Clinical outcome and failure analysis of medial meniscus bucket-handle tear repair: a series of 96 patients with a minim
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ORTHOPAEDIC SURGERY
Clinical outcome and failure analysis of medial meniscus bucket‑handle tear repair: a series of 96 patients with a minimum 2 year follow‑up Mathieu Thaunat1 · Gaspard Fournier1 · Padhraig O’Loughlin2 · Biova Teko Kouevidjin1 · Gilles Clowez1 · Matteo Borella1 · Jean‑Marie Fayard1 · Bertrand Sonnery‑Cottet1 Received: 5 June 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The failure rate of meniscal repair remains significant, especially for bucket-handle tears. This study aimed to evaluate the clinical outcomes, failure rate and risk factors for failure of bucket-handle medial meniscal tear repairs performed during ACL reconstruction. Materials and methods A retrospective analysis of prospectively collected data was performed on a consecutive series of 96 ACL reconstructions with meniscal arthroscopic suture of a bucket-handle tear of the medial meniscus with a minimum 2 year follow-up. Preoperative and postoperative evaluation at last follow-up included objective IKDC rating, instrumented differential laxity and Tegner activity level. Functional outcome was evaluated with Lysholm score at last follow-up. Failure rate, survival curves and risk factor analysis using Cox proportional hazard ratio models were performed to analyze suture repair failure. Results At IKDC rating, all patients were C or D preoperatively, whereas they where all A or B at last follow-up. Instrumented differential laxity improved from 6.77 mm (1.57) to 1.02 mm (1.15) mm at last follow-up (p = 1.9 E−18). The mean Tegner score before injury was 6.79 (± 1.47) and 6.11 (± 1.75) at last follow-up (p = 0.0011). Mean Lyholm score at last follow-up was 91.53 (± 11.6). The average entire cohort failure rate was 19% at final follow-up of 35.2 ± 9.8 months. Kaplan–Meier survival analysis demonstrated that the probability of the absence of failure decreased constantly over time. No significant difference in the objective IKDC, Lysholm or Tegner scores was observed between the failure group and the success group. Multivariate analysis revealed that younger patients and a procedure of ACL revision are more at risk for suture repair failure. In the majority of cases, the meniscal lesion observed at revision was equivalent or less extensive than the initial lesion. Conclusion Despite the fact that failure rate remains high for medial meniscus bucket-handle tears, suture repair of buckethandle tears should be encouraged taking into account the long-term consequences of menisectomy. Keywords Knee · Meniscus · Bucket-handle tear · Suture repair · Arthroscopic surgery
Introduction Anterior cruciate ligament (ACL) tears are frequently associated with meniscal lesions. Preservation of meniscal tissue in a young and active population is critical to prevent * Mathieu Thaunat [email protected] 1
Ramsay Générale de Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, 24, Avenue Paul Santy, 69008 Lyon, France
Mater Private Cork, City Gate, Mahon, Cork, Ireland
2
degenerative ch
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