Advertisement

Surgical Techniques and Outcomes of Repairing Meniscal Radial Tears: A Systematic Review

      Purpose

      To systematically review meniscal radial tear repair procedures and compare the techniques, outcomes, and complications.

      Methods

      Studies were identified through a systematic review of the literature using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2014), Medline (1980-2014), and Embase. Inclusion criteria included a minimum follow-up of 24 months, English language, and publications from 1980 or later. Exclusion criteria were surgical techniques not reporting follow-up, biomechanical studies, cadaver/anatomic studies, and non-radial tear meniscal repair procedures. Meniscal radial repair, meniscal radial tear, meniscal radial tear repair, radial repair and radial tear were used as search terms.

      Results

      A total of 6 studies (55 patients) met the inclusion criteria. The mean duration of follow-up ranged from 24 to 71 months. Of the 6 studies, 5 reported radial tears to the lateral meniscus and 1 study reported cases of both medial and lateral meniscal radial tears. Two studies reported different inside-out repair techniques, 2 studies reported the use of an all-inside anchor-based repair system, 1 study reported an all-inside repair technique with absorbable sutures, and 1 study reported an inside-out repair with fibrin clots. Average postoperative Lysholm scores were reported in all 6 studies and ranged from 86.9 to 95.6. Average postoperative Tegner activity scores were reported in 4 studies and ranged from 1 to 6.7. The majority of studies concluded that their techniques produced satisfactory healing of the radial tear, without serious subsequent complications.

      Conclusions

      Radial repair techniques differed among studies; however, postoperative subjective outcomes revealed patient improvement with repairing radial tears. With the increasing concern of long-term osteoarthritis after meniscectomy, meniscal preservation with repair of radial tears results in improved short-term clinical outcomes; however, long-term outcomes remain unknown.

