A Systematic Review of Clinical Outcomes in Patients Undergoing Meniscectomy

Abstract

Knee meniscectomy is the most common procedure performed by orthopaedic surgeons. While it is generally believed that loss of meniscal tissue leads to osteoarthritis and poor knee function, many variables may significantly influence this outcome. Through literature search engines including PubMed and Ovid, 4 randomized controlled trials, 2 prospective cohorts, and 23 retrospective cohorts that fit the criteria for level I, II, and III level of evidence were included in this systematic review. For the level III evidence studies, follow-up of 5 years or more was required. Preoperative and intraoperative predictors of poor clinical or radiographic outcomes included total meniscectomy or removal of the peripheral meniscal rim, lateral meniscectomy, degenerative meniscal tears, presence of chondral damage, presence of hand osteoarthritis suggestive of genetic predisposition, and increased body mass index. Variables that were not predictive of outcome or were inconclusive or had mixed results included meniscal tear pattern, age, mechanical alignment, sex of patient, activity level, and meniscal tears associated with anterior cruciate ligament (ACL) reconstruction. While an intact meniscus or meniscal repair was generally favorable in the ACL-reconstructed knees, meniscal repair of degenerative meniscal tissue was not favorable. There is a lack of uniformity in the literature on this subject with a preponderance of lower level evidence. Although randomized controlled trials are considered to be the gold standard in medical research, a multicenter prospective cohort design may be more appropriate in assessing the long-term outcome of meniscal surgery and the role that multiple preoperative and intraoperative variables may play in clinical outcomes. In addition, future studies should include factors not assessed or adequately evaluated by several of the included studies, such as meniscal tear pattern, age, mechanical alignment, sex of the patient, activity level, meniscal tears associated with other injuries such as the ACL, smoking, and the effect of previous surgery.

The Effectiveness of Postoperative Physical Therapy Treatment in Patients Who Have Undergone Arthroscopic Partial Meniscectomy: Systematic Review With Meta-analysis

“…7,15 Many studies have confirmed the importance of the meniscus to the knee joint, and its loss is associated with instability and degeneration of the joint. 38 There are 2 main groups of patients with meniscus injuries who undergo arthroscopy: those with acute injuries and those with degenerative injuries. Acute lesions generally occur when an axial load is transmitted directly to the flexed knee associated with rotation.…”

Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees

“…1,2 Radial tears in the avascular zone requires partial meniscectomy. 3 Total meniscectomy increases the risk of premature osteoarthritis, so partial meniscectomy has proven the better choice after meniscal lesions. 4,5 However, partial meniscectomy can also lead to degenerative radiological signs.…”

Chondrocyte-based intraoperative processing strategies for the biological augmentation of a polyurethane meniscus replacement

“…The meniscus plays a pivotal role in load transfer and knee stabilisation during normal joint motion. Damage to the meniscus exposes articular surfaces to excessive peak stresses and predisposes them to cartilage degeneration and progressive osteoarthritis (2,3). In pursuit of a feasible clinical substitute for damaged meniscus, clinical evidence supports the use of fresh frozen allografts (4)(5)(6) or as an alternative, synthetic meniscus replacements such as the Collagen Meniscus Implant (Ivy Sports Medicine) (7)(8)(9) or Actifit® (a polyurethane meniscus implant; Orteq) (10).…”