Second look arthroscopy after meniscal repair. Factors affecting the healing rate.

Second look arthroscopy was performed on 46 of 137 consecutive patients who underwent arthroscopic meniscal repair. All tears were of the vertical type. Thirty-two tears were located in avascularized areas. Thirty-one patients had associated anterior cruciate ligament insufficiencies. Anterior cruciate ligament reconstructions were performed simultaneously on 26 patients. The double-needle cannula method was used in all the patients. An additional transplantation of a vascularized synovial pedicle flap to the suture site was performed on 7 tears in avascularized areas. Second look arthroscopy showed no healing in 8 patients and healing in 38. Four of the 8 unhealed tears were located in avascularized areas, and 4 had unreconstructed anterior cruciate ligament injuries respectively. All 7 patients with synovial pedicle flaps showed healing. All patients with anterior cruciate ligament reconstructions showed healing, and the healing rate was significantly higher than that of the other patients (p < 0.005). Patients with anterior cruciate ligament insufficiencies showed a significantly lower healing rate than the others (p < 0.005). In patients with tears in avascularized areas, the conventional meniscal repairs showed a lower healing rate than did the repairs with a synovial pedicle transplantation or an anterior cruciate ligament reconstruction (p < 0.005). These results suggest that the most important factors influencing meniscal healing are the presence of anterior cruciate ligament tears, ligamentous reconstruction, and vascularity of the tear site.