Meniscal Suture in Athletes: Failure Analysis and Return to Sport
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Published:
Jun 17, 2023
Keywords:
Meniscal suture, athletes, meniscal injury, meniscal suture failure
Main Article Content
Abstract
Introduction: Meniscal suturing is a technique increasingly used in patients with meniscal lesions, with good outcomes in the general population. However, research on athletes is limited. Meniscal suture failures and return to sport in athletes were analyzed, and possible contributing factors were identified.
Materials and Methods: Sixty-one meniscal sutures in athletes (Tegner score ≥6) with a minimum follow-up of 12 months were retrospectively evaluated. Forty-nine were isolated lesions and 12 were associated with anterior cruciate ligament reconstruction. The average follow-up was 61 months and patients were evaluated with Tegner and Lysholm scores.
Results: Meniscal suture failure was noted in 12 (19.67%) patients; failure occurred, on average, 14 months post-surgery. Nine failures occurred in isolated sutures and 3 were associated with anterior cruciate ligament reconstruction (p<0.05). The meniscus that failed the most was the internal meniscus. Seventy-five percent corresponded to patients who practiced pivot-contact sports (p<0.05). Patients who did not suffer failure were able to continue with the same sporting activity as before the injury and the Lysholm score had significantly improved (p<0.05).
Conclusions: Failures were significantly more frequent in internal menisci, isolated sutures, bucket-handle injuries, and pivot-contact sports. We believe that meniscal suture is an excellent surgical option for athletic patients because a high percentage of them return to sports.
Materials and Methods: Sixty-one meniscal sutures in athletes (Tegner score ≥6) with a minimum follow-up of 12 months were retrospectively evaluated. Forty-nine were isolated lesions and 12 were associated with anterior cruciate ligament reconstruction. The average follow-up was 61 months and patients were evaluated with Tegner and Lysholm scores.
Results: Meniscal suture failure was noted in 12 (19.67%) patients; failure occurred, on average, 14 months post-surgery. Nine failures occurred in isolated sutures and 3 were associated with anterior cruciate ligament reconstruction (p<0.05). The meniscus that failed the most was the internal meniscus. Seventy-five percent corresponded to patients who practiced pivot-contact sports (p<0.05). Patients who did not suffer failure were able to continue with the same sporting activity as before the injury and the Lysholm score had significantly improved (p<0.05).
Conclusions: Failures were significantly more frequent in internal menisci, isolated sutures, bucket-handle injuries, and pivot-contact sports. We believe that meniscal suture is an excellent surgical option for athletic patients because a high percentage of them return to sports.
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How to Cite
Yeregui, S., Dalton, P., Mallea, A., & Abalo, E. (2023). Meniscal Suture in Athletes: Failure Analysis and Return to Sport. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(3), 314-320. https://doi.org/10.15417/issn.1852-7434.2023.88.3.1585
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Clinical Research
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References
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https://doi.org/10.1055/s-0038-1676959
4. Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 2020;28(4):1177-94.
