Background:

Secondary meniscectomy rates after repair of longitudinal tears of the posterior horn of the medial meniscus (PHMM) performed concomitantly with anterior cruciate ligament reconstruction (ACLR) are reported to be as high as 25% with an all inside repair technique. Posteromedial portal suture hook repair is an emerging technique; however, it is unknown whether it confers a significantly reduced secondary meniscectomy rate compared with the current gold standard.

Purpose/Hypothesis:

The primary objective of this study was to compare the secondary meniscectomy rates of suture hook repair and all inside repair for longitudinal tears of the PHMM performed concomitant to ACLR. The secondary outcome was to determine the risk factors associated with the failure of the repair. It was hypothesized that repair with an all inside device would be associated with higher secondary meniscectomy rates when compared with suture hook repair and that concomitant anterolateral ligament reconstruction (ALLR) would confer improved meniscal repair survivorship.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients with longitudinal tears of the PHMM who underwent meniscal repair during primary ACLR between January 2011 and December 2015 at our institution were eligible for the study. Patients undergoing suture hook repair were propensity matched in a 1:1 ratio to patients who underwent all inside repair. At the end of the study period, secondary meniscectomy rates were determined.

Results:

The study population comprised 237 matched pairs. The mean follow up was 97.7 ± 17.3 months. Patients who underwent an all inside repair had a >2-fold higher failure rate compared with patients who underwent suture hook repair through a posteromedial portal (31.2% vs 15.6%; P = .0003). Patients in the suture hook repair group undergoing additional ALLR demonstrated a >3-fold higher meniscal repair survival rate compared with all other subgroups (P = .0014). This association was not seen in the all inside repair group. The only statistically significant risk factor for meniscal repair failure was the suture repair technique (hazard ratio, 2.133 [95% CI, 1.383-3.292]; P = .0008).

Conclusion:

Suture hook repair through a posteromedial portal is associated with a significantly lower secondary meniscectomy rate when compared with the all inside meniscal repair of longitudinal tears of the PHMM performed at the time of ACLR. Furthermore, patients in the suture hook repair group who underwent an additional ALLR had a significantly better meniscal repair survivorship compared with all other subgroups.

中文翻译：

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前交叉韧带重建伴随内侧半月板后角纵向撕裂的缝合钩与全内修复：SANTI 研究组的配对分析

背景：

据报道，采用全内修复技术修复内侧半月板后角纵向撕裂 (PHMM) 并同时进行前交叉韧带重建 (ACLR) 后的二次半月板切除率高达 25%。后内侧门静脉缝合钩修复是一项新兴技术；然而，与目前的黄金标准相比，它是否能显着降低二次半月板切除率尚不清楚。

目的/假设：

本研究的主要目的是比较缝合钩修复的二次半月板切除率和所有内部修复的 PHMM 纵向撕裂伴随 ACLR。次要结果是确定与修复失败相关的风险因素。据推测，与缝合钩修复相比，使用全内装置进行修复与更高的二次半月板切除率相关，并且伴随的前外侧韧带重建 (ALLR) 将提高半月板修复的存活率。

学习规划：

队列研究；证据水平，3。

方法：

PHMM 纵向撕裂患者在 2011 年 1 月至 2015 年 12 月期间在我们机构的初级 ACLR 期间接受半月板修复，符合该研究的条件。接受缝合钩修复的患者与接受所有内部修复的患者的倾向性匹配比例为 1:1。在研究期结束时，确定了二次半月板切除率。

结果：

研究人群包括 237 对配对。平均随访时间为 97.7 ± 17.3 个月。与通过后内侧入口进行缝合钩修复的患者相比，接受全内修复的患者的失败率高出 2 倍以上（31.2% 对 15.6%；P = .0003）。与所有其他亚组相比，接受额外 ALLR 的缝合钩修复组患者的半月板修复存活率高出 3 倍以上（P = .0014）。这种关联在全内修组中是看不到的。半月板修复失败的唯一具有统计学意义的风险因素是缝合修复技术（风险比，2.133 [95% CI，1.383-3.292]；P = .0008）。

结论：

与 ACLR 时进行的 PHMM 纵向撕裂的全内侧半月板修复相比，通过后内侧入口缝合钩修复与显着较低的二次半月板切除率相关。此外，与所有其他亚组相比，接受额外 ALLR 的缝合钩修复组患者的半月板修复存活率显着提高。