Review of the clinical results of arthroscopic meniscal repair

doi:10.1016/S0968-0160(01)00061-8

The Knee

Volume 8, Issue 2, May 2001, Pages 129-133

https://doi.org/10.1016/S0968-0160(01)00061-8 Get rights and content

Abstract

A total of 62 arthroscopic meniscal repairs (60 knees in 59 patients) over a 5-year period were evaluated retrospectively to assess outcome and to identify factors that might improve future clinical results. The overall success rate was 66.1%. Early repair within 3 months of sustaining the tear gave better results (91%) than if carried out later (58%). Suture repair alone yielded better results (78%) than meniscal arrows or a T-fix device (56%). Healing rates of atraumatic meniscus tears were much lower than for traumatic tears (42 vs. 73%). The isolated atraumatic medial meniscal tear appeared to do particularly poorly (33% healing) and may be better treated by meniscectomy.

Introduction

The deleterious effect of removing the meniscus was reported as early as 1948 by Fairbank [1], who observed radiographic evidence of degenerative change in 69% of 107 knees subjected to total meniscectomy. The procedure has also been shown to result in changes in load transmission in the knee [2] and instability, particularly in anterior cruciate-deficient knees [3]. The functional role of the meniscus in load transmission, shock absorption, joint stability, proprioception, articular cartilage lubrication and nutrition has now been well established. Attempts at preserving the meniscus whenever possible are hence desirable, and there is evidence to suggest that repair reduces the incidence of degenerative change compared to meniscectomy [4].

Meniscal repair initially evolved with open procedures [5], [6], but as arthroscopic techniques and equipment have improved, there has been an increasing trend towards performing repairs by this method. Several authors have now reported good results with arthroscopic meniscal repair [7], [8], [9], [10], [11].

The purpose of the present study was to review our clinical results of arthroscopic repair and to identify factors that may affect results, which may in turn influence our future management of such cases.

Section snippets

Materials and methods

Between January 1994 and January 1999, a total of 67 meniscal repairs in 64 patients were performed by the two senior authors, who are both specialist knee surgeons. Five patients have either moved from the local area or defaulted from follow-up early, and have therefore been excluded. The study group therefore consists of 62 repairs in 59 patients (two patients had both menisci in one knee repaired and one had a single meniscus repair in either knee). The mean age at repair was 28 years (range

Results

The average post-operative duration was 21 months (range 9–65 months). Patients were considered to have had a successful result if: (a) they had no pain or only mild pain that did not interfere with activity; (b) no locking, catching, giving way or significant swelling; and (c) no subsequent surgical procedures on the repaired meniscus. Based on these criteria, 41 repairs (66.1%) were deemed to be clinically successful. The overall failure rate was 33.9% (21 repairs). The average time to retear

Discussion

The reported results of the outcome of arthroscopic meniscal repair vary considerably. Morgan and Casscells reported a 98.6% overall clinical success rate [7], whereas Albrecht-Olsen and Bak reported 10 failures in 27 repairs, giving a success rate of 63% [8]. Most long-term studies seem to achieve a clinical success rate of between 70 and 80% [9], [10], [11]. Our clinical success rate at an average follow-up of 21 months is 66.1%, and we are aware that the anatomical healing rate may well be

Conclusions

1.
We achieved clinical healing in 66% of patients whose torn menisci were repaired in this retrospective study.
2.
Suture repair by the out-to-in method gave better results (78%) than meniscus arrows (56%).
3.
Arrow breakage in four patients was associated with repair failure and further morbidity. We would caution against the indiscriminate use of these devices.
4.
Early repairs within 3 months of injury gave better results (91.6%) than late repairs (58.3%).
5.
Atraumatic tears, particularly isolated tears of

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Cited by (92)

