To assess the outcomes of the various techniques of primary repair of proximal anterior cruciate ligament (ACL) tears in the recent literature using a systematic review with meta-analysis. Methods PRISMA guidelines were followed. All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears using primary repair, repair with static (suture) augmentation and dynamic augmentation between January 2014 and July 2019 in PubMed, Embase and Cochrane were identified and included. Primary outcomes were failure rates and reoperation rates, and secondary outcomes were patient-reported outcome scores. Results A total of 13 studies and 1,101 patients (mean age 31 years, mean follow-up 2.1 years, 60% male) were included. Nearly all studies were retrospective studies without a control group and only one randomized study was identified. Grade of recommendation for primary repair was weak. There were 9 out of 74 failures following primary repair (10%), 6 out of 69 following repair with static augmentation (7%) and 106 out of 958 following dynamic augmentation (11%). Repair with dynamic augmentation had more reoperations (99; 10%), and more hardware removal (255; 29%) compared to the other procedures. All functional outcome scores were > 85% of maximum scores. Conclusions This systematic review with meta-analysis found that the different techniques of primary repair are safe with failure rates of 7-11%, no complications and functional outcome scores of > 85% of maximum scores. There was a high risk of bias and follow-up was short with 2.1 years. Prospective studies comparing the outcomes to ACL reconstruction with sufficient follow-up are needed prior to widespread implementation. Level of evidence IV. * Jelle P. van der List
Medial collateral ligament lengthening by standardized pie-crusting technique: A cadaver study
Orthopaedics & Traumatology: Surgery & Research, 2016
Introduction: Pie-crusting (PC) is a tissue expansion technique using multiple perforation to lengthen the medial collateral ligament (MCL), but has still to be codified. Hypothesis: Standardized MCL PC allows measured opening of the medial femorotibial (MFT) joint line, without risk of MCL tear. Material and method: Thirty-one knees were dissected, with medial parapatellar arthrotomy and resection of the cruciate ligaments and menisci. The deep MCL bundle was sectioned, and the thick anterior bundle (AB) of the MCL was observed in each knee. Knees were randomly allocated between AB sparing (AB+; n = 15) or sectioning (AB−; n = 16). A graduated dynometric tensor applied constant 80 N distraction on the MFT joint line. MCL PC used a 19-G needle at the joint line, with a horizontal series of perforations every 2 mm over the width of the MCL. MFT compartment opening was measured after each PC series. Results: Mean MFT space after sectioning the cruciate ligaments was 5.52 ± 0.37 mm, increasing by 1.64 ± 1.28 mm with AB sectioning. Twenty-five perforations were made in the AB+ and 16 in the AB− group. Final mean joint-line increase was 0.18 ± 0.18 mm in AB+ and 3.16 ± 2.70 mm in AB−. There were no MCL tears. Discussion: MCL pie-crusting was reliable and reproducible, achieving progressive MFT joint-line lengthening to a mean 8.71 ± 2.62 mm when associated to sectioning of the cruciate ligaments and MCL AB.
Archives of Orthopaedic and Trauma Surgery, 2005
Introduction We have previously reported results after 2-5 and 5-10 years follow-up of repair of acute anterior cruciate ligament (ACL) ruptures by suturing. Reports of results after more than 10 years are rare. Materials and methods A total of 140 patients were operated on in the period 1975-1983 (age range 13-71 years, median 28 years) by the modified Palmer technique. Only 2 meniscus resections and 4 meniscectomies were performed at the primary operation; while 28 menisci were sutured. At follow-up,12 patients were dead. Eighteen patients (13%) underwent repeat operations for secondary instability. Of the remaining 110 patients, 81 appeared for follow-up. Results Only 6 secondary meniscus resections were performed, all in the group of 18 patients operated on again for instability. No secondary meniscus surgery was performed on the 81 patients who appeared for follow-up. The median Lysholm score was 88, and 58 of the 81 patients (71%) classified their total knee function as good or excellent. By KT-1000 testing, 33 (41%) patients had less than 3 mm anterior instability, 29 (36%) had 3-5 mm instability, and 17 (21%) had more than 5 mm. With 18 patients from the total of 128 living patients re-operated for instability, we estimate the rate of total failure of stability as 27%. Radiological osteoarthritis grade C was present in 8 operated and 2 control knees, while only 1 operated knee revealed osteoarthritis grade D. Thirty-four operated and 20 control knees had grade B. Osteoarthritis was correlated to more advanced age at injury, while correlation to function could not be proven. Radiographs were obtained of 61 patients at followup. Conclusions Some 50% of patients had stable or slightly unstable knees, and 40% good or excellent function according to the Lysholm score. Re-operation for instability was more frequent in younger patients, while ostearthritis was more frequent in older patients. The rate of meniscus resection or extirpation was low. Open repair by suture is no longer recommended. Further research is indicated on the possible use of refixation of the ruptured ACL by arthroscopy.
