A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome?

Abstract

Meta-analysis, Level III.

Meniscectomy versus meniscal repair: 10years radiological and clinical results in vertical lesions in stable knee

“…There are numerous reports of results in meniscectomy [2][3][4][5][6][7][8]10,[22][23][24] and meniscal repair [25][26][27][28][29], comparisons between the two [20,30,31] and meta-analyses [32][33][34]. Interpretation, however, is hindered by numerous biases: meniscal surgery was either isolated or associated to anterior cruciate ligament surgery; patient ages and clinical and radiological assessment scoring systems differed; follow-up was short or variable; and initial meniscal lesion type, repair technique, meniscectomy extent and initial chondral status were not always specified.…”

“…Regarding functional results, in a meta-analysis of 7 studies including 367 patients at a minimum 7 years' follow-up, Xu and Zhao [34] reported significantly better Lysholm scores and a smaller reduction in Tegner score with meniscal repair than with meniscectomy. This difference in Lysholm score was likewise found, at more than 10 years' follow-up, in Paxton's meta-analysis [2], but not in other long-term studies, where functional scores differed less between the two techniques [30,31].…”

Analysis of 3D strain in the human medial meniscus

“…Total meniscectomy (removal of the meniscus) can produce a 14-fold increase in the risk of developing osteoarthritis at 21 years following the procedure, therefore, repair or replacement of the meniscus where possible is essential. 21,7 Outlining the structure-function relationship in the meniscus will aid in determining the onset and progression of disease. 9 In addition, an accurate, quantitative measure of the mechanical response of the meniscus to load is essential in the development of synthetic or tissue engineered replacements or repair techniques.…”

Tips and Pearls for All-Inside Medial Meniscus Repair

“…It also has been proven that long-term outcomes of arthroscopic meniscal repair are significantly better than outcomes after partial meniscectomy in terms of slowing osteoarthritis progression and return to preinjury activity level 3 . Moreover, meniscal repair is a more cost-effective procedure than meniscectomy, as indicated by long-term observation, and it has been associated with a lower failure rate 4, 5. Although the inside-out technique has been considered the gold standard for meniscal repair, the all-inside technique seems to have some advantages over the inside-out technique in terms of anatomy with respect to surrounding soft tissues; it also allows for the introduction of a more aggressive rehabilitation protocol with early full range of motion.…”