Good Surgical Outcomes After Concomitant Repair of Double Radial Tears of the Lateral Meniscus and Anterior Cruciate Ligament Reconstruction
2021, Arthroscopy, Sports Medicine, and Rehabilitation
To describe double radial tears of the lateral meniscus (LM), report early clinical treatment outcomes, and determine reoperation and failure rates.
Twenty-one (N = 21) consecutive cases of arthroscopic-treated lateral meniscus double radial tears treated between 2012 and 2018 were reviewed, including 15 males (71.4%) and 6 females (28.6%). Meniscus repairs were all performed at the time of anterior cruciate ligament (ACL) reconstruction. Patients with associated fractures or prior surgeries were excluded. Concomitant injuries were reported, as were preinjury and postoperative Tegner scores, preoperative and postoperative visual analogue pain scale (VAS) scores, and postoperative International Knee Documentation Committee (IKDC) subjective scores. Reoperation and failure rates were documented.
Twenty-one (N = 21) tears were located in the posterior horn of the meniscus near the root attachment; 15 (71.4%) underwent all-inside repair, 4 (19.0%) underwent transtibial pull-through repair, 1 (4.8%) was partially debrided, and 1 (4.8%) was left untreated. Twenty-one tears (N = 21) were in the body of the meniscus; 7 (33.3%) were repaired, 7 (33.3%) were partially debrided, and 7 (33.3%) were left untreated. Thirteen patients (62%) had associated medial collateral ligament (MCL) injuries. Mean follow-up was 2.6 years. VAS at rest and with activity improved by 2.1 points (P < .001) and 3.1 points (P = .017) after surgery. The mean postoperative Tegner activity score was 6.4, and the mean IKDC score was 83.2 at final follow-up. Reoperation was required in 5 patients (23.8%), and the surgical treatment failed in 1 patient (4.7%).
Double radial tears of the LM are uncommon injuries that occur in the setting of ACL tears, usually combined with MCL injury. The variety of surgical treatment techniques have a low failure rate at short-term follow-up. Patients tend to have good clinical outcomes with improvement in pain and overall function after surgically treating these injuries with simultaneous ACL reconstruction.
Level IV, therapeutic study, case series
Differences in Access to Outpatient Care in the State of Ohio for an Orthopaedic Sports Medicine Patient
2021, Arthroscopy, Sports Medicine, and Rehabilitation
To evaluate the impact of either Medicaid or private insurance on securing an appointment in an outpatient orthopaedic clinic and to determine waiting periods until an appointment as well as the relationship between population metrics and access to care.
A total of 88 clinics were called. There were 2 fictitious patients, one with an anterior cruciate ligament (ACL) injury and the other with a medial meniscus injury, with each calling as having Medicaid or private insurance. Clinic responses were recorded for whether an appointment could be made, when it was scheduled, and with what provider.
A total of 32 of 88 (36.4%) of the clinics scheduled an appointment for the Medicaid patient reporting an ACL injury versus 71 of 88 (80.6%) of the clinics that scheduled an appointment for the same patient with private insurance. A total of 34 of 88 (38.6%) of the clinics scheduled an appointment for the Medicaid patient reporting a medial meniscus injury versus 71 of 88 (80.6%) of the clinics that scheduled an appointment for the same patient with private insurance. Mean waiting period for ACL patients with Medicaid was 8.6 days and 4.5 days for patients with private insurance, whereas medial meniscus patients with Medicaid was 7.7 days and 5.4 days for patients with private insurance. In total, 60 of the 66 (90.9%) patients with Medicaid who received an appointment were scheduled to see the orthopaedic surgeon (30 in both ACL and medial meniscus groups). In total, 126 (71.6%) patients with Medicaid and 34 (19.3%) patients with private insurance of the 176 encounters faced barriers to scheduling an appointment. Rural communities were associated with appointment acceptance for patients with Medicaid (P < .05), and patients with private insurance had successful appointment scheduling in all community types (P < .05).
This study suggests that patients with Medicaid are less likely to receive orthopaedic care for multiple sports medicine injuries, are more likely to encounter barriers, and endure longer waiting periods. There are different patterns of insurance acceptance according to population metrics.
