Favorable Reoperation Rate at 2 Years Following Repair of Horizontal Cleavage Tears Using an All Suture-Based Technique: A Prospective, Multicenter Trial

Peter Kurzweil; Aaron J Krych; Adam Anz; F Winston Gwathmey; Gregory Loren; Matthew Lavery; David C Flanigan

doi:10.1016/j.asmr.2021.01.018

Favorable Reoperation Rate at 2 Years Following Repair of Horizontal Cleavage Tears Using an All Suture-Based Technique: A Prospective, Multicenter Trial

Arthrosc Sports Med Rehabil. 2021 Mar 13;3(3):e773-e780. doi: 10.1016/j.asmr.2021.01.018. eCollection 2021 Jun.

Authors

Peter Kurzweil¹, Aaron J Krych², Adam Anz³, F Winston Gwathmey⁴, Gregory Loren⁵, Matthew Lavery⁶, David C Flanigan⁷

Affiliations

¹ Memorial Orthopaedic Surgical Group, Long Beach, California, U.S.A.
² Mayo Clinic, Rochester, Minnesota, U.S.A.
³ Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, Florida, U.S.A.
⁴ University of Virginia, Charlottesville, Virginia, U.S.A.
⁵ CORE Orthopaedic Medical Center, Encinitas, California, U.S.A.
⁶ OrthoIndy, Greenwood, Indiana, U.S.A.
⁷ The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, Ohio, U.S.A.

Abstract

Purpose: This prospective, multicenter trial evaluates the clinical success (as measured by reoperation rates and improvements in patient-reported outcome measures) of using circumferential compression stitches with all-suture techniques for horizontal cleavage tears (HCTs) of the meniscus.

Methods: Investigators enrolled 30 patients (mean age, 38.2 years; standard deviation, 11.1 years) aged 18 to 60 years with HCTs in the symptomatic compartment at 8 centers in the United States who underwent HCT repair with all-suture circumferential stitches using a self-retrieving all-inside suture passing device. Postoperative follow-up visits were conducted at 6 months, 1 year, and 2 years. Study outcomes included freedom from reoperation of the index meniscus repair site; knee pain and function, as measured by International Knee Documentation Committee Knee evaluation (IKDC), Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, and Tegner Activity Scale; and serious complications observed during the study. Minimal clinically important difference at 1 year was assessed for IKDC and Lysholm.

Results: Twenty-three patients had 2-year follow-up data available. Freedom from reoperation was 96.0% at 6 months (26/27, 91.7% at 1 year [23/25], and 82.6% at 2 years [19/23]). Significant improvement was observed in over baseline at 2 years for IKDC (36.7-82.5; P < .001), Knee injury and Osteoarthritis Outcome Score (52.2-89.3; P < .001), Lysholm (50.2-87.4; P < .001), and Tegner scores (3.3-5.3; P = .007). Minimal clinically important difference was met or exceeded for IKDC and Lysholm scores at 1 year 69.2% and 65.4% of patients, respectively. Four patients (6.7%) experienced serious complications, of which 2 were assessed as being related to the procedure.

Conclusions: Repair of HCTs using all-suture circumferential stitches placed with a self-retrieving all-inside suture passing device leads to a favorable reoperation rate (17.4%), significant improvements in clinical outcomes, and an acceptable rate of serious complications (6.7%) at 2 years, supporting the viability of this treatment approach in this indication.

Level of evidence: Level IV, therapeutic case series.