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Document Title: Majewski-AJSM-Jul06.shtml
Article Title: Midterm and Long-term Results After Arthroscopic Suture Repair of Isolated, Longitudinal, Vertical Meniscal Tears in Stable Knees
Authors: Martin Majewski, MD, Reinhard Stoll, MD, Heinz Widmer, MD, Werner Müller, MD and Niklaus F. Friederich, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: July 2006
Volume 34, pages 1072-1076
Keywords: Degenerative joint disease, knee, meniscus, arthroscopy, meniscal repair, vertical-mattress, osteoarthritis prevention.
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Comments: This study, with an impressive follow-up of a mean of 10 years (ranging from 5 to 17 years), looked at meniscal repair via suturing. The authors found that suturing brings excellent results, although they note that osteoarthritis remains a concern. They found a higher rate of osteoarthritis in meniscal-injured-and-repaired knees than in the never-injured contralateral knees. However, there is a catch here: the original meniscal injuries may have been accompanied by hidden damage, such as bone-bruising, which is a well-known harbinger of osteoarthritic degeneration. Remember, too, that in the past, bone-bruising was often unrecognized or unnoticed on knee examinations. So, what may have been recorded as "meniscal tear" may in fact have been a more complex injury involving multiple structures in addition to the meniscus. Subtle partial tearing of tensile structures (ligaments) may also have accompanied the meniscal tearing; such partial tearing may have affected overall knee motion and thus could have altered the loadings (compression and shear) which the compromised-and-repaired meniscus is subjected to over the long term.
ABSTRACT
Background: The long-term outcome of meniscal suture repair has not been firmly established.
Purpose: To compare the midterm and long-term functional and radiographic outcome of meniscal suture repairs with the natural history of the uninjured knees of each of a cohort of patients.
Study Design: Cohort study; Level of evidence, 3.
Methods: Eighty-eight patients with an isolated, longitudinal, vertical tear of one of the menisci within a stable knee were arthroscopically treated with a meniscal suture repair. No patient had a previous surgery, and no additional chondral lesion was present. The opposite knee of each patient was uninjured. Both knees of each patient were examined clinically and radiographically in a retrospective follow-up 5 to 17 years (mean, 10 years) after meniscal repair.
Results: Three patients with postoperative complications and 21 patients whose menisci had to be removed because of rerupture were excluded from further evaluation for purposes of this study. The remaining 64 patients reached a mean Tegner activity level of 6 points (range, 3–10 points) and achieved a mean Lysholm score of 94 points (range, 26–100 points). Osteoarthritis was found in 46 of the injured knees, compared with 27 of the uninjured knees (P = .004). However, 42 of the patients had no difference in the grade of osteoarthritis between the injured knee and the uninjured knee, 19 had a difference of 1 grade, 2 had a difference of 2 grades, and 1 had a difference of 3 grades.
Conclusion: Arthroscopic meniscal repair for isolated longitudinal meniscal injuries in stable knees yields favorable functional results, but its effects on the risk of secondary osteoarthritis are not clear.
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