Indirect Magnetic Resonance Arthrography May Help Avoid Second Look Arthroscopy for Assessment of Healing After Bucket Handle Medial Meniscus Repairs: A Prospective Clinico-Radiological Observational Study

Overview

Journal Indian J Orthop

Publisher Springer Nature

Specialty Orthopedics

Date 2021 Apr 30

PMID 33927820

Citations 2

Authors

Sachin Tapasvi

Anshu Shekhar

Aparna Chandorkar

Anupama Patil

Shantanu Patil

Affiliations

Soon will be listed here.

Abstract

Objectives: The objectives were: (1) to analyze the MRI healing rates of bucket-handle meniscus repair; (2) to compare the accuracy of assessment of meniscus healing for conventional MRI and Indirect Magnetic Resonance Arthrography (IMRA); and (3) to identify patients who may require second-look arthroscopy after meniscus repair.

Methods: This is a prospective observational case series of thirty-seven patients with repaired bucket-handle medial meniscus tear with a minimum one year follow-up. Meniscus healing rates were assessed on direct MRI and IMRA using Henning's criteria. At the same time, patients' symptoms were evaluated according to Barrett's criteria and functional outcomes were recorded using International Knee Documentation Committee (IKDC) score, Knee Osteoarthritis and Outcomes Score (KOOS) and Tegner-Lysholm scores. A further clinical review was performed 18 months after the imaging to assess the evolution of symptoms.

Results: At a mean of 22.3 ± 7.8 months after the meniscus repair, 56.7% patients showed complete healing and 40.5% patients demonstrated incomplete repair healing on IMRA. 52% patients with complete healing and 40% patients with incomplete healing demonstrated meniscus symptoms. At the second clinical review, 19% patients with complete healing and 20% patients with incomplete healing had meniscus symptoms. There was no co-relation between symptoms, PROMs and healing on MRI.

Conclusion: Indirect MR arthrography offers distinct advantages over direct MRI for assessment of meniscus healing, especially in symptomatic patients. Patient-reported outcome measures and symptomatology are not co-related with the healing status of the meniscus and they resolve in the majority on longer follow-up. A more conservative approach guided by IMRA to assess meniscus healing will avoid early re-operations.

Citing Articles

Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?-A Prospective Comparative Cohort Study.

Martinkeniene V, Austys D, Saikus A, Brazaitis A, Bernotavicius G, Makulavicius A Clin Pract. 2024; 14(2):602-613.

PMID: 38666805 PMC: 11049170. DOI: 10.3390/clinpract14020047.

Clinical outcome and healing rate after meniscal bucket handle tear repair.

Muench L, Achtnich A, Krivec L, Diermeier T, Woertler K, Braun S BMC Musculoskelet Disord. 2022; 23(1):1063.

PMID: 36471335 PMC: 9721037. DOI: 10.1186/s12891-022-06037-7.

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