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- Title
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.
- Authors
El Helou, Abdo; Gousopoulos, Lampros; Shatrov, Jobe; Hopper, Graeme P.; Philippe, Corentin; Ayata, Merwane; Thaunat, Mathieu; Fayard, Jean-Marie; Freychet, Benjamin; Vieira, Thais Dutra; Sonnery-Cottet, Bertrand
- 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.
- Subjects
TRAUMA surgery; PATIENT aftercare; KRUSKAL-Wallis Test; CONFIDENCE intervals; ORTHOPEDIC surgery; RETROSPECTIVE studies; FISHER exact test; MANN Whitney U Test; TREATMENT failure; TREATMENT effectiveness; QUALITATIVE research; T-test (Statistics); CHI-squared test; DESCRIPTIVE statistics; SURVIVAL analysis (Biometry); ANTERIOR cruciate ligament surgery; ODDS ratio; MENISCUS injuries; LONGITUDINAL method; EVALUATION
- Publication
American Journal of Sports Medicine, 2023, Vol 51, Issue 3, p585
- ISSN
0363-5465
- Publication type
Article
- DOI
10.1177/03635465221148497