Meniscal Suture Influence on Driving Ability 6 Weeks after Anterior Cruciate Ligament Reconstruction with Hamstring Autograft

The purpose of this study was to determine if driving ability 6 weeks after anterior cruciate ligament (ACL) reconstruction is affected by the addition of a meniscal suture. It was also hypothesized that no differences in the driving performance would be found between right or left knee surgery subgroups. A total of 82 people participated in this prospective cohort study: 36 healthy controls, 26 patients undergoing isolated ACL (iACL) reconstruction with hamstring autograft, and 20 patients undergoing ACL and meniscal suture (ACL-MS) reconstruction. ACL-MS group followed a weight-bearing and movement restriction protocol during the first 2 postoperative weeks, whereas patients undergoing iACL could start range-of-motion exercises and full weight-bearing ambulation on the first postoperative day. A driving simulator that reproduced real-life driving conditions was used to evaluate driving ability. The software analyzed multiple driving and braking variables. Driving performance in the sixth postoperative week was compared with that of a healthy control group. Subgroup analysis considering additional procedures (iACL, ACL-MS) and the side of the operated knee (right, left) was also performed. No statistically significant differences were found in the demographic characteristics nor in the driving performance (collisions, p = 0.897; sidewalk invasions, p = 0.749; pedestrian impact, p = 0.983) between iACL, ACL-MS, and control groups. No statistically significant differences were found in right–left subgroup analysis. The results of the present study show that patients in their sixth postoperative week after right or left ACL reconstruction showed similar driving performance as compared with a healthy control group, regardless of associating or not a meniscal suture, suggesting it is safe to resume driving 6 weeks after the mentioned surgeries.

The modified cross-suture technique for unilateral pulled-out anchor during all-inside meniscal repair

Background: In consideration of meniscal repair has received increasingly more attention, but for inexperienced doctors, various technical errors may occur when meniscal suture repair is performed, particularly during all-inside meniscal suture repairing. When the errors is happened intraoperatively, how to minimize the loss under the effectiveness of treatment is a topic worth studying. Methods: From May 2014 to May 2017, 28 cases diagnosed with injures of meniscus and anterior cruciate ligaments were enrolled in the study as observation group. All cases underwent anterior cruciate ligament (ACL) reconstruction concurrently. All meniscus injuries were repaired with an all-inside meniscal repair technique, and 1-3 needles of unilateral suture anchor pulling out occurred intraoperatively. The method of modified cross-suture was used to remedy the error of anchor pulling out and to eventually complete the effective repair. During postoperative follow-up, the range of motion, Lachman test and pivot shift test were confirmed by physical examination. The clinical healing of meniscus was evaluated according to the Barrett standard. Meniscus healing status was also confirmed with magnetic resonance imaging (MRI). The function of the knee joint was evaluated with the IKDC, Lysholm and Tegner scores. Results: 25 cases of observation group and 28 cases of control group received complete follow-up with an average follow-up of 18.4±5.2 months. All operations were finished by the same surgeon. At the follow-up one year after operation, the average knee ROM of two groups were 125.2±4.3 degrees and 124.7±3.8 degrees, the clinical healing rate of the meniscus of two groups were 92.0% (23/25) and 92.9% (26/28), the MRI healing rate of the menniscus of two groups were 72.0% (18/25) and 71.4% (20/28), the IKDC, Lysholm and Tegner scores of two groups were 90.52±2.8, 89.17±3.1, 6.81±1.7 and 91.42±1.9, 90.32±3.4, 7.02±1.4, the differences were not statistically significant (P>0.05). Conclusions: The method of modified cross-suture is effective for arthroscopic remediation for unilateral suture anchor pulling out of an all-inside meniscal repair system.

Chondral Injury After Inside-Out Meniscal Suture Repair Using Meniscal Sutures

Chondral injury after arthroscopic meniscal suture repair is rare. We present a case of chondral injury due to the migration of suture after meniscal repair. The aberrant suture that remained temporarily at the medial tibiofemoral joint may have led to the chondral lesion of the femoral medial condyle and the tibial medial plateau at the weight-bearing portion.