Serves as a baseline evaluation of the difference in access to health care that may be impacted by increases in Medicaid coverage and/or changes in government policies.
The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population
2018, Osteoarthritis and Cartilage
Citation Excerpt :
However, the long-term consequences of meniscus repair have not been sufficiently investigated. Large cohort studies with long follow-up time and the appropriate reference materials are scarce, making the potential long-term benefits of meniscus repair as compared to APM still somewhat speculative, i.e., more based on biological plausibility and face validity rather than evidence4–6. In fact, it has even been suggested that there is no difference in the risk of OA in a 13-year follow-up7.
To compare consultation rate for knee osteoarthritis (OA) after meniscus repair, arthroscopic partial meniscectomy (APM), and in general population, respectively.
We identified patients aged 16–45 years having had meniscus surgery due to traumatic meniscus tear in 1998–2010 in southern Sweden by a healthcare register. Patients were followed from surgery until a diagnosis of knee OA, relocation, death, or December 31st, 2015. We studied the consultation rate for knee OA compared to the general population.
We identified 2,487 patients diagnosed with traumatic meniscus tear (mean [SD] age 30.5 [8.6] years); 229 (9.2%) of them had had meniscus repair. The absolute risk of having consulted for knee OA during the study was 17% after APM, 10.0% after meniscus repair, and 2.3% in the general population. Hazard ratio (HR) (95% confidence interval (CI)) for knee OA after repair vs APM was: 0.74 (0.48, 1.15). Excluding cases with OA within 2 years post-surgery, yielded the HR of 0.51 (0.27, 0.96). The consultation rate for knee OA standardized to the general population was then 42 per 10,000 person-years (95% CI 12, 71) in the meniscus repair group, 118 per 10,000 person-years (95% CI 101, 135) after APM, and 20 per 10,000 person-years (95% CI 19.9, 20.1) in the general population.
The point estimates suggests about 25–50% lower risk of consultation for knee OA after meniscus repair as compared to APM. However, the consultation rate for knee OA after repair was still at least two times higher as compared to the general population.
Prognostic factors for all-inside meniscal repair. A 87-case series
2017, Revue de Chirurgie Orthopedique et Traumatologique
La réparation méniscale est recommandée sur les ménisques non dégénératifs. La littérature montre un taux d’échec moyen des réparations tout en dedans de 15 %. L’objectif de l’étude était d’étudier les facteurs pronostiques d’échecs des réparations méniscales tout en dedans. L’hypothèse était que des facteurs épidémiologiques, cliniques, et chirurgicaux influencent le taux de succès.
Cette étude rétrospective a porté sur 87 réparations méniscales associées ou non à une rupture du ligament croisé antérieur (LCA). Les lésions siégeaient en zone rouge–rouge ou rouge–blanc. Le ménisque était réparé après avivement par technique arthroscopique tout en dedans par FasT-Fix (Smith&Nephew) associée ou non à une ligamentoplastie (70,1 %). Tous les LCA rompus ont été reconstruits. En préopératoire, étaient recueillis : l’âge, le sexe, le tabagisme, le sport, le délai accident-chirurgie, l’indice de masse corporelle (IMC), le morphotype frontal et le score IKDC. En per- et postopératoire, étaient recueillis : les caractéristiques des lésions méniscales, leurs localisations, le nombre de sutures, le type de ligamentoplastie, la présence de chondropathie, les mobilités postopératoires autorisées et le score IKDC. L’échec était défini par une méniscectomie secondaire.
À 31 mois de recul moyen, 13 échecs (15 %) ont été observés. L’IKDC postopératoire était de 88,19 (64,37–98,95). Les lésions en anse de seau (p = 0,006) et l’IMC > 25 (p = 0,014) étaient statistiquement des facteurs de mauvais pronostic.
Ce taux d’échec correspond aux données de la littérature. Plus la lésion est étendue plus le taux d’échec est élevé. L’IMC élevé impose aux réparations des contraintes biomécaniques importantes responsables de l’augmentation du taux d’échec.
Étude rétrospective de cohorte. Niveau IV.
Prognostic factors for all-inside meniscal repair. A 87-case series
2017, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
