The three portal (including transpatellar tendon portal) versus two portal technique in the arthroscopic menisectomy procedure for isolated medial bucket-handle type meniscal tears
Onat Üzümcügil, Ahmet Doğan, Merter Yalçınkaya, Erhan Mumcuoğlu, Yavuz Kabukçuoğlu
Department of Orthopedics and Traumatology, İstanbul Education and Research Hospital, İstanbul, Turkey
Keywords: Arthroscopy; bucket handle meniscal tear; central portal.
Objectives: The aim of this study is to evaluate the efficacy of the central (transpatellar tendon) portal technique for the treatment of isolated medial bucket-handle type meniscal tears with the arthroscopic menisectomy procedure.
Patients and methods: In this study, fifty patients with isolated medial bucket-handle type meniscal tears were evaluated. They were divided into two groups with 25 patients in each group. In the first group, the three portal (including central portal) technique was used and in the second group, the two portal technique was used. The results of the two groups were compared in terms of (i) operation times; (ii) changes in Insall-Salvati ratios postoperatively; (iii) postoperative Cincinatti scores; (iv) quadriceps muscle strengths; (v) the presence of anterior knee pain and; (vi) complication rates, in order to determine the significance of adding a central portal to the standard anterolateral and anteromedial portals in the menisectomy procedure.
Results: There was no significant difference between the two groups in terms of Cincinnati clinical scores, quadriceps muscle strenghts and complication rates. However, the operation time values of the first group were significantly shorter than the second group (p<0.001). The postoperative changes in Insall-Salvati ratio values were significantly higher in the first group than the second group (p<0.002). This results show us that the first group had a significant decrease in patellar tendon length whereas the second group had no change in size postoperatively.
Conclusion: We suggest that the use of the central portal for viewing and instrumentation is a safe and quick technique in the menisectomy procedure for medial bucket-handle type meniscal tears, due to its unexpected lower complication rates and shorter operation times. While it causes patellar tendon shortening, this does not effect the clinical outcomes