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Risk Factors and Prevalance Rate for Meniscal Cysts as a Complication of All-Inside Meniscus Suture Anchors
Author(s):
Terai S. (Japan)
Terai S. (Japan)
Affiliations:
ESSKA Academy. Terai S. 05/09/18; 209780; P15-1294 Topic: Arthroscopic Surgery
Dr. Shozaburo Terai
Dr. Shozaburo Terai
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Abstract
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Objectives: The aim of this study is to investigate the prevalence of cyst formation as a complication of all-inside meniscal suture device using magnetic resonance imaging (MRI) and analyze the risk factors.

Methods: Of the patients who had undergone meniscal repair surgery in our institution between August 2008 and October 2012, 46 cases (46 knees) were selected to be in the case-control study. 51 menisci (34 medial menisci, 17 lateral menisci) of 46 cases were included to the study.
Out of 51 menisci, 46 menisci combined anterior cruciate ligament (ACL) ruptures and had performed ACL reconstruction (ACLR). 5 cases (5 menisci) had been performed meniscal repair (MR). All cases who had been performed meniscal repair suffered from discoid lateral meniscus tears. MRIs of the knee were performed 6, 12 and 24 months post-meniscal surgery. The MRIs were examined to detect the new development of cysts encasing the suture anchors and evaluate meniscal healing. Univariate and multivariate risk factor analyses was used to account for the suture technique (suture device alone versus suture device and inside-out suture repair), concurrent operation (MR alone versus MR with ACL reconstruction), patient gender, medial versus lateral menisci, number of device use, side-to-side difference of knee arthrometer, type of anchor (acetal resin versus PEEK material) and clinical scores (Lysholm score, Tegner activity scale, IKDC score).

Results: Out of the 51 menisci examined, MRI examinations revealed cyst formation in 15 menisci. 3 menisci were detected cyst formation at 6 months of surgery, 9 menisci at 12 months and 3 menisci at 24 months. Only 3 patients (6.5%) were symptomatic, so that cystectomy had been performed in these 3 patients. Compared with suture device and inside-out suture repair, using the suture device alone were more likely to develop cysts: the adjusted odds ratio (OR) of the subject with suture device only was 10.67 (95% confidence interval (CI) 1.25 to 91.41). Medial meniscus statistically tended to develop cyst compared with lateral meniscus and OR was 7.92 (95% confidence interval (CI) 1.23 to 51.07). Even though it was not statistically significant, the patients who have instability (side-to-side difference of knee arthrometer > 3mm) are likely to develop cysts than that of less than or equal to 3mm (p = 0.06). There were no statistical differences found regarding the remaining variables.

Conclusions: This study revealed the risk factors and prevalence rate for cyst formation after using the all-inside meniscal suture device. The prevalence rate of cyst formation around suture implant was 29%, however most cases didn't have any symptoms. Suture device only and medial meniscus were significant risk factors for cyst formation. Knee instability was greater in the cyst developed menisci though it was not significant, which suggested that knee instability could affect cyst formation around suture anchors.

Keywords:
meniscus, suture device, cyst
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