Clinical and radiographic outcomes of meniscus surgery and future targets for biologic intervention: A review of data from the MOON Group

Abstract

Meniscus injury and treatment occurred with the majority of anterior cruciate ligament reconstructions (ACLR) in the multicenter orthopaedic outcomes (MOON) cohort. We describe the patient reported outcomes, radiographic outcomes and predictors of pain from meniscus injuries and treatment in the setting of ACLR. Patient reported outcomes improve significantly following meniscus repair with ACLR, but differences exist based on the meniscus injury laterally (medial or lateral). Patients undergoing medial meniscus repair have worse patient-reported outcomes and more pain compared to those with uninjured menisci. However, lateral meniscal tears can be repaired with similar outcomes as uninjured menisci. Medial meniscal treatment (meniscectomy or repair) results in a significant loss of joint space at 2 years compared to uninjured menisci. Menisci treated with excision had a greater degree of joint space loss compared to those treated with repair. Clinically significant knee pain is more common following injuries to the medial meniscus and increased in patients who undergo early re-operation after initial ACLR. Future research efforts aimed at improving outcomes after combined ACLR and meniscus treatment should focus on optimizing biologic and mechanical environments that promote healing of medial meniscal tears sustained during ACL injury.

Meniscus beyond mechanics: Using biology to advance our understanding of meniscus injury and treatment

“…In this cohort, the authors found that a retear of the meniscus was associated with an initial complete tear of the meniscus, as well as with a positive postoperative pivot shift test. Furthermore, Westermann and colleagues highlight important differences in outcomes for medial and lateral meniscus injuries with ACL reconstruction (8). In particular, the authors report that medial meniscus injuries more commonly result in pain and medial meniscus repairs result in worse patient reported outcomes.…”

High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

“…Values represent mean ± standard deviation BMI body mass index, STSD side-to-side differences, BPTB bone patellar tendon bone, A-B anterior horn to body, B-P body to posterior horn, A-P anterior horn to posterior horn a Hamstring autograft + tibialis allograft [1]. The MOON group's findings that discuss the inferior outcomes after MM injuries have been supported by the recent literature [7,8].…”

“…Meniscal tears occurring concurrently with anterior cruciate ligament (ACL) injuries are common and can affect treatment outcomes [1,2]. As the meniscus has an important role for normal knee function, preservation of the meniscus as much as possible during ACL reconstruction (ACLR) has been generally accepted.…”

“…Recent literature have reported the superior biologic healing potential of the lateral meniscus (LM) compared to the medial meniscus (MM) [1,[7][8][9][10]. These studies compared the healing rate of repaired or left in situ meniscus between MM and LM.…”

“…The purpose was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with ACL injuries. Based on the previous study [1], the hypothesis was that healing of the lateral meniscal tears would be superior to the healing of medial meniscal tears and that the incidence of subsequent re-operation would be higher in patients with MM tears.…”