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Complications in posteromedial arthroscopic suture of the medial meniscus
N Jan1, B Sonnery-Cottet2, J-M Fayard2
1CHRU de Lille, Service d'orthopédie D, 59000 Lille, France.
Introduction:
All-inside posteromedial suture for lesions of the posterior horn of the medial meniscus in anterior cruciate ligament (ACL) repair provides effective freshening and good healing.
Hypothesis:
The posteromedial portal provides satisfactory healing rates without increasing morbidity or complications rates.
Material And Methods:
Intra- and postoperative complications were collected for a consecutive single-center series of 132 patients undergoing posteromedial hook suture of the medial meniscus in ACL repair. Meniscal healing was assessed as the rate of recurrence of symptomatic medial meniscus lesions (Barret criteria) and on revision surgery, if any, in terms of the aspect and extent of the iterative lesion. The severity of any sensory disorder was assessed by questionnaire.
Results:
The intraoperative complications rate was 1.5% (2 saphenous vein punctures). At a mean 31months (range, 28-35months), there was no loss to follow-up. Twelve patients (9%) showed symptomatic recurrence of the medial meniscus lesion, requiring 10 repeat surgeries. In 6 cases (4.5%), the iterative lesion involved a smaller, more central part of the meniscus anterior to the sutures, of "postage-stamp" effect, possibly implicating the suture hook and/or non-absorbable sutures. There were no cases of infection or fistula. Postoperative hematoma occurred in 7% of patients. In total, 1.8% reported dysesthesia areas equal to or greater than the size of a credit card (45cm2).
Discussion:
Some retears, or "partial failures", may implicate a new lesion caused by the suture hook and possibly prolonged by non-resorbable sutures. Hematoma and sensory disorder rates were comparable to those reported in isolated ACL repair without posteromedial portal.
Conclusion:
The present results show that posteromedial arthroscopic hook suture in posterior medial meniscus tear provides good healing rates without increased morbidity due to the supplementary portal.
Level Of Evidence:
IV.
Insights
Posteromedial hook suture for posterior medial meniscus tears during anterior cruciate ligament (ACL) repair shows good healing rates. This technique offers effective treatment without increasing patient morbidity or complications.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Arthroscopy
Background:
- Lesions of the posterior horn of the medial meniscus often accompany anterior cruciate ligament (ACL) tears.
- Traditional repair methods may have limitations in achieving optimal healing for these specific meniscal injuries.
Purpose of the Study:
- To evaluate the efficacy and safety of the all-inside posteromedial suture technique for medial meniscus posterior horn lesions during ACL repair.
- To assess healing rates and complication profiles associated with the posteromedial portal approach.
Main Methods:
- A consecutive single-center series of 132 patients undergoing ACL repair with posteromedial hook suture for medial meniscus lesions was analyzed.
- Intraoperative and postoperative complications were recorded, and meniscal healing was assessed via recurrence of symptomatic lesions and revision surgery rates.
- Sensory disorders were evaluated using a questionnaire.
Main Results:
- The intraoperative complication rate was 1.5%. At a mean follow-up of 31 months, 9% of patients experienced symptomatic recurrence of the medial meniscus lesion, with 4.5% requiring revision surgery.
- Postoperative hematoma occurred in 7% of patients, and 1.8% reported significant sensory disturbances.
- No cases of infection or fistula were observed.
Conclusions:
- Posteromedial arthroscopic hook suture for posterior medial meniscus tears in ACL repair demonstrates good healing rates.
- The use of a supplementary posteromedial portal does not appear to increase morbidity or complication rates compared to isolated ACL repair.
