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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (5): 870-874. doi: 10.19723/j.issn.1671-167X.2020.05.012

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A mid-term clinical follow-up study on repair of the meniscus tears by a modified arthroscopic outside-in puncture suture technique

Zhong-di LIU,Ting-min XU,Yu DANG(),Dian-ying ZHANG,Zhong-guo FU   

  1. Trauma Medicine Center, Department of Trauma and Orthopaedics, Peking University People’s Hospital, Beijing 100044, China
  • Received:2020-01-08 Online:2020-10-18 Published:2020-10-15
  • Contact: Yu DANG E-mail:drdangyu@163.com
  • Supported by:
    Ministry of Education Innovation Program of China(IRT_16R01);Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education(BMU2019XY007-01)

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Abstract:

Objective: To investigate the clinical effect of a modified arthroscopic outside-in suture technique in the treatment of meniscus tear using a spinal needle. Methods: From January 2015 to October 2017, 95 patients treated with this method were followed-up. Among these cases, there were 36 males and 59 females. The age of the patients ranged from 16 to 77 years,(46.79±18.07) years in average. Among them, there were 28 patieats aged 16-35, 53 patients aged 36-65, and 14 patients aged over 65 years old. 28 cases were diagnosed with medial meniscus tear, 43 cases with lateral meniscus tear and 24 cases with both medial and lateral meniscus tear. Causes of the injury included sports, sprain, etc. According to Barrett standard, the clinical healing of meniscus tear was judged. Lysholm score, knee range of motion,visual simulation score (VAS) and magnetic resonance imaging (MRI) were used to evaluate the postoperative knee function and recovery of the patients. Results: The 95 patients were followed up for 22 to 36 months, with an average of (28.32±3.98) months. According to Barrett standard, 90 patients (94.7%) obtained meniscus clinical healing. Meniscal healing rates were 96.43%, 96.23% and 85.71% in the three age groups, respectively. The meniscal healing rate was lower in the elderly group, but there was no significant difference in statistical results (P=0.262). Five patients had deep tenderness in the joint space of the injured side, and the overstretch test was positive. The preoperative and postoperative VAS scores, Lysholm scores and knee motion were compared in each group, and the differences were statistically significant (P<0.01). At the end of the last follow-up, there were no cases of knee joint effusion, swelling and interlocking, and the joint function was effectively improved in most patients. No surgical site infection, periarticular vascular/nerve injury or knotting reaction was found during the follow-up. Conclusion: This modified arthroscopic outside-in suture technique using a spinal needle has the characteristics of simple operation, small trauma and rapid recovery, and the mid-term follow-up results were satisfactory. Therefore, we consider this method to be a safe and efficient method for the treatment of meniscus anterior horn and body tear.

Key words: Meniscus, Arthroscopy, Knee joint

CLC Number: 

  • R684

Figure 1

Legends show the whole process of effective meniscus repair with spinal needle and absorbable suture A, a horizontally torn meniscus was exposed after arthroscopic cleaning; B, the torn meniscus was detached from the capsule; C, the needle with absorbable suture passed through the joint capsule and penetrates the upper edge of the torn meniscus; D, two puncture needles respectively entered the joint cavity through the upper and lower edge of the torn meniscus; E, the vascular clamp was inserted through the entrance of the ipilateral arthroscopy and the internal ends of the two absorbable sutures were clamped simultaneously; F, two puncture needles were extracted and two absorbable sutures were pulled out of the joint cavity; G, the fixed suture is pulled into the joint cavity through the damaged meniscus by the traction suture and the two ends of the fixed suture are knotted subcutaneously, then a stitch is completed; H, the meniscus was repaired by multiple suture fixation using the same method. "

Table 1

Comparison of data before and after arthroscopic repair by outside-in puncture and suture technique"

Items VAS score Lysholm score Range of motion /(°)
Pre-operation 6.06±0.84 57.15±6.09 125.61±6.06
Post-operation 2.33±0.77 79.66±7.03 137.50±6.76
t value 29.88 -27.44 -9.11
P value <0.01 <0.01 <0.01

Figure 2

MRI findings before and after operation for typical lateral meniscus tear A to C, sagittal, coronal, cross-sectional MRI showing lateral meniscus tear, and the teared meniscus showed typical high signal; D to F, MRI findings of lateral meniscus tear six months after repair, and the menisci after suture still showed high signal. "

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