Time Interval between Trauma and Arthroscopic Meniscal Repair Has No Influence on Clinical Survival

Abstract

Arthroscopic meniscal repair is the gold standard for longitudinal peripheral meniscal tears. The time interval between trauma and meniscal repair remains controversial. The aim of this study was to evaluate failure rates and clinical outcome of arthroscopic meniscal repair in relation to chronicity of injury. A total of 238 meniscal repairs were performed in 234 patients. Anterior cruciate ligament (ACL) was reconstructed in almost all ACL-deficient knees (130 out of 133). Time interval between injury and repair was divided into acute (< 2 weeks), subacute (> 2 to < 12 weeks), and chronic (> 12 weeks). Patients completed postal questionnaires to evaluate clinical outcome and failure rates. Study instruments included Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner scoring systems. At a median follow-up of 41 months (interquartile range [IQR], 34-53 months) 55 medial and 10 lateral meniscal repairs failed (overall failure rate, 27%). There was a significant higher failure rate for medial meniscal repair (p < 0.05) and ACL-deficient knees without ACL reconstruction. Functional outcome scores showed only significant differences on the KOOS subscale "function in daily living" (95% confidence interval, 1.05-15.27, p < 0.05). No significant difference was found for any interval between trauma and repair. The interval between trauma and arthroscopic meniscal repair has no influence on the failure rate. Differences in survival rate of meniscal repair are more dependent on location of the lesion and ACL status, rather than chronicity of injury.

Does Anterior Cruciate Ligament Reconstruction Protect the Meniscus and Its Repair? A Systematic Review

“…Failure of meniscal repair was compared between patients who underwent simultaneous or delayed (>6 weeks) ACLR in a cohort study by Majeed et al 36 Meniscal repair failed in 14.5% of patients who underwent concomitant ACLR (or within 6 weeks) and in 27% of patients who underwent delayed reconstruction ( P < .05). Similar results were reported by Gallacher et al 21 and several other investigators, 5 , 26 , 42 , 52 although in these studies, the results were not statistically significant or no statistical analysis was reported. Only 1 study reported no detrimental effect of ACL deficiency on survival of meniscal repair, although no specific data were provided.…”

Magnetic resonance imaging can increase the diagnostic accuracy in symptomatic meniscal repair patients

“…The time between injury and primary repair varied among the patients, but a study by Espejo‐Reina et al [10] demonstrated that there is a good clinical healing rate of 83% for meniscal repairs 2–60 months after injury. van der Wal et al [30] found no significant difference in clinical outcomes in meniscal repairs < 2 weeks or > 12 weeks after injury. Other studies [14, 31] have shown better clinical outcomes in early repairs within 3–6 months after injury.…”

Meniscus Repair Techniques

“…Failure rates in older patients have been shown to be similar to those quoted for younger patients and good clinical outcomes can be obtained,30,31 but care should be taken to determine whether tears in older populations are degenerative or traumatic in nature as this may speak to the quality of meniscal tissue present and its suitability for repair 12. Finally, while some studies have demonstrated improved outcomes with earlier repair,32,33 chronicity is not necessarily prohibitive in an otherwise indicated meniscal repair 34. Rather, as with the other factors listed above, tissue quality present at the time of repair is the most important.…”

“…12 Finally, while some studies have demonstrated improved outcomes with earlier repair, 32,33 chronicity is not necessarily prohibitive in an otherwise indicated meniscal repair. 34 Rather, as with the other factors listed above, tissue quality present at the time of repair is the most important.…”