RESUMEN
BACKGROUND: There is significant discrepancy in the reported vascularity within the meniscus, and a progressively diminishing blood supply may indicate a differential healing capacity of tears that is dependent on the affected meniscal zone. PURPOSE: To examine the outcomes after inside-out meniscal repair in all 3 meniscal vascularity zones. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients were included if they underwent inside-out meniscal repair by a single surgeon between 2010 and 2014 and had a minimum 2-year follow-up. Patients were divided into 3 groups based on the meniscal tear location (red-red, red-white, and white-white zones) as determined during an intraoperative assessment. Patient-reported outcome scores were obtained at final follow-up. RESULTS: A total of 173 patients (mean age, 33.6 ± 14.3 years) were included, with a mean follow-up of 2.9 ± 0.9 years. All patients demonstrated significant improvements with inside-out meniscal repair from preoperatively to postoperatively, regardless of the meniscal tear location. Patients who underwent meniscal repair in the red-red and red-white zones had significantly increased postoperative Tegner, Lysholm, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores compared with patients who underwent meniscal repair in the white-white zone (P < .05). Patients who underwent acute repair (≤6 weeks) demonstrated significantly higher improvements on the Tegner activity scale (acute: 5.8 ± 2.2; chronic: 4.6 ± 2.2; P = .001) and Lysholm score (acute: 85.6 ± 13.3; chronic: 80.8 ± 13.5; P = .025) compared with patients treated beyond 6 weeks from injury, regardless of the meniscal tear zone. Patients with grade IV femoral condyle chondral lesions at the time of surgery had significantly inferior outcomes compared with patients with grade I through III chondral lesions, regardless of the meniscal tear zone. Three patients (1.7%) subsequently underwent revision inside-out repair, and 3 (1.7%) underwent partial meniscectomy. CONCLUSION: Patients who underwent inside-out meniscal repair demonstrated significant improvements on subjective outcome measures at a minimum 2-year follow-up, regardless of the meniscal tear zone. Inside-out meniscal repair is recommended for potentially reparable meniscal tears in all 3 vascular zones; however, improved outcomes can be achieved when performed acutely, in the absence of full-thickness femoral condyle chondral injuries, and in the red-red and red-white zones.
RESUMEN
BACKGROUND: A common treatment for radial tears of the meniscus has historically been partial meniscectomy. Owing to the poor outcomes associated with partial meniscectomy, repair of the meniscus is an important treatment option. It is important to evaluate different repair techniques for radial tears of the meniscus. PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate 2 novel techniques to repair radial tears of the lateral meniscus. The 2 techniques were compared biomechanically with the cross-suture method with an inside-out technique. The authors hypothesized that novel repair techniques would result in less displacement after cyclic loading, increased load required to displace the repair 3 mm, greater load to failure, decreased displacement at load to failure, and increased stiffness of the repair, resulting in a construct that more closely re-creates the function of the intact meniscus. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 36 fresh-frozen cadaveric tibial plateaus containing intact menisci were obtained. The menisci were divided into 3 groups (n = 12 in each group), and each meniscus was repaired simulating an inside-out technique. The 3 repairs completed were the hashtag, crosstag, and cross-suture techniques. Radial tears were created at the midbody of the lateral meniscus and repaired via the 3 techniques. The repaired menisci were attached to an axial loading machine and tested for cyclic and failure loading. RESULTS: After cyclic loading, the cross-suture repair displaced 4.78 ± 1.65 mm; the hashtag, 2.42 ± 1.13 mm; and the crosstag, 3.13 ± 1.77 mm. The hashtag and cross-tag repairs both resulted in significantly less displacement (P = .003 and .024, respectively) as compared with the cross-suture repair. The cross-suture technique had a load to failure of 81.43 ± 14.31 N; the hashtag, 86.08 ± 23.58 N; and the crosstag, 62.50 ± 12.15 N. The cross-suture and hashtag repairs both resulted in a greater load to failure when compared with the crosstag (P = .009 and .009, respectively). There was no difference comparing the load required to displace the cross-suture technique 3 mm versus the hashtag or crosstag technique (P = .564 and .094, respectively). However, when compared with the crosstag technique, the hashtag technique required a significantly greater load to displace the repair 3 mm (P = .015). CONCLUSION: This study introduced 2 novel repair techniques-hashtag and crosstag-that did not demonstrate superiority in terms of load to failure or stiffness, but both repairs were statistically superior to the cross-suture repair in terms of displacement after cyclic loading. Considerations that may influence the validity of these techniques include cost, surgical time, and increased technical demand. CLINICAL RELEVANCE: Radial tears of the meniscus are difficult to repair. Further research into more stable constructs is necessary.