Are clinical outcomes and failure rate following meniscal repair for vertical-longitudinal tears age-dependent

This study aimed to compare the clinical outcomes and failure rate following meniscal repair for vertical-longitudinal tears between patients 40 years of age or older and patients younger than 40 years. Between 2008 and 2016, 134 patients with vertical longitudinal meniscal tear repair (121 males and 13 females) were included in the study. Patients were divided into two main groups according to age: 40 years (Group 2). The clinical status of patients was evaluated by the Visual Analog Scale (VAS), Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores, Barrett’s criteria were used to assess meniscal healing. Patient and tear characteristics, operative features were also investigated. The mean follow-up time was 57.8 ± 13.0 months (range, 24-84 months). There was a significant improvement in clinical scores in both groups (p 0.05). Failure was noted in 8 patients (8.9%) in group 1, 4 patients (9.1%) in group 2 (p>0.05). Time to failure was significantly lower in the older-aged group (p=0.040). Red-white (RW) zone tears, Body Mass Index (BMI) (kg/m2) and late repairs (>2 months) were found to be significantly higher in failed repairs (p=0.005, p=0.020, p=0.042, respectively). Clinical outcomes following arthroscopic repair for vertical-longitudinal meniscal tears do not differ in terms of age. Especially peripheral tears should be repaired in the early period because of their better healing potential regardless of age.

PDF

___

1. Henning CE. Arthroscopic repair of meniscus tears. Orthopedics United States. 1983;6:1130–2.

2. Noyes FR, Heckmann TP, Barber-Westin SD. Meniscus repair and transplantation: a comprehensive update. J Orthop Sports Phys Ther. 2012;42:274–90.

3. Buseck MS, Noyes FR. Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion. Am J Sports Med. 1991;19:489–94.

4. Eggli S, Wegmuller H, Kosina J, et al. Long-term results of arthroscopic meniscal repair. An analysis of isolated tears. Am J Sports Med. 1995;23:715– 20.

5. Barrett GR, Field MH, Treacy SH, et al. Clinical results of meniscus repair in patients 40 years and older. Arthroscopy. 1998;14:824–9.

6. Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older. Arthroscopy. 2000;16:822–9.

7. Steadman JR, Matheny LM, Singleton SB, et al. Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older. Am J Sports Med. 2015;43:2222–7.

8. Everhart JS, Magnussen RA, Poland S, et al. Meniscus repair five-year results are influenced by patient pre-injury activity level but not age group. Knee.2020;27:157-64.

9. Poland S, Everhart JS, Kim W, et al. Age of 40 Years or Older Does Not Affect Meniscal Repair Failure Risk at 5 Years. Arthroscopy. 2019;35:1527–32.

10. Outerbridge re. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43–B:752–7.

11. Cannon WDJ, Vittori JM. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med. 1992;20:176–81.

12. Tegner Y, Lysholm J, Lysholm M, et al. A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med. 1986;14:156–9.

13. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;(198):43–9.

14. Irrgang JJ, Ho H, Harner CD, et al. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 1998;6:107–14.

15. Abrams GD, Frank RM, Gupta AK, et al. Trends in meniscus repair and meniscectomy in the United States, 2005-2011. Am J Sports Med. 2013;41:2333–9.

16. Bach BRJ, Dennis M, Balin J, et al. Arthroscopic meniscal repair: analysis of treatment failures. J Knee Surg. 2005;18:278–84.

17. Lyman S, Hidaka C, Valdez AS, et al. Risk factors for meniscectomy after meniscal repair. Am J Sports Med. 2013;41:2772–8.

18. Kalliakmanis A, Zourntos S, Bousgas D, et al. Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients. Arthroscopy. 2008;24:810–6.

19. Fok AWM, Yau WP. Early results of all-inside meniscal repairs using a pre-loaded suture anchor. Hong Kong Med J = Xianggang yi xue za zhi. 2013;19:124–8.

20. Majeed H, Karuppiah S, Sigamoney KV, et al. All-inside meniscal repair surgery: factors affecting the outcome. J Orthop Traumatol. 2015;16:245–9.

21. Everhart JS, Higgins JD, Poland SG, et al. Meniscal repair in patients age 40years and older: A systematic review of 11 studies and 148 patients. Knee. 2018;25:1142–50.

22. Ahn JH, Wang JH, Yoo JC. Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament--deficient knees: results of second-look arthroscopies in 39 cases. Arthroscopy. 2004;20(9):936–45.

23. Kubiak G, Fabis J. Clinical results of meniscus repair. Ortop Traumatol Rehabil. 2010;12:28–40.

24. Miao Y, Yu J-K, Ao Y-F, et al. Diagnostic values of 3 methods for evaluating meniscal healing status after meniscal repair: comparison among second-look arthroscopy, clinical assessment, and magnetic resonance imaging. Am J Sports Med. 2011;39:735–42.

25. Brillante MJ, Diduch DR, Lunardini DJ, et al. Meniscal repair using an allinside, rapidly absorbing, tensionable device. Arthroscopy. 2008;24:779–85.

26. Kise NJ, Drogset JO, Ekeland A, et al. All-inside suture device is superior to meniscal arrows in meniscal repair: a prospective randomized multicenter clinical trial with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2015;23:211–8.

27. Kotsovolos ES, Hantes ME, Mastrokalos DS, et al. Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy. 2006;22:3–9.

28. Rothermel SD, Smuin D, Dhawan A. Are Outcomes After Meniscal Repair Age Dependent? A Systematic Review. Arthroscopy. 2018;34:979–87.

29. Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94:2222–7.

30. Moses MJ, Wang DE, Weinberg M, et al. Clinical outcomes following surgically repaired bucket-handle meniscus tears. Phys Sportsmed. 2017;45:329–36.

31. Laurendon L, Neri T, Farizon F, et al. Prognostic factors for all-inside meniscal repair. A 87-case series. Orthop Traumatol Surg Res. 2017;103:1017–20.

32. Jiang EX, Abouljoud MM, Everhart JS, et al. Clinical factors associated with successful meniscal root repairs: A systematic review. Knee. 2019;26:285–91.

33. Haklar U, Donmez F, Basaran SH, et al. Results of arthroscopic repair of partialor full-thickness longitudinal medial meniscal tears by single or double vertical sutures using the inside-out technique. Am J Sports Med. 2013;41:596–602.

34. Blackwell R, Schmitt LC, Flanigan DC, et al. Smoking increases the risk of early meniscus repair failure. Knee Surg Sports Traumatol Arthrosc. 2016;24:1540–3.

35. Gormeli G, Gormeli CA, Sevimli R, Karakaplan M, Aslanturk O. Knee osteoarthritis after ACL injury: does early reconstruction prevents posttraumatic osteoarthritis. J Turgut Ozal Med Cent. 2015; 22: 276-7.