Failed meniscal repair increases the risk for osteoarthritis and poor knee function at an average of 9 years follow-up.

PURPOSE: The purpose of this study was to determine the effect of meniscal repair on OA in the knee joint and patient-related outcomes. METHODS: Three-hundred and sixteen meniscal repairs performed between 1999 and 2011 were analysed. Patient-related outcome measures were assessed through mailed questionnaires including KOOS, Lysholm score and Tegner activity level. Patients answering the questionnaires were encouraged to perform a radiographic evaluation with Rosenberg views, assessed according to Kellgren-Lawrence (KL) classification. The primary endpoint was to determine the effect of meniscal repair on the development of radiographic OA defined as a KL grade 2 or more. RESULTS: Mean follow-up time was 9.3 years (SD 3.6), 162 (51%) patients answered the questionnaires, and 86 patients completed the X-ray. The odds ratio for OA with a failed meniscus repair was 5.1 (p = 0.007) adjusted for gender and age at time of follow-up. KOOS showed a clinically important difference in the sport and recreation subscale (p = 0.041). CONCLUSIONS: There was an increased risk for OA in the affected compartment with a failed meniscus fixation. This supports the fact that the meniscus is an important protector of the cartilage in the knee. The meniscus injury affects the long-term health-related quality of life according to KOOS and in light of this study we recommend repair of a torn meniscus whenever possible. LEVEL OF EVIDENCE: III.

Autologous semitendinosus tendon graft could function as a meniscal transplant.

PURPOSE: Meniscectomy results in poor knee function and increased risk for osteoarthritis. Meniscal allograft transplantation is not widely used due to costs and availability. The semitendinosus tendon (ST) has the potential to remodel and revascularize in an intraarticular environment, such as ACL reconstruction. The objective for this pilot study was to investigate whether the ST graft could function as a meniscal transplant. METHODS: The ST was doubled and sutured with running sutures and pull-out sutures in each end. Bone tunnels were used for root anchorage and the graft was sutured with allinside, inside-out and outside-in technique. The pull-out sutures were fixed over a button. Partial weight bearing was allowed with limited range of motion in a brace for the first 6 weeks. Evaluation was assessed using clinical examination, radiology and patient reported outcome. RESULTS: A total of seven patients have been included between January 2018 and June 2020. Six medial transplants and one lateral transplant were performed. Mean age was 29 years. Four patients had completed the 12-month follow-up. Improvements were noted for IKDC Global Score, KOOS pain subscale and Lysholm. MRI indicated that the transplant become more wedge-like with visible roots and minor protrusion. CONCLUSIONS: Even though this is primarily a technical report the follow-up data indicate that the transplant survives and adapts in shape and capabilities to an original meniscus. There were no adverse events and the patients seem to improve in terms of pain and quality of life.

Predictive Factors for Failure of Meniscal Repair: A Retrospective Dual-Center Analysis of 918 Consecutive Cases.

BACKGROUND: Meniscal surgery is one of the most common surgical procedures performed by orthopaedic surgeons. Over the past decade, awareness has increased regarding the importance of meniscal preservation to prevent the development of osteoarthritis in the knee joint. Removal of meniscal tissue can lead to a high risk of cartilage degeneration, and moreover, meniscus-preserving surgery rather than meniscal resection is likely to have better long-term outcomes. Success rates after meniscal repair range from 60% to 95%, but many reports are based on a small number of patients. PURPOSE/HYPOTHESIS: The purpose of this study was to review all meniscal repairs and potential predictors for failure during a 12-year period. We hypothesized that meniscal anchors, lateral repairs, and repairs made in conjunction with an anterior cruciate ligament reconstruction (ACLR) would have fewer failures than meniscal arrows, medial repairs, and isolated repairs. We also hypothesized that younger patients and acute tears would be associated with fewer failures. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: This study was a dual-center, retrospective analysis on consecutive meniscal repairs. The surgical protocols were reviewed, including type of tear, location, associated injury to the knee, and surgery. The study endpoint was failure of repair, defined as a need for reoperation and secondary partial or total meniscal resection, within 3 years. Kaplan-Meier analysis was performed to assess repair survival, with multivariate Cox regression to adjust for confounders. RESULTS: A total of 954 meniscal repairs were performed on 918 patients (536 male patients [58%]; 382 female patients [42%]) with a mean age of 26 years (range, 12-60 years). The failure rate for the entire cohort was 22.5%. Bioabsorbable arrows had significantly more failures than all-inside sutures with anchors (hazard ratio [HR], 1.8; 95% CI, 1.2-2.5; P = .002). Medial meniscal repairs had a higher failure rate than lateral meniscal repairs (HR, 3.7; 95% CI, 2.3-6.0; P < .001). Simultaneous ACLR resulted in less failure than when no simultaneous ACLR was performed (HR, 0.5; 95% CI, 0.3-0.9; P = .009). Age at repair and acuity of tear did not affect the outcome (P = .6 and .07, respectively). CONCLUSION: The failure rate after meniscal repair was significantly higher on the medial side, especially when using arrows. Meniscal repairs performed concomitantly with an ACLR result in fewer reoperations.

