Repair v Meniscectomy
Stein et al Am J Sports Med 2010
- follow up of repair v partial meniscectomy for 8 years
- repair group: 96% return to preinjury activity, 20% develop OA
- partial meniscetomy: 50% return to preinjury activity, 50% develop OA
Shelbourne et al Am J Sports Med 2003
- repair v partial meniscectomy in ACLR
- equal results in each group
- 90% good outcome in each group
Outcome Repair Combined ACL / Meniscal Repair
Symptomatic / Clinical Failure and Meniscectomy
Kalliakmanis et al Arthroscopy 2008
- 280 meniscal repairs with ACLR with 2 year follow up
- 92% success FasT-Fix based on symptomatic failure / excision
- 86% RapidLoc
Toman et al Am J Sports Med 2009
- 77 mensical repairs combined with ACLR
- 96% success rate
- 3/77 (4%) failure at 2 years as defined by symptomatic failure / excision
Second Look Arthroscopy
Tachibana et al Am J Sports Med 2010
- second look arthroscopy after ACLR and meniscal repair in 46 patients
- 83% patients symptom free
- 74% healed, 15% incompletely healed and 11% failed
- 3/9 incomplete healing had vague knee pain
- 1/7 failed meniscus had symptoms
Ahn et al Am J Sports Med 2010
- ACLR + medial meniscus tear in 140 patients
- second look arthroscopy at average 3 years
- 84% complete healing
- 12.1% incomplete healing with no symptoms
- 3.6% (5/77) failed to heal and were failures
Feng et al Arthroscopy 2008
- ACLR + BH meniscal repair in 64 patients
- relook arthroscopy
- 90% success rate
- 82% completely healed
- 7.5% incompletely healed with joint line tenderness but otherwise asymptomatic
- 10% failed with locking symptoms (7/64)
- 4/7 failures occured in failed ACLR
Outcome Mensical Repair ACL Deficient Knee
Steenbrugge et al Int Orthop 2005
- 23 meniscal repair in ACL intact knee v 22 meniscal repair in ACL deficient knee
- 1 failure in the ACL intact group
- 4 failures in the ACL deficient group (18%)
Hanks et al Am J Sports Med 1990
- meniscal repair in 22 patients who were ACL deficient
- 3 failures (13%)
Outcome Repair Isolated Meniscal Repair in Stable Knee
Majewski et al Am J Sports Med 2006
- 88 isolated meniscal repairs in stable knees
- 21 clinical failures requiring partial meniscectomy (24%)
Eggli et al Am J Sports Med 1995
- 52 isolated meniscal repairs in ACL stable knee
- follow up 7 years
- 14/52 failed (27%)
- significantly more failures in group with resorbable sutures
Bak et al Acta Orthop Scand 1993
- 27 isolated bucket handle tears in ACL stable knees
- failure 10 / 27 (37%)
Tear Type
Krych et al Am J Sports Med 2010
- medial meniscal repair with ACL reconstruction 18 years or younger
- successful 84% with simple tears
- 57 - 59% success for displaced bucket handle or complex tears
Krych et al Am J Sports Med 2008
- isolated meniscal repair in patients 18 years or younger
- successful 80% with simple tears
- successful 68% in displaced bucket handle tears
- 13% complex tear
Noyes et al Am J Sports Med 2002
- 71 patients < 20 with complex avascular zone tears in patients
- meticulous inside out vertical repair
- 75% success rate
All Inside Implant
Seibold et al Arthroscopy 2007
- 113 patients with the meniscal arrow
- combined isolated and meniscal repairs with ACLR
- 28% retear requiring repeat arthroscopy and partial meniscectomy
Gifstad et al Am J Sports Med 2006
- 41% failure rate with Biofix Arrow
Barber et al Arthroscopy 2006
- success 87.5% with RapidLoc device
Barber et al Arthroscopy 2006
- 95% success with Biostinger
Kotsovolos et al Am J Sports Med 2006
- 9.8% failure rate with FasT-Fix
All Inside v Inside Out
Bryant et al Am J Sports Med 2007
- RCT of arrows v inside out suturing
- isolated repair and meniscal repairs with ACLR
- 11% failure rate in each group
- 2 arrows required surgical removal because of subcutaneous position
Spindler et al Am J Sports Med 2003
- prospective comparison of arrows v inside out suturing
- all in ACLR
- 88 and 89% success rates in each group
- comparison of inside out versus all inside
- 192 elite athletes
- overall failure rate 21%
- increased failure rate with medial meniscus tears treated with all inside
Failed Repair
Miao et al Am J Sports Med 2011
- follow up of 89 repaired meniscal tears
- used arthroscopy as gold standard to see if healed or failed repair
- overall healing rate 86%
- clinical examination limited
- MRI 90% sensitive, but up to 98% specific
Re- repair
Voloshin et al Am J Sports Med 2003
- re-repair in 14 patients
- 72% survival rate