Failure rates of repaired bucket-handle tears of the medial meniscus concomitant with anterior cruciate ligament reconstruction: a cohort study of 253 patients from the SANTI Study Group with a mean follow-up of 94 months

El Helou, A. et al. (2023) Failure rates of repaired bucket-handle tears of the medial meniscus concomitant with anterior cruciate ligament reconstruction: a cohort study of 253 patients from the SANTI Study Group with a mean follow-up of 94 months. American Journal of Sports Medicine, 51(3), pp. 585-595. (doi: 10.1177/03635465221148497) (PMID:36734511)

Abstract

Background: Failure rates of repaired bucket-handle medial meniscal tears (BHMMTs) concomitant with anterior cruciate ligament reconstruction (ACLR) are as high as 20%. The outcomes of posteromedial portal suture hook repair have not been compared with all-inside repair techniques for this subtype of meniscal lesion. Purpose/Hypothesis: The aim of this study was to evaluate the outcomes and failure rates of patients who underwent BHMMT repair concomitant with ACLR using an all-inside technique, suture hook + all-inside technique, or suture hook + outside-in technique. It was hypothesized that no significant differences in failure rates would be found between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed on patients diagnosed with a BHMMT who underwent meniscal repair during primary ACLR and had a minimum follow-up of 2 years. Patients were grouped based on the meniscal repair technique used: all-inside repair, suture hook + all-inside repair, or suture hook + outside-in repair. At the end of the study period, secondary medial meniscectomy rates were determined. Results: The study population comprised 253 patients who underwent repair of a BHMMT with concomitant ACLR with a mean follow-up of 94.0 ± 47.6 months. A total of 114 patients (45.1%) underwent all-inside repair, 61 patients (24.1%) underwent suture hook + all-inside repair, and 78 patients (30.8%) underwent suture hook + outside-in repair. Overall, there were 36 failures. The failure rates were 20.2%, 14.8%, and 5.1%, respectively (P = .0135). All-inside repairs were >4 times more likely to fail than suture hook + outside-in repairs (hazard ratio [HR], 4.103; 95% CI, 1.369-12.296; P = .0117). Failure was also 3 times higher (HR, 2.943; 95% CI, 1.224-7.075; P = .0159) for patients <30 years of age compared with those aged ≥30 years. An additional anterolateral ligament reconstruction (ALLR) was also found to reduce the failure rate of repaired BHMMTs concomitant with ACLR. Conclusion: Combined suture hook + outside-in repair of BHMMTs resulted in significantly fewer failures than all other techniques. Furthermore, age <30 years and no additional ALLR were associated with higher failure rates.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hopper, Mr Graeme
• Authors: El Helou, A., Gousopoulos, L., Shatrov, J., Hopper, G. P., Philippe, C., Ayata, M., Thaunat, M., Fayard, J.-M., Freychet, B., Vieira, T. D., and Sonnery-Cottet, B.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: American Journal of Sports Medicine
• Publisher: SAGE Publications
• ISSN: 0363-5465
• ISSN (Online): 1552-3365
• Published Online: 03 February 2023