      Level of Evidence

      Level IV, systematic review of level IV studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Athanasiou K.A.
        • Sanchez-Adams J.
        Engineering the knee meniscus.
        Synth Lectures Tissue Eng. 2009; 1: 1-97
        • Ahmed A.M.
        • Burke D.L.
        In-vitro measurement of static pressure distribution in synovial joints, Part I: Tibial surface of the knee.
        J Biomech Eng. 1983; 105: 216-225
        • Gray J.C.
        Neural and vascular anatomy of the menisci of the human knee.
        J Orthop Sports Phys Ther. 1999; 29: 23-30
        • Jerosch J.
        • Prymka M.
        • Castro W.H.
        Proprioception of knee joints with a lesion of the medial meniscus.
        Acta Orthop Belg. 1996; 62: 41-45
        • Voloshin A.S.
        • Wosk J.
        Shock absorption of meniscectomized and painful knees: A comparative in vivo study.
        J Biomed Eng. 1983; 5: 157-161
        • Krause W.R.
        • Pope M.H.
        • Johnson R.J.
        • Wilder D.G.
        Mechanical changes in the knee after meniscectomy.
        J Bone Joint Surg Am. 1976; 58: 599-604
        • Newman A.P.
        • Anderson D.R.
        • Daniels A.U.
        • Dales M.C.
        Mechanics of the healed meniscus in a canine model.
        Am J Sports Med. 1989; 17: 164-175
        • Bin S.I.
        • Kim J.M.
        • Shin S.J.
        Radial tears of the posterior horn of the medial meniscus.
        Arthroscopy. 2004; 20: 373-378
        • Harper K.W.
        • Helms C.A.
        • Lambert 3rd, H.S.
        • Higgins L.D.
        Radial meniscal tears: Significance, incidence, and MR appearance.
        AJR Am J Roentgenol. 2005; 185: 1429-1434
        • Badlani J.T.
        • Borrero C.
        • Golla S.
        • Harner C.D.
        • Irrgang J.J.
        The effects of meniscus injury on the development of knee osteoarthritis: Data from the osteoarthritis initiative.
        Am J Sports Med. 2013; 41: 1238-1244
        • Lerer D.B.
        • Umans H.R.
        • Hu M.X.
        • Jones M.H.
        The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion.
        Skeletal Radiol. 2004; 33: 569-574
        • Pena E.
        • Calvo B.
        • Martinez M.A.
        • Palanca D.
        • Doblare M.
        Finite element analysis of the effect of meniscal tears and meniscectomies on human knee biomechanics.
        Clin Biomech (Bristol, Avon). 2005; 20: 498-507
        • Passler H.
        • Yang Y.
        The past and future of arthroscopy.
        in: Tandoğan R.N. Mann G. Verdonk R. Doral M.N. Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation. Springer Science & Business Media, Berlin2011
        • Watanabe M.T.
        • Takeda S.
        • Ikeuchi H.
        Atlas of Arthroscopy.
        Igaku Shoin, Tokyo1957
        • Garrett Jr., W.E.
        • Swiontkowski M.F.
        • Weinstein J.N.
        • et al.
        American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix.
        J Bone Joint Surg Am. 2006; 88: 660-667
        • Messner K.
        • Gao J.
        The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment.
        J Anat. 1998; 193: 161-178
        • Fairbank T.J.
        Knee joint changes after meniscectomy.
        J Bone Joint Surg Br. 1948; 30: 664-670
        • Hede A.
        • Larsen E.
        • Sandberg H.
        Partial versus total meniscectomy. A prospective, randomised study with long-term follow-up.
        J Bone Joint Surg Br. 1992; 74: 118-121
        • Papalia R.
        • Del Buono A.
        • Osti L.
        • Denaro V.
        • Maffulli N.
        Meniscectomy as a risk factor for knee osteoarthritis: A systematic review.
        Br Med Bull. 2011; 99: 89-106
        • James E.W.
        • LaPrade C.M.
        • Feagin J.A.
        • LaPrade R.F.
        Repair of a complete radial tear in the midbody of the medial meniscus using a novel crisscross suture transtibial tunnel surgical technique: A case report.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2750-2755
        • Nakata K.
        • Shino K.
        • Kanamoto T.
        • et al.
        New technique of arthroscopic meniscus repair in radial tears.
        in: Sports Injuries. Springer, Berlin2012: 305-311
        • Ra H.J.
        • Ha J.K.
        • Jang S.H.
        • Lee D.W.
        • Kim J.G.
        Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 2126-2130
        • Saliman J.D.
        The circumferential compression stitch for meniscus repair.
        Arthrosc Tech. 2013; 2: e257-e264
        • Song H.S.
        • Bae T.Y.
        • Park B.Y.
        • Shim J.
        • In Y.
        Repair of a radial tear in the posterior horn of the lateral meniscus.
        Knee. 2014; 21: 1185-1190
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred Reporting Items for Systematic review and Meta-Analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1
        • Harris J.D.
        • Quatman C.E.
        • Manring M.M.
        • Siston R.A.
        • Flanigan D.C.
        How to write a systematic review.
        Am J Sports Med. 2014; 42: 2761-2768
        • Wright J.G.
        • Swiontkowski M.F.
        • Heckman J.D.
        Introducing levels of evidence to the journal.
        J Bone Joint Surg Am. 2003; 85-a: 1-3
        • Anderson L.
        • Watts M.
        • Shapter O.
        • et al.
        Repair of radial tears and posterior horn detachments of the lateral meniscus: Minimum 2-year follow-up.
        Arthroscopy. 2010; 26: 1625-1632
        • Choi N.H.
        • Kim T.H.
        • Son K.M.
        • Victoroff B.N.
        Meniscal repair for radial tears of the midbody of the lateral meniscus.
        Am J Sports Med. 2010; 38: 2472-2476
        • Haklar U.
        • Kocaoglu B.
        • Nalbantoglu U.
        • Tuzuner T.
        • Guven O.
        Arthroscopic repair of radial lateral meniscus [corrected] tear by double horizontal sutures with inside-outside technique.
        Knee. 2008; 15: 355-359
        • Ruiz-Iban M.A.
        • Diaz-Heredia J.
        • Elias-Martin E.
        • Moros-Marco S.
        • Cebreiro Martinez Del Val I.
        Repair of meniscal tears associated with tibial plateau fractures: A review of 15 cases.
        Am J Sports Med. 2012; 40: 2289-2295
        • McDermott I.
        Meniscal tears, repairs and replacement: Their relevance to osteoarthritis of the knee.
        Br J Sports Med. 2011; 45: 292-297
        • LaPrade C.M.
        • James E.W.
        • Cram T.R.
        • Feagin J.A.
        • Engebretsen L.
        • LaPrade R.F.
        Meniscal root tears: A classification system based on tear morphology.
        Am J Sports Med. 2015; 43: 363-369
        • Bedi A.
        • Kelly N.H.
        • Baad M.
        • et al.
        Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy.
        J Bone Joint Surg Am. 2010; 92: 1398-1408
        • LaPrade C.M.
        • Jansson K.S.
        • Dornan G.
        • Smith S.D.
        • Wijdicks C.A.
        • LaPrade R.F.
        Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs.
        J Bone Joint Surg Am. 2014; 96: 471-479
        • Mononen M.E.
        • Jurvelin J.S.
        • Korhonen R.K.
        Effects of radial tears and partial meniscectomy of lateral meniscus on the knee joint mechanics during the stance phase of the gait cycle—A 3D finite element study.
        J Orthop Res. 2013; 31: 1208-1217
        • Ode G.E.
        • Van Thiel G.S.
        • McArthur S.A.
        • et al.
        Effects of serial sectioning and repair of radial tears in the lateral meniscus.
        Am J Sports Med. 2012; 40: 1863-1870
        • LaPrade C.M.
        • LaPrade M.D.
        • Turnbull T.L.
        • Wijdicks C.A.
        • LaPrade R.F.
        Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels.
        Am J Sports Med. 2015; 43: 899-904
        • Rubman M.H.
        • Noyes F.R.
        • Barber-Westin S.D.
        Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears.
        Am J Sports Med. 1998; 26: 87-95
        • Arnoczky S.P.
        • Warren R.F.
        Microvasculature of the human meniscus.
        Am J Sports Med. 1982; 10: 90-95
        • Beaufils P.
        • Hulet C.
        • Dhenain M.
        • Nizard R.
        • Nourissat G.
        • Pujol N.
        Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults.
        Orthop Traumatol Surg Res. 2009; 95: 437-442
        • Ozkoc G.
        • Circi E.
        • Gonc U.
        • Irgit K.
        • Pourbagher A.
        • Tandogan R.N.
        Radial tears in the root of the posterior horn of the medial meniscus.
        Knee Surg Sports Traumatol Arthrosc. 2008; 16: 849-854
        • Roos H.
        • Adalberth T.
        • Dahlberg L.
        • Lohmander L.S.
        Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: The influence of time and age.
        Osteoarthritis Cartilage. 1995; 3: 261-267
        • Hoser C.
        • Fink C.
        • Brown C.
        • Reichkendler M.
        • Hackl W.
        • Bartlett J.
        Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage.
        J Bone Joint Surg Br. 2001; 83: 513-516
        • Stein T.
        • Mehling A.P.
        • Welsch F.
        • von Eisenhart-Rothe R.
        • Jager A.
        Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears.
        Am J Sports Med. 2010; 38: 1542-1548
        • LaPrade C.M.
        • James E.W.
        • LaPrade R.F.
        • Engebretsen L.
        How should we evaluate outcomes for use of biologics in the knee?.
        J Knee Surg. 2015; 28: 35-44