Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Servicemembers from 2010 to 2015

Pekari, Timothy B.; Wang, Kevin C.; Cotter, Eric J.; Kusnezov, Nicholas; Waterman, Brian R.

doi:10.1055/s-0038-1636838

Cited by 4 publications

(9 citation statements)

References 33 publications

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“…32,33 Meniscal surgery, either through transplant or repair, has significantly increased over the past decade, even with cartilage restoration procedures. [34][35][36][37] Addressing the meniscus allows repaired cartilage to have the greatest likelihood of successful implantation and preservation of joint integrity. 38 Lee et al 39 performed meniscal allograft transplant (MAT) alone on 222 patients and found this treatment to be effective in managing patients with advanced cartilage disease.…”

Section: Discussionmentioning

confidence: 99%

“…32 , 33 Meniscal surgery, either through transplant or repair, has significantly increased over the past decade, even with cartilage restoration procedures. 34 , 35 , 36 , 37 Addressing the meniscus allows repaired cartilage to have the greatest likelihood of successful implantation and preservation of joint integrity. 38 Lee et al.…”

Section: Discussionmentioning

confidence: 99%

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Cartilage Restoration for Tibiofemoral Bipolar Lesions Results in Promising Failure Rates: A Systematic Review

Gowd

Weimer

Rider

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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The purpose of the present study is to systematically review the available literature for management of bipolar lesions within the tibiofemoral joint and determine whether tibiofemoral cartilage restoration is an effective treatment modality. Methods: PubMed and MEDLINE databases were queried between 2000 and 2020 using the following keywords: "osteochondral" and "knee" and "microfracture," "autologous chondrocyte implantation (ACI)," or "transplantation." Articles were reviewed for the presence of a bipolar or "kissing" tibiofemoral lesion and reported lesion size, concomitant procedures, failure rates, and time to failure. Results: After screening 1,295 articles, there were 4 articles available for analysis and a total of 152 knees involving the management of bipolar tibiofemoral lesions. Age ranged from 14 to 60 years, and mean follow-up was between 12 and 240 months. There was 1 retrospective cohort study (36 knees) and 3 case series (mean, 38.7 AE 17.5 knees). There were 58 knees treated with bipolar osteochondral allograft (OCA) transplantation, 58 knees treated with bipolar ACI, 20 knees treated with femoral OCA and tibial debridement, and 16 knees treated with femoral OCA and tibial microfracture. There were 37 failures (24.3%): 16 patients (10.5%) were converted to unicompartmental or total knee arthroplasty, 4 restorative procedures (2.6%) were revised, and 8 patients (1.6%) had unsatisfactory outcomes only. The remaining 15 failures (9.9%) had an unspecified combination of objective failure. The mean rate of failure ranged between 0% and 44.1% (I 2 ¼ 83.2%). The mean time to failure ranged between 2.7 and 4.1 years (I 2 ¼ 79.1%). Conclusions: Cartilage restoration, through both ACI and OCA, had failure rates between 0% and 44% in patients with bipolar lesions of the tibiofemoral compartment. Although a higher level of evidence is required to prove efficacy, the current study demonstrates midterm survivorship rates between 55% and 100%, which may delay the need for secondary arthroplasty. Level of Evidence: Level IV, systematic review of Level IV studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cartilage Restoration for Tibiofemoral Bipolar Lesions Results in Promising Failure Rates: A Systematic Review

Gowd

Weimer

Rider

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Several recent publications have sought to characterize surgical trends in the management of meniscal tears, rates of reoperation following meniscal repair, and meniscal tears in the setting of failed ACL reconstruction 12,23,24 (►Table 1). There are almost 5,000 meniscal procedures per year in the military.…”

Section: Epidemiology Of Meniscus Tears In the Militarymentioning

confidence: 99%

“…Two-thirds of meniscal repairs occur on the medial meniscus. 23 The overall rate of meniscal repair is 47.6 per 100,000 person-years. 12 In the setting of meniscal repair, the most common concomitant procedure performed is ACL reconstruction-similar to published civilian data.…”

