Clin Orthop Surg.  2015 Jun;7(2):177-184. 10.4055/cios.2015.7.2.177.

The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

• Kang HJ
• Chun CH
• Kim KM
• Cho HH
• Espinosa J

• KMID: 2164542
• DOI: http://doi.org/10.4055/cios.2015.7.2.177

Abstract

BACKGROUND
Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction.
METHODS
Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing.
RESULTS
The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present.
CONCLUSIONS
The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.

Keyword

Anterior cruciate ligament; Meniscus; Reapir; Viper; All inside

MeSH Terms

Adolescent
Adult
Anterior Cruciate Ligament/*injuries/pathology/*surgery
*Anterior Cruciate Ligament Reconstruction
Arthroscopy/*methods
Female
Humans
Magnetic Resonance Imaging
Male
Menisci, Tibial/*injuries/pathology/*surgery
Middle Aged
Rupture
Second-Look Surgery
Treatment Outcome
Young Adult

Figure

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  Fig. 1 The Meniscal Viper Repair System.

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  Fig. 2 Patient selection process. ACL: anterior cruciate ligament, MRI: magnetic resonance imaging.

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  Fig. 3 Healing rates by segment according to Henning's criteria: (A) complete healing, (B) partial healing > 50%, and (C) < 50% healing.

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  Fig. 4 An 18-year-old woman with a complete rupture of the anterior cruciate ligament and longitudinal tear of the medial meniscus of her left knee. (A) Arthroscopic findings of longitudinal tear of medial meniscus. (B-D) Arthroscopic findings during meniscus repair using the Meniscal Viper Repair System. (E) Arthroscopic finding immediately after suture. (F) Second-look arthroscopic findings after meniscus repair show complete healing.

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  Fig. 5 A 41-year-old man with complete rupture of the anterior cruciate ligament and longitudinal tear of the lateral meniscus of his right knee. (A) Arthroscopic findings of longitudinal tear of lateral meniscus. (B, C) Arthroscopic findings during meniscus repair using the Meniscal Viper Repair System. (D) Arthroscopic findings immediately after suture. (E) Second-look arthroscopic findings after meniscus repair show complete healing.

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  Fig. 6 (A) The preoperative coronal magnetic resonance imaging (MRI) scan revealed a longitudinal tear of the medial meniscus. (B) The follow-up MRI obtained 15 months after the operation shows partial healing at the previous tear of medial meniscus. (C) The MRI at the 24-month follow-up appointment shows almost complete healing at the medial meniscus lesion.

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