Clinical outcomes after repair of an isolated radial tear in the middle segment of the lateral meniscus - All-inside suture repair vs trans-capsular suture repair

Ryohei Uchida; Shuji Horibe; Yoshinari Tanaka; Akira Tsujii; Yuta Tachibana; Kazutaka Kinugasa; Konsei Shino

doi:10.1016/j.asmart.2023.08.002

Clinical outcomes after repair of an isolated radial tear in the middle segment of the lateral meniscus - All-inside suture repair vs trans-capsular suture repair

Asia Pac J Sports Med Arthrosc Rehabil Technol. 2023 Aug 29:33:25-31. doi: 10.1016/j.asmart.2023.08.002. eCollection 2023 Jul.

Authors

Ryohei Uchida^{1

2}, Shuji Horibe², Yoshinari Tanaka³, Akira Tsujii⁴, Yuta Tachibana⁵, Kazutaka Kinugasa⁵, Konsei Shino⁶

Affiliations

¹ Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Japan.
² Department of Orthopaedic Sports Medicine, Seifu Hospital, Sakai, Japan.
³ Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, Habikino, Japan.
⁴ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
⁵ Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Sakai, Japan.
⁶ Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan.

Abstract

Background/objective: For radial tears, all-inside suture (AIS) repair was clearly biomechanically superior, compared to conventional trans-capsular suture (TCS) repairs. However, clinical comparative studies of these two repairs techniques have not to be performed. Therefore, the aim of this study was to compare the clinical outcomes after AIS repair and TCS repairs for isolated radial tear at middle segment of lateral meniscus (RTMLM) in stable knees of young athletes.

Methods: Twenty-six athletes (mean age, 19.1 years) underwent AIS repair with the double horizontal suture technique, using SutureLasso™ (Arthrex, Naples, FL) for isolated RTMLM (AIS group), and 20 athletes (mean age, 19.0 years) underwent inside-out repair, one of TCS repairs, with tie-grip suture technique (TCS group). All athletes were assessed for preoperative and two-year postoperative Knee injury and Osteoarthritis Outcome Score (KOOS). At six-month after repair, the lateral meniscal extrusion on mid-coronal plane on MRI and healing status on second-look arthroscopy were also evaluated in all patients.

Results: In both groups, KOOS improved to either good or excellent postoperatively, while complete healing was found in only 23 and 25% at second-look arthroscopy. We identified no group-dependent differences in KOOS or healing status on arthroscopy. However, a close examination of failure rates revealed significant lower rates in AIS group relative to that of TCS group (p = 0.048). Moreover, the change from preoperative to postoperative lateral meniscal extrusion in AIS group was significantly smaller than that in TCS group (p = 0.038).

Conclusions: AIS and TCS repairs for RTMLM were comparable in providing satisfactory clinical results with low rates of complete healing on arthroscopy. However, AIS repair could have lower failure rate of healing on arthroscopy and minimize postoperative lateral meniscal extrusion more effectively than TCS repair on MRI.

Keywords: All-inside suture repair; Lateral meniscus; Meniscal extrusion; Meniscus healing; Radial tear; Suture passer.