Meniscal Repair Outcomes at Greater Than Five Years

Nepple, Jeffrey J.; Dunn, Warren R.; Wright, Rick W.

doi:10.2106/jbjs.k.01584

Cited by 311 publications

(170 citation statements)

References 33 publications

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“…Nepple et al, in a recent systematic review, estimated failure rate to be 27% at minimum 5-year follow-up for combined ACLR and meniscus repair. 26 Our study demonstrated a combined failure rate of 14% or just over half the rate of Nepple et al’s similar ACLR and meniscus repair cohort (27%) and other similar cohorts (27–29%) 11, 19, 20 . This may be partially explained by improvement in operative techniques over time, as the index procedures in our cohort took place between 2002 and 2004, while the comparative studies took place between 1985–1998 19, 20, 33 .…”

Section: Discussionsupporting

confidence: 52%

“…In the Nepple et al systematic review inclusive of 566 cases with a minimum 5-year follow-up 26 , the failure rate of all combined meniscus repairs was estimated to be 23%. This is significantly higher than our observed 14% rate of failure in a similar follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, the drilling of the tibial and femoral tunnels may produce a biologically advantaged environment to augment meniscal healing 39 . Third, meniscus injury patterns that accompany acute ACL disruptions may be more amendable to repair 5, 26 while meniscal injuries in ACL-intact knees are more commonly degenerative in nature 9, 24 . This finding is controversial, as a recent systematic review demonstrated increased failures in combined ACLR and meniscus repair groups compared to meniscus repairs in stable (ACL intact) knees.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review calculated the failure rate of meniscus repair in ACL-reconstructed knees to be 26.9% at 5 years. 26 Significant deterioration in meniscal repairs has been demonstrated in one series between published 2 and 6-year follow-up time points 12, 19 . There has also been reports of meniscal repair failures occurring at >4 years 8 .…”

Section: Introductionmentioning

confidence: 99%

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Meniscal Repair With Concurrent Anterior Cruciate Ligament Reconstruction

et al. 2014

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BACKGROUND Meniscus repairs are commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. No large-scale, prospective, multicenter studies have evaluated long-term success and patient-oriented outcomes after combined ACLR and meniscus repair. PURPOSE To define operative success and patient-oriented outcome scores 6 years after combined meniscus repair and ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All ipsilateral primary ACLR and meniscus repair cases from a multicenter study group between 2002 and 2004 were selected. Validated patient-oriented outcome instruments were completed at 3 time points: preoperatively, 2 years and 6 years following the index procedure. Subsequent ipsilateral knee re-operation was confirmed by operative reports to evaluate for failure of meniscal repairs. RESULTS In total, 286 patients of 1440 primary ACLR’s underwent concurrent meniscus repair (298 meniscal repairs). 235/286 (82.2%) were available for follow-up at 6 years (154 medial, 72 lateral and 9 both lateral and medial meniscal repairs). Repaired menisci most commonly involved the peripheral 1/3 of the meniscus (84%); patterns were typically longitudinal (84%) or displaced bucket-handle (10%), with mean length of 16.5 ±5.8mm. Overall, the meniscal repair failure rate was 14% (medial, 21/154; lateral, 10/72; both 2/9) at 6 years. Medial repairs failed earlier than lateral repairs (2.1 versus 3.7 years; p=0.01). Significant improvements in outcome instruments were sustained at 6-year follow-up. No differences in suture number or type were detected between repair failures and successes. Meniscal reoperation was higher in patients who underwent repair compared to those who did have an identified meniscal injury at the time of ACLR (p<0.01). CONCLUSIONS Concurrent meniscal repair with ACLR is associated with failure rates approximating 14% at 6-year follow-up. Improvements in patient-oriented outcome instruments were sustained at 6-year follow-up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscus repairs.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Meniscal Repair With Concurrent Anterior Cruciate Ligament Reconstruction

et al. 2014

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“…The short-term clinical success, defined as no re-operation for clinical symptoms, has been shown to be excellent with 96% success at 2-year follow-up for medial meniscus repairs. 40 However, a recent systematic review of 5-year outcomes shows 24% (range of 17-37%) had re-operation for failed medial meniscus repair, 25 indicating that these repairs are failing over time. If the repairs are failing clinically, then the meniscus cannot protect the articular cartilage nor improve clinical outcomes as measured by KOOS and IKDC.…”

Section: Discussionmentioning

confidence: 99%

Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes After Anterior Cruciate Ligament Reconstruction?

Cox¹,

Huston²,

Dunn³

et al. 2014

Am J Sports Med

226

247

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Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion on the MFC. Lateral meniscus repairs did not correlate with inferior results, but medial meniscus repairs predicted worse IKDC and KOOS scores. Lateral meniscus tears left alone significantly improved prognosis. Small partial meniscectomies (<33%) on the medial meniscus fared worse, but conversely, larger excisions (>50%) on either the medial or lateral menisci improved prognosis. Analogous to previous studies, other significant predictors of lower outcome scores were lower baseline scores, higher BMI, lower education level, smoking, and ACL revisions. Conclusions Both articular cartilage injury and meniscal tears/treatment at the time of ACLR were significant predictors of IKDC and KOOS scores 6 years following ACLR. Similarly, having a grade 4 MFC lesion significantly reduced a patient’s Marx activity level score at 6 years.

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