LIVRE JDG 2016

M. THAUNAT, N. JAN, J.M. FAYARD, C. KAJETANEK, C.G. MURPHY, B. PUPIM, R. GARDON, B. SONNERY-COTTET

132

Statistics

The Wilcoxon test was used for comparison of

the preoperative and postoperative IKDC and

Tegner scores. The Mann-Whitney test was

used to compare the age of the patient, gender,

number of devices used, tear zone, tear stability,

and knee laxity between meniscal repair

failures and nonfailures. Kaplan-Meier curves

were used to visually illustrate differences in

time to reoperation between groups.

Significance was set at

<0.05.

Results

Population characteristics

We prospectively evaluated 132 consecutive

patients in whom 132 medial menisci met the

inclusion criteria and underwent a medial

meniscus repair through a posteromedial portal

in conjunction with ACL reconstruction. The

average age was 26.4 years (12-57), the average

BMI was 24.3 (16-34) with a male to female

ratio of five to one. The surgery was performed

in the right knee in 88 cases (66.7%). There

were 106 cases of primary ACL reconstruction,

23 cases of revision ACL reconstructions and

in 3 cases (2.3%) the procedure was a re-

revision procedure. For reconstruction, a

semitendinosus-gracilis tendon graft was used

in 89 knees (67.4%), a patellar bone-tendon-

bone graft was used in 41 knees (31.1%) and a

quadriceps tendon graft was used in 2 knees

(1.5%). The average side to side difference

anterior knee laxity measured with the

rolimeter (Aircast, Boca Raton, FL)

preoperatively

was

7mm

(5-14mm).

Preoperatively, the pivot shift test was normal

in 7 cases, had a “glide” in 65 cases, a “clunk”

in 23 cases and a gross pivot shift in 16 cases.

It was not possible to test the pivot shift in

21 cases. Characteristics of the suture are

summarized in table 1.

Objective and subjective evaluation

The mean follow-up period was 27 months

(range 24-29 months). 3 patients refused to

participate in the study and 6 patients had a

new severe traumatic event postoperatively,

resulting in 3 recurrent ACL tears, 2 contra

lateral ACL tears and 1 lateral meniscus tear.

These 9 patients reported no complaints about

the sutured meniscus but were excluded from

subjective IKDC final evaluation. The average

subjective IKDC rose from 63.8 ± 13.5 (range,

27-92) preoperatively to 85.7 ± 12 (range, 43-

100) at last follow up (

<0,0001). The Tegner

activity scale at the last follow-up (6.9 ± 1.72)

was slightly lower than before surgery (7.2 ±

1.92) (

=0.0017). The rolimeter test decreased

from a side to side difference in anterior knee

laxity of 7mm (range, 5-14mm) to a mean

value of 0.4mm (range: -3mm ± 5mm) at last

follow up (

<0,0001). 82.2% of the patients

returned to their premorbid level of activity.

Clinical failure

Unhealed tears

15 patients were found to be symptomatic

according to Barret’s criteria. An MRI was

performed in all cases. The tear appeared to be

healed in 3 cases and unhealed in 12 cases.

12 patients were considered as clinical failures

(positive Barret’s criteria and unhealed tear on

MRI examination). Clinical failure rate was of

9%. It was of 4.9% in the sub-group “limited

tear” and 15.7% in the sub-group “extended

tear”. The extended lesions had an increased

risk of clinical failure (

=0.036). 3 patients

considered their symptoms were not so intense

as to require revision surgery and only

9 patients underwent a revision surgery.

Need for revision surgery

The primary outcome in this study was the

need for reoperation on the repaired meniscus.

9 patients (6.8%) had failure of the meniscal

repair. 3.7% (3/81) occurred in the in the sub-

group of “limited tears” and 11.7% (6/51) in

the sub-group “extended tears” (fig. 3). With

repeat surgical intervention involving resection

or revision of the repair as the end-point, the