Arthroscopic repair of degenerative medial meniscus tears in patients aged over 45 years resulted in favorable clinical outcomes and low clinical failure rates at a minimum 2-year follow-up

Zhu, Siyuan; Li, Xinning; Lu, Zhenfei; Koh, Jason L.; Wang, Chenglong; Wang, Peng; Shao, Xiexiang; Wang, Jianhua

doi:10.1007/s00167-022-07133-w

Cited by 10 publications

(18 citation statements)

References 41 publications

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“…Thirteen studies were included in this review, encompassing a total of 316 meniscal repairs in patients over the age of 40 years [10][11][12][13][14][15][16][17][18][19][20][21][22]. There were no randomized controlled studies included or studies where data were collected prospectively.…”

Section: Resultsmentioning

confidence: 99%

“…Where the operative techniques were reported, 63 meniscal repairs used an all-inside technique, 130 used inside-out, and 4 used an outsidein technique. In all-inside meniscus repairs, six studies reported the use of a Fast-Fix© system (Smith & Nephew, Andover, MA, USA) [10][11][12]14,22,23], one study reported the used of Biofix Arrow Fixation© [17], one study reported the use of a VIPER© repair system (Arthrex, Naples, FL, USA) [17], and one study reported the use of a Zone Specific II Meniscal Repair System (Linvatec, Largo, FL, USA) [12]. In studies where meniscus repair was performed using the inside-out technique, a Juggerstitch© Meniscal Repair Device and fast-fix system (Smith & Nephew, Andover, MA, USA) were utilized [10,20].…”

Section: Repair Techniquementioning

confidence: 99%

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Outcomes of Meniscal Repair in Patients Aged 40 and Above: A Systematic Review

Jaibaji,

Khaleel,

Jaibaji

et al. 2023

JCM

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Purpose: Meniscal injuries are increasingly common in older age groups. Age is often cited as a contraindication to undergoing meniscal repair due to concerns regarding failure rates. There has recently, however, been an increasing shift towards repair in older populations. The purpose of this study was to review outcomes of meniscal repair in patients over the age of 40. Methods: A systematic search of the following databases was conducted of PubMed, SCOPUS, Web of Science, and Cochrane Library to identify studies reporting failure rates of patients over 40 with meniscal injuries undergoing repair. The definition of meniscus failure was noted for each study evaluated in this systematic review. Further data surrounding clinical and radiological outcomes were recorded and evaluated, when available. Results: Thirteen studies were included in this review, encompassing a total of 316 meniscal repairs in patients over the age of 40 years. The overall failure rate was found to be 15.5% (49/316) (range 0–33.3%). There was no difference in the failure rate in those over 40 vs. under 40, and the two groups had equivalent functional outcomes. Conclusions: Age should not be considered a contra-indication for meniscal repair. Appropriately selected older patients can have acceptably low failure rates with meniscal repair and similar functional outcomes to those under the age of forty. Meniscal repairs in those over 40 achieved better functional outcomes than patients of the same age group who underwent meniscectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Repair Techniquementioning

confidence: 99%

Outcomes of Meniscal Repair in Patients Aged 40 and Above: A Systematic Review

Jaibaji,

Khaleel,

Jaibaji

et al. 2023

JCM

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show abstract

“…33,37,47,49 This could be explained by the fact that no distinction was made between grade and signal. 33,37,47,49 However, a nuance was brought up in their discussion: the persistence of a grade 3 signal was often associated with the absence of clinical criteria for nonhealing and should be part of the healing process. 33,37,47,49…”

