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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

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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.

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Acknowledgements

Dr. Akshay Mahajan and Dr. Vishal Nikam for helping with data collection.

Funding

Tapasvi Charitable and Medical Center, Pune and Star Imaging and Research Center, Pune.

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Authors and Affiliations

  1. The Orthopaedic Speciality Clinic, 16-Status Chambers, 1221/A Wrangler Paranjpe Road, Pune, 411004, India

    Sachin Tapasvi & Anshu Shekhar

  2. Star Imaging and Research Centre, Pune, India

    Aparna Chandorkar & Anupama Patil

  3. SRM University, Kattankulathur, Tamilnadu, India

    Shantanu Patil

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  1. Sachin Tapasvi
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  2. Anshu Shekhar
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Correspondence to Sachin Tapasvi.

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Conflict of interest

Sachin Tapasvi reports personal fees and non-financial support from SMITH AND NEPHEW, personal fees from ARTHREX, personal fees from STRYKER, personal fees from CONMED, grants and personal fees from ZIMMER BIOMET, outside the submitted work. Anshu Shekhar, Aparna Chandorkar, Anupama Patil and Shantanu Patil declare that they have no conflict of interest.

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Tapasvi, S., Shekhar, A., Chandorkar, A. et al. 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. JOIO 55, 416–424 (2021). https://doi.org/10.1007/s43465-020-00334-w

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