Borque Kyle A, Laughlin Mitzi S, Webster Emily, Jones Mary, Pinheiro Vítor Hugo, Williams Andy
Houston Methodist Hospital, Houston, Texas, USA.
Houston Methodist Academic Institute, Houston, Texas, USA.
Am J Sports Med. 2023 Mar;51(3):579-584. doi: 10.1177/03635465221147058. Epub 2023 Feb 6.
The popularization of all-inside (AI) meniscal repair devices has led to a shift away from the historical gold standard of inside-out (IO) meniscal repair without comparative studies to support the change.
To compare the failure rate and time to failure of AI and IO meniscal repair performed in elite athletes.
Cohort study; Level of evidence, 3.
A retrospective review was performed of all professional and national- and international-level amateur athletes who underwent meniscal repair, with a minimum of 2-year follow-up between January 2013 and September 2019. Meniscal repair was classified as AI or IO depending on the surgical technique performed. Treatment failure was defined as patients having to undergo subsequent surgery to address a persistent meniscal tear after repair. Cox proportional hazards modeling was used to determine if meniscal repair failure rates differed by the location and technique of meniscal repair. Models were controlled for known risk factors such as age, sex, sport, and concurrent cruciate ligament reconstruction.
A total of 192 (135 lateral and 57 medial) meniscal repairs were performed in elite athletes during the study period. Overall, 41 (21%) meniscal repairs met the criteria for failure. Medial meniscal tears repaired with the AI technique failed at a significantly higher rate (18/31 [58%]) than medial meniscal tears repaired with the IO technique (6/26 [23%]) or lateral meniscal tears repaired with the AI (9/76 [12%]) or IO (8/59 [14%]) technique ( < .001). Cox proportional hazards modeling revealed that a medial meniscal tear repaired with the AI technique had an almost 8 times greater hazard of failure than a lateral meniscal tear repaired with the AI technique ( < .001). At 1 year postoperatively, 8% of lateral meniscal repairs had failed (regardless of technique), while medial meniscal tears failed at a rate of 16% with the IO technique and 42% with the AI technique. By 2 years, 53% of medial meniscal tears repaired with the AI technique had failed, and by 5 years, 63% had failed.
AI repair of medial meniscal tears led to a higher rate of failure than IO repair of medial or lateral meniscal tears in elite athletes. Medial meniscal repair failed at a higher rate than lateral meniscal repair.
全内（AI）半月板修复装置的普及导致了与传统由外向内（IO）半月板修复这一历史金标准的背离，且缺乏对比研究来支持这一转变。
比较精英运动员中AI和IO半月板修复的失败率及失败时间。
队列研究；证据等级，3级。
对2013年1月至2019年9月期间接受半月板修复且随访至少2年的所有职业及国家级和国际级业余运动员进行回顾性研究。根据所采用的手术技术，半月板修复分为AI或IO。治疗失败定义为患者在修复后因持续性半月板撕裂而不得不接受后续手术。采用Cox比例风险模型来确定半月板修复失败率是否因半月板修复的位置和技术而异。模型对年龄、性别、运动项目和同时进行的交叉韧带重建等已知风险因素进行了控制。
在研究期间，精英运动员共进行了192例（135例外侧和57例内侧）半月板修复。总体而言，41例（21%）半月板修复符合失败标准。采用AI技术修复的内侧半月板撕裂失败率（18/31 [58%]）显著高于采用IO技术修复的内侧半月板撕裂（6/26 [23%]）或采用AI（9/76 [12%]）或IO（8/ 5 9 [14%]）技术修复的外侧半月板撕裂（P <.001）。Cox比例风险模型显示，采用AI技术修复的内侧半月板撕裂失败风险几乎是采用AI技术修复的外侧半月板撕裂的8倍（P <.001）。术后1年，8%的外侧半月板修复失败（无论技术如何），而采用IO技术的内侧半月板撕裂失败率为 16%，采用AI技术的为42%。到2年时，采用AI技术修复的内侧半月板撕裂中有53%失败，到5年时，63%失败。
在精英运动员中，AI修复内侧半月板撕裂的失败率高于IO修复内侧或外侧半月板撕裂。内侧半月板修复的失败率高于外侧半月板修复。
