Save the meniscus – Clinical outcomes of meniscectomy versus meniscal repair

Abstract

This study was designed to compare the clinical outcomes of meniscectomy versus repair and to study the effects of (1) duration of follow-up and (2) concomitant anterior cruciate ligament (ACL) reconstruction on clinical outcomes. Methods: A retrospective study was conducted, involving 112 knees of 106 patients who underwent meniscus surgery, either partial meniscectomy or meniscal repair between 2008 and 2016. There were 42 meniscectomies and 70 meniscal repairs. Patients were graded pre-and post-operatively using the International Knee Documentation Committee (IKDC) score and Tegner Activity Level Scale through case notes review. Statistical analysis was done using the paired Student's t-test (two-tailed) or Wilcoxon signed-rank test for paired scores. The two-sample Student's t-test (two-tailed) or Mann-Whitney U test was used for independent scores. Multiple variable linear regression analysis was used to assess the importance of the variables on outcomes. A statistical significance is taken as p < 0.05. Results: Meniscectomy and repair had good outcomes. IKDC scores improved from 46.6 to 81.7 after meniscectomy and from 45.9 to 84.4 after repair (p < 0.001). Meniscectomy fared worse in late follow-up (>18 months), decreasing from 88.2 in early follow-up (18 months) to 72.1 (p < 0.05). The post-operative scores in meniscal repair were maintained in the late follow-up group (82.9 compared to 87.1, p > 0.05). Concomitant ACL reconstruction improved the outcomes of meniscectomy (IKDC and Tegner: p < 0.05) and repair (IKDC and Tegner: p < 0.05). Conclusion: Both meniscectomy and meniscal repair are viable surgical techniques for meniscal injury and have good outcomes. Meniscal repair has a better prognosis in the long run.

Risk of Subsequent Knee Arthroplasty After Sports Medicine Procedures

“… 10 , 11 The importance of meniscus repair is in keeping with past literature. 8 , 9 Johnson et al found that at almost 11 years after isolated meniscus repair, minimal joint changes were seen in only 8% of his patients on the surgical knee with 3% of patients having changes also on the contralateral side. He evaluated radiographs and found joint changes in 69% of his patients after a meniscectomy was done.…”

“…Restoring or preserving the normal anatomy of the knee leads to restoration of function but can also return knee biomechanics to the intact state. 5 6 7 8 9 This in turn can reduce loading and sheer forces on the hyaline cartilage. 10 , 11 Many surgeries were done that seek to restore the normal structure and function of the knee.…”

Circumferential-Surrounding (“Sandwich”) Meniscal Repair: A Salvage Technique to Save the Meniscus

“… 4 In fact, it has been shown that meniscal repair does better than partial meniscectomy with long follow-up periods. 5 Therefore, it is nowadays widely accepted that surgeons must make all efforts to preserve the meniscus tissue and try to repair over-resection, 6 so a solution for irreparable meniscal tears is warranted.…”

Meniscal Tears: Current Understanding, Diagnosis, and Management

“…Various studies have compared the outcomes of partial meniscectomy with meniscal repairs. While meniscectomy has better pain relief as opposed to repair in the early stages, it can be attributed to the fact that a meniscectomy removes the pathology immediately by excision of the tear, whereas repairs are based on the principle of regeneration and hence have better outcomes at long-term follow-up [36]. Higher activity levels and better functional outcomes are seen with meniscal repair as opposed to meniscectomy, as it postulated that preservation of the meniscus leads to higher stability of the knees and delays the onset of osteoarthritis.…”

“…Higher activity levels and better functional outcomes are seen with meniscal repair as opposed to meniscectomy, as it postulated that preservation of the meniscus leads to higher stability of the knees and delays the onset of osteoarthritis. Recent studies have shown that repairs exhibit improved healing in knees where ACL is also repaired along with the meniscus [36]. Although no consensus exists on why this happens, various theories have been put forward.…”