The study hypothesis was confirmed: epidemiological and lesion-related factors influenced the success of all-inside meniscal repair. Clinical results for arthroscopic all-inside meniscal repair vary considerably, from 70% to 94% success [10,15–17]. The present 85% success rate matches the literature.
Repair is indicated for tears in non-degenerative menisci. The literature reports a 15% failure rate for all-inside repair. The aim of the present study was to determine prognostic factors for failure of all-inside meniscal repair. The study hypothesis was that epidemiological, clinical and surgical factors affect success.
A retrospective study included 87 meniscal repair procedures, with or without anterior cruciate ligament (ACL) tear. Lesions were located in red-red or red-white zones. After freshening, repair comprised an all-inside arthroscopic technique using the FasT-Fix^® system (Smith & Nephew), with (70.1%) or without ligament reconstruction; all ACL tears were reconstructed. Preoperative data comprised: age, gender, smoking status, sports activity, trauma-to-surgery time, body mass index (BMI), frontal morphotype, and IKDC score. Intra- and postoperative data comprised: meniscal lesion characteristics, location, number of sutures, type of ACL reconstruction, presence of chondropathy, authorized postoperative ranges of motion, and IKDC score. Failure was defined by secondary meniscectomy.
At 31 months’ follow-up, there were 13 failures (15%). Mean postoperative IKDC score was 88.19 (range: 64.37–98.95). Bucket-handle lesion (P = 0.006) and BMI > 25 (P = 0.014) emerged as significant factors of poor prognosis.
The present failure rate matched those reported in the literature. The more extensive the lesion, the higher the risk of failure. High BMI incurs mechanical stresses that increase the risk of failure.
IV, retrospective cohort study.
Rehabilitation and Return to Play Following Meniscal Repair
2017, Operative Techniques in Sports Medicine
The outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play (RTP). Athletes represent the most demanding subgroup of patients as they have high expectations to return to their preinjury level of activity and in doing so they place maximum stress on any meniscal repair. Physical therapy rehabilitation protocols and RTP decision-making remains controversial in the setting of meniscal repair. Protective protocols had been the mainstay of treatment for many years, however, newer research has shown no harm and quicker RTP for longitudinal and bucket-handle tears located close to the outer vascular zone of the periphery of the meniscus using accelerated rehabilitation. Protective protocols and slower RTP remain the most prudent choice in complex, horizontal and radial tears or those extending into the middle to central third of the more avascular zone of the meniscus. The authors have therefore, with evidence from current publications, developed 2 separate protocols to treat both peripheral and complex tears. One accelerated and one protective protocol is established. During the preoperative planning, it would be helpful for the surgeon, patient, and family to know what can be expected with regard to the surgical success of meniscal repair and the likelihood of RTP in this active population. A literature review on the outcome of meniscal repair related to RTP was performed and revealed that the majority of patients succeed to RTP at the same or similar to their preinjury level, between 4 and 6 months following meniscal repair. Factors that may affect the outcome and RTP along with rehabilitative considerations following meniscal repair are discussed.

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Review of the clinical results of arthroscopic meniscal repair

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusions

Arthroscopy

Arthroscopy

Clin Sports Med.

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Knee joint changes after meniscectomy

J Bone Joint Surg (Br)

Mechanical changes in the knee after meniscectomy

J Bone Joint Surg (A)

Factors affecting late results after meniscectomy

J Bone Joint Surg (A)

Knee joint surface changes: long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions

Clin Orthop

Peripheral meniscal repair: an alternative to meniscectomy (abstract)

J Bone Joint Surg (Br)

Open meniscus repair: technique and 2–9-year results

Am J Sports Med

Arthroscopic repair of the bucket-handle meniscus. 10 failures in 27 stable knees followed for 3 years

Acta Orthop Scand