Indian journal of orthopaedics · 2026
Impact of Suture Configurations for Posterior Horn Meniscal Repair on Postoperative Stability and Reoperation Rates in Patients Undergoing Concurrent Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study.
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Vincent Audrey, Hong Seung-Mo, Hu Chaoxin, Omura Noriyuki, Young Angela, Kim Haeryoung, Yu Jun, Knight Spencer, Ayars Michael, Griffith Margaret, Van Seuningen Isabelle, Maitra Anirban, Goggins Michael
Аннотация
BACKGROUND: Posterior horn meniscal tears often accompany ACL injuries, requiring surgical repair to preserve knee function and prevent osteoarthritis. The optimal suture configuration remains debated.
OBJECTIVE: To compare the impact of vertical mattress, horizontal mattress, and combined sutures for posterior horn meniscal repair on knee stability and reoperation rates in patients undergoing concurrent ACL reconstruction.
METHODS: This retrospective study analyzed 186 patients (January 2022-December 2024) who underwent arthroscopic meniscal repair with ACL reconstruction. Patients were grouped by suture technique: vertical mattress (n = 64), horizontal mattress (n = 58), or combined (n = 64). Tear length, injury-to-surgery interval as a surrogate of tear chronicity, tear zone, and tear pattern (simple longitudinal vs bucket-handle) were extracted from operative and preoperative records and incorporated into adjusted survival analyses. Outcomes assessed at minimum 24-month follow-up included IKDC score, Lysholm score, Tegner scale, KT-1000 arthrometer measurements, reoperation rates, and Kaplan-Meier failure-free survival.
RESULTS: The combined suture group achieved significantly higher IKDC scores (87.6 ± 8.4) than the vertical (82.4 ± 9.2) and horizontal groups (79.8 ± 10.6) (P < 0.01). KT-1000 side-to-side differences were significantly lower (better stability) in the combined group (1.8 ± 0.9 mm) versus the horizontal group (2.6 ± 1.2 mm) (P < 0.05). The overall meniscal repair failure rate was 11.8% (22/186), differing significantly among groups: horizontal 17.2%, vertical 10.9%, combined 7.8% (P = 0.024). Kaplan-Meier analysis demonstrated significant between-group differences in failure-free survival, with estimated 24-month survival of 92.2% in the combined group, 89.1% in the vertical group, and 82.8% in the horizontal group (overall log-rank P = 0.024). Horizontal suture configuration (HR 2.84, 95% CI 1.32-6.14; P = 0.008) and medial meniscus location (HR 2.42, 95% CI 1.18-4.96; P = 0.014) were independent risk factors for failure, whereas tear length, chronicity, and bucket-handle tear pattern were not independently associated after adjustment.
CONCLUSIONS: Combined vertical-horizontal suture repair for posterior horn meniscal tears during ACL reconstruction was associated with superior clinical outcomes, better knee stability, and lower reoperation rates compared with single-plane techniques. Given the retrospective non-randomized design, combined sutures should be considered rather than routinely mandated.
OBJECTIVE: To compare the impact of vertical mattress, horizontal mattress, and combined sutures for posterior horn meniscal repair on knee stability and reoperation rates in patients undergoing concurrent ACL reconstruction.
METHODS: This retrospective study analyzed 186 patients (January 2022-December 2024) who underwent arthroscopic meniscal repair with ACL reconstruction. Patients were grouped by suture technique: vertical mattress (n = 64), horizontal mattress (n = 58), or combined (n = 64). Tear length, injury-to-surgery interval as a surrogate of tear chronicity, tear zone, and tear pattern (simple longitudinal vs bucket-handle) were extracted from operative and preoperative records and incorporated into adjusted survival analyses. Outcomes assessed at minimum 24-month follow-up included IKDC score, Lysholm score, Tegner scale, KT-1000 arthrometer measurements, reoperation rates, and Kaplan-Meier failure-free survival.
RESULTS: The combined suture group achieved significantly higher IKDC scores (87.6 ± 8.4) than the vertical (82.4 ± 9.2) and horizontal groups (79.8 ± 10.6) (P < 0.01). KT-1000 side-to-side differences were significantly lower (better stability) in the combined group (1.8 ± 0.9 mm) versus the horizontal group (2.6 ± 1.2 mm) (P < 0.05). The overall meniscal repair failure rate was 11.8% (22/186), differing significantly among groups: horizontal 17.2%, vertical 10.9%, combined 7.8% (P = 0.024). Kaplan-Meier analysis demonstrated significant between-group differences in failure-free survival, with estimated 24-month survival of 92.2% in the combined group, 89.1% in the vertical group, and 82.8% in the horizontal group (overall log-rank P = 0.024). Horizontal suture configuration (HR 2.84, 95% CI 1.32-6.14; P = 0.008) and medial meniscus location (HR 2.42, 95% CI 1.18-4.96; P = 0.014) were independent risk factors for failure, whereas tear length, chronicity, and bucket-handle tear pattern were not independently associated after adjustment.
CONCLUSIONS: Combined vertical-horizontal suture repair for posterior horn meniscal tears during ACL reconstruction was associated with superior clinical outcomes, better knee stability, and lower reoperation rates compared with single-plane techniques. Given the retrospective non-randomized design, combined sutures should be considered rather than routinely mandated.