Section: Epidemiology Of Meniscus Tears In the Militarymentioning

confidence: 99%

“…This similar emphasis is evident in the high rate of meniscal repair performed throughout the military. 23 Excessive debridement of the meniscus can damage the circumferential orientation of continuous fibers which contribute to hoop stress dissipation and lead to increase tibiofemoral contact stress. 26,27 Because of the convex shape of the lateral tibial plateau, the lateral meniscus plays a greater role in maintaining congruity of the joint; partial lateral meniscectomy has a greater effect to increase tibiofemoral contact pressure compared with partial medial meniscectomy.…”

Section: Treatment Optionsmentioning

confidence: 99%

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Meniscus Injuries in the Military Athlete

2019

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Meniscal injuries in the young, active patient are often challenging injuries for the orthopaedic surgeon whose goal is to provide pain-free return to play/military duty and preserve maximal meniscal integrity. In the U.S. military, the incidence rate of meniscal tears is almost 10 times higher than that of the civilian population; although, the rates of reoperation following meniscal repair are fairly similar. The decision to pursue meniscal debridement versus repair is multifactorial depending on tear characteristics, concomitant injury, patient characteristics, and goals. Meniscal allograft transplantation remains reserved as a salvage procedure but with limited goals for potential to return to complete unrestricted military duties. The purpose of this article is to review treatment principles for the military athlete with meniscal pathology.

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Epidemiology of Meniscus Injuries in the Military Health System and Predictive Factors for Arthroscopic Surgery

et al. 2022

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Meniscus injuries occur at a higher rate in the military than the general population. Appropriate management and rehabilitation of meniscus injuries is important for maintaining readiness. The purpose of this study was to describe the health burden of meniscus injuries in the Military Health System (MHS) to identify the surgical intervention rate for meniscus injuries, and to determine which injury characteristics and demographic variables were associated with the likelihood of surgery after injury. The U.S. Department of Defense Management Analysis and Reporting Tool, a database of health care encounters by military personnel and dependents, was queried for encounters associated with a meniscal injury diagnosis between January 1, 2010, and December 31, 2011. Meniscus injuries were categorized into (1) isolated medial, (2) isolated lateral, (3) combined medial and lateral, and (4) unspecified cohorts. Patients under 18 and over 51 years were excluded, as well as patients without records at least 1 year prior to diagnosis or 2 years after. Relevant surgical procedures were identified with the Current Procedural Terminology (CPT) codes for arthroscopic surgery of the knee, meniscus repair, meniscectomy, and anterior cruciate ligament (ACL) reconstruction. There were 2,969 meniscus injuries meeting inclusion criteria during the study period. There were 1,547 (52.1%) isolated medial meniscus injuries, 530 (17.9%) isolated lateral meniscus injuries, 452 (15.3%) involved both menisci, and 435 (14.7%) were unspecified. The mean age was 35.5 years (standard deviation [SD] = 9.3). An adjacent ligamentous injury occurred in 901 patients (30.3%). The treatment course led to arthroscopic surgery in 52.8% (n = 1,568) of all meniscus injuries. Eighty-five percent (n = 385) of combined medial and lateral tears, 54.9% of medial tears, and 51.6% of lateral tears underwent surgery. Partial meniscectomy was the most common procedure performed while 47.2% (n = 1,401) of tears were not treated surgically. Bilateral meniscus injuries had 4.57 greater odds of undergoing knee arthroscopy (95% confidence interval [CI]: 3.46, 6.04), 2.42 times odds of undergoing a meniscus repair, and 4.59 times odds for undergoing a meniscus debridement (95% CI: 3.62, 5.82). The closed nature of the MHS allows reliable capture of surgical rates for meniscus injuries within the military population. Meniscus injuries are common in the military and impose a significant burden on the MHS. Appropriate management and rehabilitation of this injury is important for maintaining readiness.

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Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Servicemembers from 2010 to 2015

Abstract: IV, cross-sectional study.

Cited by 4 publications

References 33 publications

Cartilage Restoration for Tibiofemoral Bipolar Lesions Results in Promising Failure Rates: A Systematic Review

Cartilage Restoration for Tibiofemoral Bipolar Lesions Results in Promising Failure Rates: A Systematic Review

Meniscus Injuries in the Military Athlete

Epidemiology of Meniscus Injuries in the Military Health System and Predictive Factors for Arthroscopic Surgery

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