Factores de riesgo relacionados a la falla de la sutura meniscal en niños y adolescentes

Resumen

Las lesiones meniscales en niños son cada día más frecuentes. La preservación meniscal es una prioridad en este grupo de pacientes, sin embargo, existen pocos artículos que muestran los resultados de suturas meniscales en niños.

Objetivo El objetivo de este estudio es identificar factores de riesgo de falla en pacientes sometidos a una sutura meniscal en niños menores de 18 años.

Método Estudio retrospectivo de 35 pacientes sometidos a una sutura meniscal, con una edad promedio de 16 años (13–18) y un seguimiento de 71 meses de media (16–115). Se evaluaron 6 variables: tipo, localización y tamaño de la lesión, edad, técnica quirúrgica y asociación a rotura de ligamento cruzado anterior (LCA). Los pacientes que presentaron falla de la sutura meniscal fueron identificados y sometidos a una regresión logística usando un modelo Stata V.14.0.

Resultados 9 pacientes (24.3%) presentaron una falla en su cirugía durante el seguimiento. Lesiones iniciales mayores a 16 mm mostraron una tasa de re-rotura de un 73% independiente de la técnica quirúrgica. En lesiones menores a 16 mm, se obtuvo un 78% de reparaciones exitosas. No se encontró relación entre la re-rotura meniscal y lesión de LCA, tipo y localización de la lesión, técnica quirúrgica y edad de los pacientes.

Conclusión  Este estudio muestra que la reparación meniscal en niños tiene buenos resultados con una tasa de éxito promedio de un 75%. El riesgo de falla de sutura meniscal se correlacionó con el tamaño inicial de la lesión con un 73% de fallo en lesiones mayores a 16 mm independientemente del tipo de cirugía.

Nivel de Evidencia 4, Serie de casos.

Abstract

Meniscal tears are uncommon in the pediatric population, with an increasing number. Currently meniscal preservation is a priority when treating these injuries. However, only a few studies have reported the clinical outcomes of arthroscopic meniscal repair in children and its risk factors of failure.

Objective Identify risk factors related to meniscal suture failure in patients under 18 years who underwent a meniscal repair.

Methods Retrospective study of 35 patients with an average age of 16 years (13 - 18) who underwent arthroscopic meniscal repair with a mean follow up of 71.1 months (16–115). We evaluate 6 variables: type, location and size of meniscal tear, age, surgical technique and anterior cruciate ligament (ACL) association. Patients with re-rupture were identified and statistical analysis was performed through a logistic regression model using Stata V.14.0.

Results 9 patients (24.3%) presented a suture failure during follow-up. Average time for re-rupture was 16 months (4–60 months). With an initial tear size of 16 mm or bigger, 73% of the meniscal repair will fail despite surgery technique. With an initial tear size smaller than 16 mm, 78% of will heal. No association was found between meniscal re-rupture and ACL rupture, type and location of tear, surgical technique and age. Conclusion: In our study meniscal repairs in pediatric population had good overall results with a global healing rate of 75.7%. The risk of suture failure was related to the initial size of meniscal tear: when meniscal tear is bigger than 16 mm, 73% of them will fail despite surgery.

Level of Evidence 4, Case-series.

Palabras Claves

sutura meniscal - niños - pediatría - lesión meniscal

Keywords

meniscal suture - children - meniscal tear repare

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