Meniscal Tear at Knee: Repair or Resect? An Early Experience from a University Hospital in Nepal

Abstract

Background The meniscus plays an important role in maintaining healthy articular cartilage. Meniscus tear, one of the common intra-articular knee lesions, is treated by either debridement or repair.
 Objective This study aims at identifying the early outcome of meniscus tears treated by debridement or repair. This study also elaborates on the spectrum of meniscal injuries presented in a tertiary care hospital in Nepal.
 Method A retrospective descriptive cross-sectional study was conducted at Orthopedic Department of Dhulikhel Hospital from February 2018 until January 2020 among patients who underwent knee arthroscopies for meniscal tears treated either by debridement or repair. Patients having intra articular fractures, osteochondral injuries and multi-ligament injuries were excluded. The meniscal tears were classified according to location and type of tear. Those patients who had at least one-year of follow up were evaluated with Lysholm score for functional outcome. Data were compiled and analyzed with Microsoft Excel 2011.
 Result One hundred and ten cases of meniscal tears were managed over the study period. Ninety-three cases could be traced for outcome evaluation, which included 50 cases of meniscal debridement and 43 cases of meniscal repair. The mean Lysholm score of the patients who received debridement was 81.5 (SD 10.4) and those who received meniscal repair was 84.9 (SD 9.1) (p=0.105). The population distribution was found to be similar in both the groups according to age and sex distribution and associated ligamentous injuries.
 Conclusion Good functional outcome was seen for meniscal tears managed with debridement or repair in at least one year follow up and could not establish one modality of management better than the other.

Trauma Training Courses and Programs in Low‐ and Lower Middle‐Income Countries: A Scoping Review

“…Seven studies were multiple publications reporting on the same training course or study cohort and therefore are reported with their parent study to avoid duplication, resulting in 45 unique studies (Fig. 1) [12–63]. Descriptions of included studies can be found in Table 1.…”

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

“…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].…”

“…Most of the current studies are retrospective [17, 24, 45, 49, 50, 81–83, 88, 92]. Level I studies are completely missing, only four have an evidence level of II [36, 71, 75, 81], and 80% (16 of 20) of the included studies achieve level III evidence [12, 17, 23, 24, 45, 46, 49, 50, 76, 82–85, 87, 88, 92]. Further long‐term high‐quality studies considering the limitations mentioned above are needed to confirm the advantage of meniscal repair over resection.…”

“…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 ].…”

The OA Trial Bank: Update of individual patient data meta-analysis of intra-articular glucocorticoids in persons with knee and hip osteoarthritis

“…Further three months were required for data extraction, checking and harmonisation before analyses commencement. In this timeframe, only one additional IA glucocorticoid/placebo randomised trial was published [ 50 ]. This highlights the acquisition of data in an IPD analysis being a time-consuming and resource-intensive process.…”