Meniscus repair with simultaneous ACL reconstruction demonstrated similar clinical outcomes as isolated ACL repair: a result not seen with meniscus resection.

PURPOSE: To compare Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol-5D (EQ-5D) subscale scores at 2-year follow-up for patients with primary isolated ACL reconstruction with patients undergoing ACL reconstruction and simultaneous meniscal treatment in terms of either resection or repair in the Swedish National Knee Ligament Register (SNKLR). METHODS: All ACL reconstruction patients within the SNKLR at 2-year follow-up were reviewed. The KOOS and EQ-5D subscales were assessed in four distinct patient groups: isolated ACL reconstruction, ACL reconstruction + medial meniscus resection, ACL reconstruction + lateral meniscus resection, ACL reconstruction + medial meniscus repair, and ACL reconstruction + lateral meniscus repair. The primary analysis was conducted using linear regression with isolated ACL reconstruction designated as the reference group, and was adjusted for patient age, gender, and time from injury to surgery. RESULTS: The included patients consisted of 10,001 (65.0%) individuals with an isolated ACL injury, 588 (3.8%) with ACL injury plus treated with medial meniscus repair, 2307 (15.0%) with ACL injury plus treated with medial meniscus resection, 323 (2.1%) with ACL injury plus treated with lateral meniscus repair, and 2173 (14.1%) with ACL injury plus treated with lateral meniscus resection. Meniscus resection demonstrated significantly worse results with respect to the KOOS Symptoms subscale for both the medial and lateral meniscus resection groups. Medial meniscus resection also demonstrated worse results for the KOOS quality of life (QoL) subscale, while lateral meniscus resection only approached significance. Outcomes were not different between the isolated ACL reconstruction group and the meniscus repair groups. CONCLUSION: Meniscus resection in addition to ACL reconstruction resulted in worse clinical outcomes than isolated ACL reconstruction patients; a result not seen within the meniscus repair group. This suggests that, when possible, meniscus repair may provide greater clinical outcomes over resection when treating a reparable meniscal tear that presents along with an ACL tear. Clinicians should consider and implement these findings for the management of future meniscus tear patients within their clinical practice. LEVEL OF EVIDENCE: Level III.

Medial Meniscus Resection Increases and Medial Meniscus Repair Preserves Anterior Knee Laxity: A Cohort Study of 4497 Patients With Primary Anterior Cruciate Ligament Reconstruction.

BACKGROUND: There are still controversies regarding the effects on knee laxity of additional meniscus resection or repair in the setting of anterior cruciate ligament reconstruction (ACLR). Hypothesis/Purpose: The purpose was to determine the effects on knee laxity of resection or repair of medial meniscus (MM) or lateral meniscus (LM) injuries in the ACLR knee. The hypothesis was that patients with an additional meniscus resection would have significantly increased postoperative knee laxity versus that of an isolated ACLR, whereas patients with meniscus repair would have laxity comparable to that of an isolated ACLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The KT-1000 arthrometer, with an anterior tibial load of 134 N, was used to evaluate knee laxity preoperatively and at 6-month postoperative follow-up for a total of 4497 patients with primary hamstring tendon ACLR. Patients with isolated ACLR or ACLR with additional MM resection, MM repair, LM resection, LM repair, or MM plus LM resection were compared, with the isolated ACLR group as a control. RESULTS: All patients showed a significant reduction of knee laxity preoperatively (3.6 ± 3.1 mm) to postoperatively (1.9 ± 2.2 mm) ( P < 0.0001). Patients who had an ACLR with either an MM resection (2.2 ± 2.55 mm) or MM + LM resection (2.35 ± 2.30 mm) showed significant increased postoperative knee laxity versus isolated ACLR (1.74 mm ± 2.11 mm) ( P < 0.05), whereas patients with MM repair (1.69 ± 2.37 mm) did not show significantly different knee laxity when compared with the control group ( P > 0.05). LM resection or repair did not significantly affect knee laxity. Significantly more surgical failures, defined as side-to-side difference >5 mm, were found in the ACLR + MM resection group and the ACLR + MM + LM resection group. CONCLUSION: In ACLR, additional MM resection increased whereas MM repair preserved knee laxity in comparison with the ACLR knee with intact menisci. Neither LM resection or LM repair showed a significant effect on knee laxity. Surgeons should make every effort to repair the meniscus whenever possible to avoid the residual postoperative laxity present in the meniscus-deficient knee.