Circumferential Suture Repair of Isolated Horizontal Meniscal Tears Augmented With Fibrin Clot.
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ABSTRACT:
SUBMITTER: Laidlaw MS
PROVIDER: S-EPMC5709922 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Although horizontal tears of the meniscus have historically been treated with partial meniscectomy due to poor vascularity within the tear, evidence suggests that repair of horizontal meniscal tears may be advantageous to partial meniscectomy. Furthermore, the addition of platelet-rich plasma has shown promise in improving meniscal healing. We present our technique of platelet-rich fibrin clot-augmented repair of horizontal cleavage meniscal tear.
| S-EPMC5794520 | biostudies-literature
Project description:Meniscal injuries and meniscal loss are associated with changes in knee kinematics and loading, ultimately leading to poor functional outcomes and increased risk of progression to osteoarthritis. Biomechanical studies have shown restored knee function, and clinical studies have reported improved outcomes and decreased risk of osteoarthritis after meniscal repair. This has led orthopaedic surgeons to try and save the meniscus by repair whenever possible, as shown by increasing incidence of meniscal repair surgeries. Historically, meniscal lesions, particularly those greater in size and located in the white-white region of the meniscus, have been shown to have poor healing. In recent years, there has been an increasing interest in the use of biologic agents to help stimulate and expedite healing in traditionally more avascular tissue. Preliminary results for biologic therapeutic agents, such as platelet rich plasma and bone marrow aspirate concentrate, have been encouraging. However, these options are more demanding in regard to time, financial burden, resources, and regulations than some more classic agents such as fibrin clots. Fibrin clot is readily available, easy to use, affordable, and minimally invasive. This Technical Note describes a step-by-step and reproducible technique for harvesting, preparation, and using a fibrin clot to augment healing of meniscal repairs.
| S-EPMC5766256 | biostudies-literature
Project description:Despite recent technical advances, rotator cuff repair continues to have a high retear rate. Recent research focused on biologic augmentation of rotator cuff repair with platelet-rich plasma has shown mixed results, and use of an endogenous fibrin clot from either peripheral blood or bone marrow may have advantages over the use of platelet-rich plasma. This technique describes a method to make an endogenous fibrin clot and arthroscopically apply the fibrin clot to the superior surface of the rotator cuff repair site.
| S-EPMC3678671 | biostudies-literature
Project description:The current consensus in the literature is that the meniscus must be saved. Even though inside-out sutures are still considered as the gold standard, the need to alternate between intra- and extra-articular structures for every stitch makes it laborious. New generations of all-inside systems are now routinely used in operating rooms and enable easier, quicker, and safer techniques. However traditional all-inside repair with limited upper fixation does not provide uniform compression from top to down, essential precondition for satisfactory meniscal healing. This Technical Note describes a simple and accessible alternative technique that provides stable fixation and overall compression of vertical meniscal tears from top to down with standard all-inside instrumentation.
| S-EPMC8355532 | biostudies-literature
Project description:Horizontal cleavage meniscus tears occur more frequently in older patient populations with degenerative changes within the meniscus. Traditionally, they have been managed with nonsurgical interventions or with partial meniscectomy. As increasing evidence demonstrates the link between partial meniscectomy and progressive osteoarthritis with these types of tears, as well as worse long-term outcomes and reduced cost savings, surgical repair of horizontal cleavage meniscal tears has increased in appropriate patients. This technique article highlights the evaluation, indications, and preferred repair technique for horizontal cleavage tears in appropriately selected patients. Technique Video Video 1 Demonstration of technique. The patient is placed in the supine position. A superolateral outflow portal is placed to allow for adequate intra-articular visualization followed by the creation of standard anteromedial and anterolateral portals. Initial diagnostic arthroscopy is performed viewing from the anterolateral portal. Once the tear has been identified, the meniscal tear is further visualized by preparation of the frayed edges with a combination of meniscal rasping, biting, and shaving. Following preparation, the meniscal repair is begun posteriorly working from the anteromedial portal to allow for direct access to the meniscus. In this case, the tear is of the medial meniscus. If the medial compartment is tight, prohibiting sufficient access, percutaneous trephination of the medial collateral ligament is performed to increase access. Using the Smith & Nephew NovoStitch Pro All-inside device, circumferential compression sutures are placed 3 to 4 mm apart working from posterior to anterior. At the mid-body of the meniscus, the working portal is switched to the anterolateral portal to allow for more direct access to the remainder of the more anterior portions of the meniscus.
