title: Second look arthroscopy after meniscal repair. Factors affecting the healing rate.
abstract: 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.
authors.affiliation: Gunma Sports Medicine Research Center, Zenshukai Hospital, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kimura
authors.forename: K
authors.initials: K
authors.lastname: Shirakura
authors.forename: A
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Y
authors.initials: Y
authors.lastname: Kobuna
authors.forename: M
authors.initials: M
authors.lastname: Niijima
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D012307:Risk Factors; D012421:Rupture; D013524:Surgical Flaps / Q000379:methods; D013583:Synovial Membrane / Q000637:transplantation; D000070600:Tibial Meniscus Injuries; D014945:Wound Healing / Q000502:physiology*