https://doi.org/10.1007/s00167-020-05847-3
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to play. Clin Sports Med 2020;39(1):165-83. https://doi.org/10.1016/j.csm.2019.08.004
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Arthroscopy 1998;14(8):824-9. https://doi.org/10.1016/s0749-8063(98)70018-0
9. Lyman S, Hidaka C, Valdez AS, Hetsroni I, Pan TJ, Do H, et al. Risk factors for meniscectomy after meniscal repair. Am J Sports Med 2013;41(12):2772-8. https://doi.org/10.1177/0363546513503444
10. DeFroda SF, Yang DS, Donnelly JC, Bokshan SL, Owens BD, Daniels AH. Trends in the surgical treatment
of meniscal tears in patients with and without concurrent anterior cruciate ligament tears. Phys Sportsmed
2020;48(2):229-35. https://doi.org/10.1080/00913847.2019.1685363
11. Kurosaka M, Yoshiya S, Kuroda R, Matsui N, Yamamoto T, Tanaka J. Repeat tears of repaired menisci after
arthroscopic confirmation of healing. J Bone Joint Surg Br 2002;84(1):34-7. https://doi.org/10.1302/0301-620x.84b1.11254
12. Lee WQ, Gan JZ, Lie DTT. Save the meniscus - Clinical outcomes of meniscectomy versus meniscal repair. J
Orthop Surg (Hong Kong) 2019;27(2):2309499019849813. https://doi.org/10.1177/2309499019849813
13. Sochacki KR, Varshneya K, Calcei JG, Safran MR, Abrams GD, Donahue J, et al. Comparing meniscectomy
and meniscal repair: A matched cohort analysis utilizing a National Insurance Database. Am J Sports Med
2020;48(10):2353-9. https://doi.org/10.1177/0363546520935453
14. Aparicio JL, Nardin L, Sava M, Giuria H. Suturas meniscales: Nuestra experiencia. Rev Asoc Argent Traumatol
Deporte 2018;25(1):44-8. Disponible en: https://revista.aatd.org.ar/wp-content/uploads/2019/02/sutura_meniscal.pdf
15. Abalo E, Previgliano JP, Mallea A. Sutura meniscal artroscópica con técnica fuera dentro. Evaluación de resultados funcionales. Artroscopia 2020;27(2):57-63. Disponible en: https://www.revistaartroscopia.com.ar/index.php/revista/article/view/73
16. Rivarola Etcheto H, Collazo Blanchod C, Mainini S, Alvarez Salinas E, Palanconi M, Autorino CM. Suturas
meniscales. Evaluación de resultados y análisis de fallas. Artroscopia 2013;20(2):60-65. Disponible en:
https://www.revistaartroscopia.com.ar/ediciones-anteriores/images/artroscopia/volumen-20-nro-2/20_02_05_rivarola.pdf
17. Albrecht-Olsen PM, Bak K. Arthroscopic repair of the bucket-handle meniscus. 10 failures in 27 stable knees
followed for 3 years. Acta Orthop Scand 1993;64(4):446-8. https://doi.org/10.3109/17453679308993664
18. Paxton ES, Stock MV, Brophy RH. Meniscal repair versus partial meniscectomy: a systematic review comparing
reoperation rates and clinical outcomes. Arthroscopy 2011;27(9):1275-88. https://doi.org/10.1016/j.arthro.2011.03.088
19. Ronnblad E, Barenius B, Engstrom B, Eriksson K. Predictive factors for failure of meniscal repair: A retrospective dual-center analysis of 918 consecutive cases. Orthop J Sports Med 2020;8(3):2325967120905529.
https://doi.org/10.1177/2325967120905529
20. Rodríguez-Roiz JM, Sastre-Solsona S, Popescu D, Montañana-Burillo J, Combalia-Aleu A. The relationship
between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate-2- to 12-
year follow-up. J Orthop Surg Res 2020;15(1):361. https://doi.org/10.1186/s13018-020-01878-1
21. Tenuta JJ, Arciero RA. Arthroscopic evaluation of meniscal repairs. Factors that affect healing. Am J Sports Med
1994;22(6):797-802. https://doi.org/10.1177/036354659402200611
22. Wasserstein D, Dwyer T, Gandhi R, Austin PC, Mahomed N, Ogilvie-Harris D. A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction. Am J Sports Med 2013;41(2):349-55. https://doi.org/10.1177/0363546512471134
23. Eberbach H, Zwingmann J, Hohloch L, Bode G, Maier D, Niemeyer P, et al. Sport-specific outcomes after isolated meniscal repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018;26(3):762-71.
