Meniscal Injuries in Patients Aged 40 Years or Older: A Comparative Study Between Meniscal Repair and Partial Meniscectomy

Abstract

IntroductionMeniscal tears represent one of the most frequent knee injuries and are the most common cause of knee surgery. Historically, age has been considered an independent factor contraindicating meniscal repair due to the assumption that meniscal injuries in this population are frequently chronic tears, mostly with a degenerative tear pattern, and low healing potential. However, recent literature has questioned this paradigm with studies reporting successful outcomes with meniscal repair in older patients. Our study aimed to evaluate and compare the short-term clinical outcomes of meniscal repair versus partial meniscectomy in patients aged ≥40 years old. MethodsA retrospective study was conducted that included patients over the age of 40 years, diagnosed with meniscal tears, that underwent arthroscopically assisted meniscal repair or partial meniscectomy between 01 January and 31 December 2020. The patients were divided into two groups: Group 1-partial meniscectomy (PM) and Group 2-meniscal repair (MR). The clinical evaluation was performed 24 months after the surgery, and the studied variables were: function (Tegner Lysholm Knee Scoring Scale), pain (Visual Analogue Scale), patient satisfaction, and failure rate. ResultsFifty-one patients met the inclusion criteria, and 7 were excluded due to loss of follow-up during telephone contact. Thus, the final sample consisted of 44 patients (mean age 52.18y), both groups with 22 patients. In both groups, we found an improvement in pain 2 years after the surgery, with a decrease in the VAS value between the pre and post-surgery. On average, the VAS score decreased from 7.9 to 4.5 in the group subjected to partial meniscectomy, and from 7.5 to 3.2 in the meniscal repair. This was statistically significant in both groups, with a p-value <0.01, but not between them (p-value = 0.363). Comparing the degree of satisfaction between both groups, we found no statistically significant difference between them (p=0.167). Regarding the functional outcome (Tegner Lysholm Knee Scoring Scale), the group that underwent the meniscal repair obtained a statistically superior score compared to the partial meniscectomy group (77.55 vs. 64.77; p-value 0.033). The failure rate was exactly equal in both groups (4.5%), therefore no statistically significant difference was found in this variable. ConclusionAge, as an independent factor, should not be considered a contraindication for meniscus repair. In fact, if technically possible, meniscal repair should always be performed as it is associated with better functional outcomes, similar failure rates, and may be protective against the development and progression of arthritis.

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

“…Six studies reported data on the rate of progression to total knee arthroplasty [12, 17, 24, 46, 84, 92] at a mean of 48.0 ± 14.7 months follow‐up. The repair group evidenced a lower rate of progression to TKA (OR0.51; 95% CI 0.39–0.69; P = 0.0001).…”

“…Six of the studies that focus on medial injuries specify the location, including only injuries at the posterior root of the medial meniscus [12, 17, 24, 45, 46, 88]. Another eight studies included tears of both medial and lateral meniscus [36, 49, 50, 75, 76, 83, 85, 92]. Two studies did not specify the site of the injury [71, 84].…”

“…Stein et al [87], Shelbourne et al [81], and Hoshino et al [36] reported tears in the red–red and red–white zones, whereas ruptures in the white–white zones underwent partial meniscectomy. The remaining studies do not describe in detail the tear location in relation to the vascular zones [12, 17, 23, 25, 45, 46, 82–85, 88, 92]. Although removal or partial resection of the meniscus is preferred for tears located in the less vascularised zones, there are increasing reports of successful repairs in the critical zones as well [18, 77].…”

“…In four studies [49, 50, 83, 88], the outside‐in or all‐inside technique was used, depending on the location of the tear. Three studies considered all common repair techniques [23, 75, 92]. All studies dealing exclusively with the repair of root tears used the transtibial pull‐out method, a modified inside‐out technique [12, 17, 24, 45, 46].…”

“…Only three studies [23, 83, 84] did not define the type of meniscectomy in detail. The other authors [12, 17, 24, 36, 45, 46, 49, 50, 71, 75, 76, 81, 82, 85, 87, 88, 92] conducted a partial meniscectomy [1, 7, 94]. An arthroscopic procedure for partial meniscectomy is used in five studies [50, 71, 75, 76, 87].…”