Similar failure rate in immediate post-operative weight bearing versus protected weight bearing following meniscal repair on peripheral, vertical meniscal tears.

PURPOSE AND HYPOTHESIS: Post-operative weight bearing after meniscal repair is a point of debate among physicians. This study sought to evaluate whether patients adhering to an immediate WBAT rehabilitation programme have a higher failure rate compared to those adhering to a more traditional, protected, NWB status following meniscal repair. The null hypothesis was that there would be no difference in failure between the two groups. METHODS: A retrospective review of meniscal repair patients greater than 5 years from surgery was performed for patients receiving meniscal repair treatment. Patients were categorized by post-surgical weight-bearing status, either NWB or WBAT, and then analysed for failure of repair. Failure was defined as re-operation on the torn meniscus. The study controlled for variables including age at surgery, sex, height, weight, and BMI, classification of tear type, acuity of the tear, repair location (medial or lateral), repair location within the meniscus, repair technique, and concomitant procedures. RESULTS: Re-operations were performed in 61 of 157 patients [38.9%]. There was no difference between weight-bearing groups for failure of meniscus repair (n.s.). The tears were acute vertical tears located in the posterior horn and body. For the 61 patients with re-operation, the average time to re-operation was 2.2 years with 10 [16%] > 5 years from surgery, 17 [28%] 2-5 years from surgery, and 34 [56%] < 2 years from surgery. In isolated meniscal repair patients (n = 62), there was no difference between weight-bearing groups for rate of re-operation (n.s.). CONCLUSION: Weight bearing as tolerated after meniscal repair for peripheral, vertical tears does not result in a higher failure rate than traditional, non-weight bearing over a five-year follow-up period. The clinical relevance is that, based on these data, it may be appropriate to allow weight bearing as tolerated following meniscal repair of peripheral, vertical tears. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

The Relationship between Body Mass Index and Risk of Failure following Meniscus Repair.

It is unknown whether body mass index (BMI) influences outcomes of meniscus repair. We hypothesized that increased BMI would be associated with increased risk of failure. A retrospective study was performed involving patients who had undergone meniscus repair between 2008 and 2012. Chart review and phone interviews were conducted to determine which patients required additional surgery. Patients were categorized as normal BMI (<25) or increased BMI (≥25). Of the 305 patients who met study criteria, 216 (70.8%) were available for follow-up at a mean of 19 months postoperatively. A total of 100 patients (46.3%) had a BMI <25 and 116 (53.7%) patients had a BMI ≥25. BMI was less than 35 in 90% of patients. Thirty-four patients (15.7%) required further surgery for a repair failure. Failure occurred in 20 patients (20%) in the normal BMI group and 14 patients (12%) in the increased BMI group (p = 0.14). Logistic regression revealed a trend toward decreased odds of repair failure in the increased BMI group (odds ratio: 0.46; 95% confidence interval: 0.20-1.05; p = 0.065). Patients with a BMI ≥25 did not have a higher risk of meniscus repair failure relative to those with a BMI <25. Given these findings, surgeons should not consider moderately increased BMI as a contraindication to meniscal repair. The effect of BMI greater than 35 on outcomes of meniscal repair remains unclear and warrants further study.