Meniscal Repair Outcome in 3829 Patients With a Minimum Follow-up From 2 Years Up to 5 Years: A Meta-analysis on the Overall Failure Rate and Factors Influencing Failure

Abstract

Background: The importance of meniscal repair is widely accepted because of the association of loss of meniscal tissue with the development of early-onset knee arthritis. Many factors influencing the results of meniscal repair have been reported, but results remain controversial. Purpose: This meta-analysis determines the pooled meniscal repair failure rate of studies with a minimum follow-up of 2 years up to 5 years, with a mean follow-up of 43 months. Moreover, selected failure-influencing factors are analyzed. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed and Scopus were searched for studies published between January 2000 and November 2021 reporting on meniscal repair outcome with a minimum follow-up of 24 months. The overall pooled failure rate and pooled failure rates for possible predictors were calculated. Random-effect models were used to pool failure rates, and effect estimates in the form of odds ratios with 95% CIs were established. Results: The initial literature search identified 6519 studies. A total of 51 studies met the inclusion criteria. In total, 3931 menisci were included with an overall failure rate of 14.8%. Subgroup analysis revealed a significantly lower failure rate for meniscal repair with concomitant anterior cruciate ligament (ACL) reconstruction compared with knees without any reported injury to the ACL (8.5% vs 14%; P = .043). The pooled failure rate for lateral meniscal repair was significantly lower than that for medial meniscal repair (6.1% vs 10.8%; P = .031). Pooled failure rates of all-inside and inside-out repair were not significantly different (11.9% vs 10.6%; P > .05). Conclusion: This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. Meniscal repair remains a procedure with a high failure rate, especially within the first 2 postoperative years. This review and meta-analysis also identified clinically relevant factors associated with favorable outcomes such as concomitant ACL reconstruction or repair of the lateral meniscus. All-inside meniscal repair with the latest-generation devices yields failure rates of <10%. The failure mechanism and the time of failure is poorly documented; further studies are needed for a better understanding of the retear mechanism.

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

“…The overall failure rate was 15.5% (49/316) (range 0-33.3%) across the 13 studies [10]. Three studies [16,17,23] comparing failure rates between patients above and below the age of 40 years demonstrated a slight increase in failure rate in those over 40 compared to those under 40: 10% (5/50) vs. 6% 8(8/137) (OR 1.79, 95% CI 0.63-5.56, p = 0.34). The failure rate in knees that were known to be ACL-deficient was 13% (6/46 knees).…”

“…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].…”

Defining Failure

“…Years or decades may be needed before these failures produce enough symptoms to distinguish them from cases that healed anatomically. In the shorter term, expensive magnetic resonance imaging (MRI) or second-look arthroscopy, which may not be acceptable to every patient or institutional ethics committee, may be needed to identify these “silent failures.” 20…”

“…Because reoperation is easiest to identify unequivocally, secondary meniscectomy or subsequent arthroplasty is often used to define failure of meniscal surgery. 7,9,17,23 Symptoms of pain, swelling, catching, or locking may be recorded if patients are interviewed and examined, 1,20 which is often not the case. A meniscal repair that fails to heal or a transplant that extrudes from the joint has probably lost much of its intended function but may not cause symptoms sufficient to warrant an additional procedure.…”

“…In the shorter term, expensive magnetic resonance imaging (MRI) or second-look arthroscopy, which may not be acceptable to every patient or institutional ethics committee, may be needed to identify these ''silent failures.'' 20 The landmark STABILITY trial, which compared isolated hamstring anterior cruciate ligament autograft reconstruction (ACLR) with hamstring autograft reconstruction augmented with a lateral extra-articular tenodesis (ACLR 1 LET), illustrates the effect that different definitions can have on the reported prevalence of failure, this time in the field of anterior cruciate ligament surgery. 8 In this study, the patients were periodically reexamined for 2 years after surgery, and suspected graft rupture was documented by MRI or arthroscopy.…”