Meniscal repair outcome in 3829 patients with a minimum follow-up from 2 years up to 5 years: a meta-analysis on the overall failure rate and factors influencing failure

Key Points

1. 14.8% of meniscal repair surgeries failed within two to five years.
2. Failure rates were lower in surgeries with lateral repair and concomitant ACL reconstruction.

BACKGROUND & OBJECTIVE

The menisci play an essential role in the normal function of the knee joint in terms of load distribution, cartilage protection, proprioception and as a knee stabilizer. Meniscal repair results in slower progression of joint degenerationand less joint space narrowing compared with partial meniscectomy. Meniscal preservation is therefore crucial to prevent early-onset knee arthritis, and repair should be attempted whenever possible.

Prior research on meniscal repair surgery showed a failure rate of approximately 19% within 2 to 5 years. However, the research includes surgical techniques that are outdated.

This systematic review and meta-analysis analyzed failure rate for meniscal repair surgeries done in the last 20 years. It also analyzed factors influencing failure.

Prior research on meniscal repair surgery showed a failure rate of approximately 19% within 2 to 5 years.

Clients considering meniscal repair surgery should be informed that although surgical techniques for meniscal repair have improved, failure within five years remains common.

METHODS

The authors collected 51 studies between 2000 and 2021 reporting meniscal repair outcomes with a minimum follow-up of two years. These studies were reviewed and analyzed to determine failure rates and the factors associated with failure.

RESULTS

• The failure rate was determined to be 14.8%.

• The failure rate for meniscal repair accompanied by ACL reconstruction (8.5%) was lower than meniscal repair without report of ACL damage (14%).

• The failure rate for lateral meniscal repair (6.1%) was lower than that for medial meniscal repair (10.8%).

• The failure rate was higher for people older than 40 (17%) than younger (10%), and higher for women (12%) than men (10%).

• There were small or no differences in failure rates related to the type of procedure (all inside versus inside-out, etc.)

• There was no difference in failure rate based on tear configuration (vertical/longitudinal, horizontal, or bucket-handle.)

• The authors concluded that failure of meniscal repair surgery remains common, and that the failure mechanism, as well as the time to failure is poorly documented.

LIMITATIONS

Many of the studies were retrospective, and the studies varied significantly in regard to repair technique, type of meniscal tear, patient characteristics, and follow-up time.

CLINICAL IMPLICATIONS

Meniscus repair is a knee surgery that sutures together torn pieces of cartilage inside the joint. It can be contrasted with partial meniscectomy, which removes the torn portion of cartilage. Compared to partial meniscectomy, meniscal repair results in slower progression of joint degenerationand less joint space narrowing (1,2).

Meniscal repair surgeries involve different variables related to: arthroscopic techniques (all-inside, inside-out, and outside-in); tear location (lateral or medial); tear configuration (vertical, horizontal or bucket handle); and the presence of a concomitant ACL reconstruction procedure.

Recent research showed that the failure rate for meniscal repair surgery within two to five years was approximately 19% (3). However, the study included many trials that were done before recent improvements in surgical techniques. Further, it did not distinguish between different kinds of repair procedures.

This study sought to update and clarify the research on failure rates, and to identify factors associated with better outcomes.

The overall failure rate was found to be 14.8%, with lateral repair and concomitant ACL repair surgeries having lower failure rates. Failure was more common in women and people over 40.There was little or no significant difference in the failure rate based on surgical technique or tear configuration.

Based on this evidence, clients considering meniscal repair surgery should be informed that although surgical techniques for meniscal repair have improved, failure within five years remains common.

+STUDY REFERENCE

Schweizer C, Hanreich C, Tscholl PM, Blatter S, Windhager R, Waldstein W (2023) Meniscal Repair Outcome in 3829 Patients With a Minimum Follow-up From 2 Years Up to 5 Years: A Meta-analysis on the Overall Failure Rate and Factors Influencing Failure. The American Journal of Sports Medicine. 2023;0(0).

SUPPORTING REFERENCE

1. Brophy RH, Wright RW, David TS, et al. Association between previ- ous meniscal surgery and the incidence of chondral lesions at revi- sion anterior cruciate ligament reconstruction. Am J Sports Med. 2012;40(4):808-814. doi:10.1177/0363546512437722
2. Jones MH, Spindler KP, Fleming BC, et al. Meniscus treatment and age associated with narrower radiographic joint space width 2-3 years after ACL reconstruction: data from the MOON onsite cohort. Osteo- arthritis Cartilage. 2015;23(4):581-588. doi:10.1016/j.joca.2014.12.018
3. Schweizer C, Hanreich C, Tscholl PM, et al. Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta- analysis with a minimum follow-up of 5 years. Knee Surg Sports TraumatolArthrosc. 2022;30(7):2267-2276. doi:10.1007/s00167- 021-06770-x