| S-EPMC10466186 | biostudies-literature
Project description:Repair of meniscus injuries always posed a significant problem, especially in relatively avascular zones. Several methods to augment the repair were devised, but only a few had convincing results. Fibrin clot augmentation is one of the augmentation procedures that shows good promise in this premise. The major hurdle to it is difficulty in delivering into the meniscus tear under constant irrigation during arthroscopic procedures. This article presents a simple and unique way to prepare and transfer a fibrin clot into a meniscal tear in a step-by-step manner.
| S-EPMC8626618 | biostudies-literature
Project description:Anterior cruciate ligament ruptures are commonly associated with ramp lesions of the medial meniscus. These posterior longitudinal peripheral tears induce medial meniscus instability and increase the anteroposterior and rotational knee laxity. We divided ramp lesions in 3 types: meniscocapsular ligament tears, meniscotibial ligament tears, and a combination of both lesions. The conventional surgical technique for treating meniscal ramp lesions is to use a suture hook device through a posteromedial approach, which is a complex process requiring a learning curve and extensive surgical time. An anterior approach often is criticized as underestimating the true incidence of ramp lesion and to offer insufficient operating space. The purpose of this technical note is to describe our arthroscopic repair technique in cases of isolated meniscotibial ligament tears. The suture is performed by an under-meniscus anterior approach with a percutaneous medial collateral ligament release to create an additional opening of the medial compartment. This simple procedure allows for accurate diagnoses of the meniscotibial lesions and enables repair of the lesions with an all-inside suture device without the usual drawbacks of a posteromedial approach.
| S-EPMC8252850 | biostudies-literature
Project description:We present a technique to implant autogenous meniscal fragments using a fibrin clot to repair a large degenerative meniscal defect. A total of 25 mL of the patient's blood is agitated for 10 minutes using a stainless steel swizzle stick in a sterile glass syringe. The elastic fibrin clot subsequently adheres to the stick in a tubular manner. Using arthroscopic debridement, native meniscal tissue is resected. The meniscal fragments are packaged into the tubular-shaped fibrin clot, and the tube is tied at both ends using 4-0 absorbable sutures. A repair suture is prepared using the inside-out meniscal repair device and woven into the margins of the tubular-shaped fibrin clot. The packaged graft with the tubular-shaped fibrin clot is placed with a horizontal suture across both edges of the meniscal defect and secured with a supplemental vertical suture using an all-inside meniscal repair device. Follow-up arthroscopy performed 6 months postoperatively reveals regeneration of meniscus-like tissue. It is ideal to treat large degenerative defects with meniscal preservation, and the present procedure has the advantage of tissue regeneration with native meniscal tissue and growth factors obtained from the fibrin clot using a simple technique. This method could prove helpful in patients with degenerative meniscal defects.
| S-EPMC5989823 | biostudies-literature
Project description:Horizontal cleavage and horizontal oblique meniscal tears have traditionally been treated with partial meniscectomy. Recent research has shown the deleterious long-term effects of meniscectomy in these patients regarding the development of osteoarthritis. Meniscal preservation is thus the preferred method of surgical treatment in patients with these tears. However, traditional repair techniques using inside-out sutures or suture anchor-based devices do not address the horizontally aligned nature of these particular tears and thus do not compress the meniscal tissue in the correct plane. The recent development of an arthroscopic suture-passing system now allows surgeons to place arthroscopic sutures in any pattern or direction. This allows surgeons to treat tears of any type with sutures ideally placed to repair the given tears. This Technical Note describes and demonstrates 2 all-suture, all-inside, arthroscopic meniscus repair techniques to treat these challenging horizontal tear types. The repair techniques are named the vertical lasso and horizontal lasso.
| S-EPMC5797710 | biostudies-literature
Project description:In recent years, to save the meniscus and prevent the progression of knee osteoarthritis, the indications for meniscus repair have been expanding instead of partial menisectomy. Accordingly, various repair techniques for meniscus tears have been developed. The conventional inside-out and outside-in meniscus repair techniques and all-inside repair technique with an implant/anchor can be classified as trans-capsular (TC) repair from the perspective of suture with penetrating capsule. Recently, new suture passers for all-inside meniscus repair have been developed. To distinguish from conventional all-inside repair with implant/anchors, all-inside repair with only suture using these suture passers was described as all-inside suture (AIS) repair. This AIS repair could achieve meniscus-to-meniscus suture across the tear without interposition of soft tissues including the capsule between suture and meniscus, leading direct gap closing of torn edges. In this respect, AIS repair is considered to be "anatomical meniscus repair". Actually, some reports showed biomechanical and clinical advantages of AIS repair. However, there is still limited evidence in clinical practice. Moreover, there are some disadvantages for AIS repair. Not only further studies but also development of new devices and surgical techniques for AIS should be required. This review describes the current status of AIS repair for each type of tear.
| S-EPMC11304093 | biostudies-literature