Background and purpose: It is a debatable subject that, early ACL reconstruction has better outcomes than the delayed one. The purpose of this prospective study is to evaluate functional outcome following ACL reconstruction in the two cohort one with early and another with delayed reconstruction. Patients and methods: Seventy six patients with ACL-deficient knees that met inclusion criteria underwent ACL reconstruction using quadrupled hamstring autograft by one surgeon. Patients were grouped into two groups on the basis of simple random sampling. patients in the group I underwent ACL reconstruction within 8 weeks after injury and patients in group II after 8 weeks of injury. All patients were subjected to same post-operative rehabilitation protocol. All the knees were observed in a prospective manner with a subjective and an objective functional outcome score, and range of motion at 2, 8, 14, 24, 52-weeks and 2-year interval. Results: Range of motion was less in the group I in the first 24 weeks, and the difference was significant (p < 0.01). At one and two years of follow-up the difference was not significant (P < 0.01). The IKDC and the Lysholm score was apparently better in the group II but the difference was significant till 52 postoperative week (p < 0.01) and was not significant at second postoperative year. Conclusion: There is no advantage in early reconstruction for the ACL insufficiency. Delayed surgery, allow the surgeon to assess more carefully a patient's suitability for the surgery.
The Knee, 2019
Introduction: There has been a recent resurgence of interest in arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears. Patient selection is critical but not much is currently known on what predicts the possibility of repair. Goal of this study was therefore to assess predictive factors for the possibility of arthroscopic primary ACL repair. Methods: In this retrospective case-control study, all patients undergoing ACL surgery in a ten-year interval were included. Patients were treated with primary repair if there was a proximal tear and good tissue quality, or otherwise underwent ACL reconstruction. Collected data were age, gender, BMI, injury-to-surgery delay, injury mechanism and concomitant injuries. Receiver operating characteristic curves were used to find cutoff values, and all significant dependent variables were used in multivariate logistic analysis to assess independent predictors for the possibility of primary repair. Results: Three hundred sixty-one patients were included, of which in 158 patients (44%) primary repair was possible. Multivariate analysis (R 2 = 0.340, p b 0.001) showed that age N 35 years (Odds ratio [OR] 4.2, 95% CI 2.4-7.5,p b 0.001), surgery within 28 days (OR 3.3, 95% CI 1.9-5.7, p b 0.001), and BMI b 26 (OR 1.9, 95% CI 1.1-3.3,p = 0.029) were predictive for the possibility of primary repair, and lateral meniscus injury presence decreased the likelihood of repair (OR 0.5, 95% CI 0.3-0.8, p = 0.008). Conclusion: In this large cohort study, it was noted that 44% of patients had repairable ACL tears. Primary repair was more likely to be possible in older patients, patients with lower BMI and when surgery was performed within four weeks of injury.
Orthopaedic Journal of Sports Medicine, 2020
Background: Previous research has shown that meniscal and articular cartilage lesions increase with time in the anterior cruciate ligament (ACL)–deficient knee. Purpose: To analyze the association between increased time from ACL injury to reconstruction and the presence of intra-articular lesions. Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed for patients who sustained an ACL injury and underwent reconstruction from January 1, 2009, to May 14, 2015. Factors analyzed included age, sex, and body mass index, as well as time from injury to surgery, the presence of meniscal tears, and the presence of cartilage lesions. The data were evaluated to quantify the association between time from ACL injury to reconstruction and presence of intra-articular lesions. Results: Overall, 405 patients were included in this study. Regarding time from injury, 27.3% patients were treated at <3 months, 23.6% at 3 to <6 months, 18% at 6 to <...