https://doi.org/10.1007/s00167-017-4463-4
24. Alvarez-Diaz P, Alentorn-Geli E, Llobet F, Granados N, Steinbacher G, Cugat R. Return to play after all-inside
meniscal repair in competitive football players: a minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2016;24(6):1997-2001. https://doi.org/10.1007/s00167-014-3285-x
25. Bitar I, Fernández Savoy I, Marangoni L, Galera H, Bustos D. Resultados de reparaciones meniscales aisladas en asa de balde en deportistas amateurs. Artroscopia 2015;22(2):46-50. Disponible en: https://www.revistaartroscopia.com/ediciones-anteriores/98-volumen-05-numero-1/volumen-21-numero-6/701-resultados-de-reparacionesmeniscales-aisladas-en-asa-de-balde-en-deportistas-amateurs
26. Villalba M, Mux J, Savastano C, Quiroga H. Retorno al deporte luego de reparación meniscal aislada en atletas
competitivos de contacto. Artroscopia 2020;27(4):162-5. Disponible en:
https://www.revistaartroscopia.com.ar/index.php/revista/article/view/91/61
Orthop Surg 2002;10(3):168-76. https://doi.org/10.5435/00124635-200205000-00003
2. Wiley TJ, Lemme NJ, Marcaccio S, Bokshan S, Fadale PD, Edgar C, et al. Return to play following meniscal repair.
Clin Sports Med 2020;39(1):185-96. https://doi.org/10.1016/j.csm.2019.08.002
3. Donohue MA, Zhou L, Haley CA. Meniscus injuries in the military athlete. J Knee Surg 2019;32(2):123-6.
https://doi.org/10.1055/s-0038-1676959
4. Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 2020;28(4):1177-94.
https://doi.org/10.1007/s00167-020-05847-3
5. Sherman SL, DiPaolo ZJ, Ray TE, Sachs BM, Oladeji LO. Meniscus injuries: A review of rehabilitation and return
to play. Clin Sports Med 2020;39(1):165-83. https://doi.org/10.1016/j.csm.2019.08.004
6. Cannon WD Jr, Vittori JM. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligamentreconstructed knees versus stable knees. Am J Sports Med 1992;20(2):176-81. https://doi.org/10.1177/036354659202000214
7. Fuchs A, Kloos F, Bode G, Izadpanah K, Südkamp NP, Feucht MJ. Isolated revision meniscal repair - failure rates,
clinical outcome, and patient satisfaction. BMC Musculoskelet Disord 2018;19(1):446. https://doi.org/10.1186/s12891-018-2368-0
8. Barrett GR, Field MH, Treacy SH, Ruff CG. Clinical results of meniscus repair in patients 40 years and older.
Arthroscopy 1998;14(8):824-9. https://doi.org/10.1016/s0749-8063(98)70018-0
9. Lyman S, Hidaka C, Valdez AS, Hetsroni I, Pan TJ, Do H, et al. Risk factors for meniscectomy after meniscal repair. Am J Sports Med 2013;41(12):2772-8. https://doi.org/10.1177/0363546513503444
10. DeFroda SF, Yang DS, Donnelly JC, Bokshan SL, Owens BD, Daniels AH. Trends in the surgical treatment
of meniscal tears in patients with and without concurrent anterior cruciate ligament tears. Phys Sportsmed
2020;48(2):229-35. https://doi.org/10.1080/00913847.2019.1685363
11. Kurosaka M, Yoshiya S, Kuroda R, Matsui N, Yamamoto T, Tanaka J. Repeat tears of repaired menisci after
arthroscopic confirmation of healing. J Bone Joint Surg Br 2002;84(1):34-7. https://doi.org/10.1302/0301-620x.84b1.11254
12. Lee WQ, Gan JZ, Lie DTT. Save the meniscus - Clinical outcomes of meniscectomy versus meniscal repair. J
Orthop Surg (Hong Kong) 2019;27(2):2309499019849813. https://doi.org/10.1177/2309499019849813
13. Sochacki KR, Varshneya K, Calcei JG, Safran MR, Abrams GD, Donahue J, et al. Comparing meniscectomy
and meniscal repair: A matched cohort analysis utilizing a National Insurance Database. Am J Sports Med
