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

Abstract 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.