Meniscal Repair of Degenerative Horizontal Cleavage Tears Using Fibrin Clots

Abstract

Background: Presently, the treatment options available for patients with horizontal degenerative cleavage tears of the meniscus are limited. These tears are considered an indication for partial or subtotal meniscectomy because when the tear is located within an avascular area, it is difficult to induce healing. However, meniscectomy is not ideal because it disrupts the normal anatomical structure and function of the meniscus. Purpose: To examine the clinical and arthroscopic outcomes following meniscal repair of degenerative horizontal cleavage tears using fibrin clots. Study Design: Case series; Level of evidence, 4. Methods: Vertical sutures were placed in the meniscal tear, and the cleft was filled with fibrin clots before the sutures were tightened. We repaired 18 menisci in 18 consecutive eligible patients using a previously described technique. Three patients with anterior cruciate ligament (ACL) injury who underwent simultaneous ACL reconstruction and 5 patients who did not undergo follow-up arthroscopy within 12 months were excluded. The remaining 10 menisci in 10 patients were evaluated in this study. The mean age of the patients was 35.8 ± 16.5 years, and the mean postoperative follow-up time was 40.8 ± 5.4 months. Pre- and postoperative Lysholm scores, International Knee Documentation Committee (IKDC) subjective scores, and Tegner activity levels were compared. The arthroscopy findings were evaluated at a mean postoperative time of 6.7 ± 2.9 months. Results: The mean Lysholm score improved significantly from 69.3 ± 16.3 points preoperatively to 95.4 ± 3.6 points postoperatively ( P < .005). The mean IKDC subjective score also improved significantly from 26.5% ± 19.0% preoperatively to 87.8% ± 7.5% postoperatively ( P < .001). The Tegner activity level recovered to the preinjury level in 6 patients and to 1 level below the preinjury level in 4 patients. The follow-up arthroscopies showed complete healing in 7 patients (70%) and incomplete healing in 3 patients (30%). Conclusion: Meniscal repair of degenerative horizontal cleavage tears using fibrin clots resulted in improved Lysholm and IKDC subjective scores, but the complete healing rate on follow-up arthroscopy was only 70%. Clinical Relevance: If we are to prevent osteoarthritis, we should minimize resection and restore the contact area of the meniscus to preserve the original shape.