2020;48(10):2353-9. https://doi.org/10.1177/0363546520935453
14. Aparicio JL, Nardin L, Sava M, Giuria H. Suturas meniscales: Nuestra experiencia. Rev Asoc Argent Traumatol
Deporte 2018;25(1):44-8. Disponible en: https://revista.aatd.org.ar/wp-content/uploads/2019/02/sutura_meniscal.pdf
15. Abalo E, Previgliano JP, Mallea A. Sutura meniscal artroscópica con técnica fuera dentro. Evaluación de resultados funcionales. Artroscopia 2020;27(2):57-63. Disponible en: https://www.revistaartroscopia.com.ar/index.php/revista/article/view/73
16. Rivarola Etcheto H, Collazo Blanchod C, Mainini S, Alvarez Salinas E, Palanconi M, Autorino CM. Suturas
meniscales. Evaluación de resultados y análisis de fallas. Artroscopia 2013;20(2):60-65. Disponible en:
https://www.revistaartroscopia.com.ar/ediciones-anteriores/images/artroscopia/volumen-20-nro-2/20_02_05_rivarola.pdf
17. Albrecht-Olsen PM, Bak K. Arthroscopic repair of the bucket-handle meniscus. 10 failures in 27 stable knees
followed for 3 years. Acta Orthop Scand 1993;64(4):446-8. https://doi.org/10.3109/17453679308993664
18. Paxton ES, Stock MV, Brophy RH. Meniscal repair versus partial meniscectomy: a systematic review comparing
reoperation rates and clinical outcomes. Arthroscopy 2011;27(9):1275-88. https://doi.org/10.1016/j.arthro.2011.03.088
19. Ronnblad E, Barenius B, Engstrom B, Eriksson K. Predictive factors for failure of meniscal repair: A retrospective dual-center analysis of 918 consecutive cases. Orthop J Sports Med 2020;8(3):2325967120905529.
https://doi.org/10.1177/2325967120905529
20. Rodríguez-Roiz JM, Sastre-Solsona S, Popescu D, Montañana-Burillo J, Combalia-Aleu A. The relationship
between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate-2- to 12-
year follow-up. J Orthop Surg Res 2020;15(1):361. https://doi.org/10.1186/s13018-020-01878-1
21. Tenuta JJ, Arciero RA. Arthroscopic evaluation of meniscal repairs. Factors that affect healing. Am J Sports Med
1994;22(6):797-802. https://doi.org/10.1177/036354659402200611
22. Wasserstein D, Dwyer T, Gandhi R, Austin PC, Mahomed N, Ogilvie-Harris D. A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction. Am J Sports Med 2013;41(2):349-55. https://doi.org/10.1177/0363546512471134
23. Eberbach H, Zwingmann J, Hohloch L, Bode G, Maier D, Niemeyer P, et al. Sport-specific outcomes after isolated meniscal repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018;26(3):762-71.
https://doi.org/10.1007/s00167-017-4463-4
24. Alvarez-Diaz P, Alentorn-Geli E, Llobet F, Granados N, Steinbacher G, Cugat R. Return to play after all-inside
meniscal repair in competitive football players: a minimum 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2016;24(6):1997-2001. https://doi.org/10.1007/s00167-014-3285-x
25. Bitar I, Fernández Savoy I, Marangoni L, Galera H, Bustos D. Resultados de reparaciones meniscales aisladas en asa de balde en deportistas amateurs. Artroscopia 2015;22(2):46-50. Disponible en: https://www.revistaartroscopia.com/ediciones-anteriores/98-volumen-05-numero-1/volumen-21-numero-6/701-resultados-de-reparacionesmeniscales-aisladas-en-asa-de-balde-en-deportistas-amateurs
26. Villalba M, Mux J, Savastano C, Quiroga H. Retorno al deporte luego de reparación meniscal aislada en atletas
competitivos de contacto. Artroscopia 2020;27(4):162-5. Disponible en:
https://www.revistaartroscopia.com.ar/index.php/revista/article/view/91/61