Section: Discussionmentioning

confidence: 99%

MRI Criteria for Healing at 1 Year After Repair of a Traumatic Meniscal Tear

Schwach,

Grange,

Klasan

et al. 2023

Am J Sports Med

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Background: Meniscal repair for a traumatic meniscal tear is increasingly used to preserve the meniscus. Interpreting postoperative magnetic resonance imaging (MRI) scans remains challenging, especially in symptomatic patients. There is a lack of reliable MRI criteria to affirm the healed character of a traumatic meniscal injury repair. Purpose: To identify relevant MRI criteria for meniscal healing after meniscal repair. Study Design: Case series; Level of evidence, 4. Methods: We prospectively included all patients with a traumatic meniscal injury who underwent either an isolated meniscal repair or a repair during a concomitant anterior cruciate ligament reconstruction. A standardized preoperative and postoperative clinical evaluation was performed, along with collection of functional scores—Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee, Lysholm Score, and 36-Item Short Form Health Survey. An MRI scan was performed 1 year postoperatively and compared with the preoperative MRI scan. The following MRI aspects were analyzed: variation of morphology and fat-saturated (FS) T2 intensity signal and pre- and postoperative tear diastasis measurement. Results: Fifty patients (age, mean ± SD, 28.7 ± 8.5 years [range, 16-45 years]) who were 1 year postoperative were included. All patients were considered clinically healed had the same MRI characteristics. A signal change (FS T2) was observed from a high signal intensity fluid to a nonfluid moderate signal intensity. The morphology of the lesion was more complex: from the initial lesion, line ramifications appeared, creating the appearance of tree branches. The tear diastasis decreased (from 2.3 ± 0.5 mm [range, 1.3-3.5] to 1.1 ± 0.28 mm [range, 0.5-1.5]). Conclusion: MRI criteria confirming meniscal healing after traumatic meniscal repair at 1 year were identified: a change in the intrameniscal signal becoming nonfluid and moderate in intensity; a reduction in tear diastasis to <1.5 mm; and a change in the signal morphology of the repaired meniscus.

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“…When the stable leaf receiving additional damage develops an unstable flap, APM will be required [ 9 , 18 ]. Recently, arthroscopic repair was also considered as a reliable option in treating MMHT because the benefit of meniscal repair had been documented [ 23 , 32 ]. However, it is not always possible to confirm the unstable flap on MRI scans [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…If surgeons preoperatively distinguish between those who would benefit from APM and those who would not, unnecessary surgery could be avoided and the outcomes of APM will be improved. Moreover, there is a growing interest in the arthroscopic repair of MMHT [ 23 , 24 ]. Predicting unstable flaps is closely related to surgical indications.…”

Section: Introductionmentioning

confidence: 99%

Hidden Unstable Flap Should Be Suspected in Treating Intractable Pain from Medial Meniscus Horizontal Tear

Kim

Joo²,

An³

et al. 2022

JCM

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(1) Background: The medial meniscus horizontal tear (MMHT) is known as a lesion that can be treated nonoperatively. However, some patients show persistent pain despite conservative treatments. In arthroscopic surgery for MMHT, surgeons often encounter unexpected unstable flaps, which can explain the intractable pain. This study aimed to determine whether preoperative factors could predict the hidden unstable flaps in MMHT. (2) Materials and Methods: Medical records of 65 patients who underwent arthroscopic partial meniscectomy (APM) for isolated MMHT during 2016–2020 were retrospectively reviewed. APM was indicated when there was no severe chondral degeneration and intractable localized knee pain in the medial compartment did not resolve despite conservative treatments. Unstable flap was confirmed based on arthroscopic images and operation notes. Each of the following preoperative factors were investigated using logistic regression analyses to determine whether they can predict an unstable flap: age, sex, body mass index, lower limb alignment, trauma history, mechanical symptoms, symptom duration, visual analogue scale (VAS), Lysholm score, cartilage wear of the medial compartment, and subchondral bone marrow lesion (BML). (3) Results: Hidden unstable flaps were noted in 45 (69.2%) patients. Based on univariate analyses for each preoperative factor, age, symptom duration, cartilage wear (of the femoral condyle and the tibial plateau), and subchondral BML were included in the multivariate logistic regression analysis. The results showed that symptom duration (p = 0.026, odds ratio = 0.99) and high-grade cartilage wear of the medial femoral condyle (p = 0.017, odds ratio = 0.06) were negatively associated with unstable flaps. A receiver operating characteristic curve was used to calculate the symptom duration at which the prediction of unstable flaps was maximized, and the cutoff point was 14.0 months. (4) Conclusions: More than two thirds of patients suffering intractable pain from MMHT had hidden unstable flaps. However, APM should not be considered when the symptom duration is more than 14 months or high-grade cartilage wear of the medial femoral condyle is noted.

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Arthroscopic repair of degenerative medial meniscus tears in patients aged over 45 years resulted in favorable clinical outcomes and low clinical failure rates at a minimum 2-year follow-up

Cited by 10 publications

References 41 publications

Outcomes of Meniscal Repair in Patients Aged 40 and Above: A Systematic Review

Outcomes of Meniscal Repair in Patients Aged 40 and Above: A Systematic Review

MRI Criteria for Healing at 1 Year After Repair of a Traumatic Meniscal Tear

Hidden Unstable Flap Should Be Suspected in Treating Intractable Pain from Medial Meniscus Horizontal Tear

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