Revision Meniscal Surgery in Children and Adolescents

Shieh, Alvin K.; Edmonds, Eric W.; Pennock, Andrew T.

doi:10.1177/0363546515623511

Cited by 45 publications

(29 citation statements)

References 38 publications

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“…We found bucket-handle tears to increase the risk of reoperation in univariate analysis, but statistical significance was lost in multivariate regression. While both the present study and that of Shieh et al 26 report meniscal repair to confer a higher risk of reoperation than meniscectomy, this finding must be balanced against the potential risk of arthritis that may develop among patients undergoing meniscectomy. These patients should be informed that while their reoperation risk is lower, their risk of eventual osteoarthritis is likely higher.…”

Section: Discussioncontrasting

confidence: 50%

“…Most of these reports consist of small series. However, in a study of 324 meniscal operations among 293 children, Shieh et al 26 reported a failure rate of 13% at a mean of 14 months after the index procedure. The authors found that meniscal repair increased the odds of reoperation approximately 2-fold and that skeletally immature patients with bucket-handle tears had the highest overall retear rate.…”

Section: Discussionmentioning

confidence: 99%

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Which Factors Increase the Risk of Reoperation After Meniscal Surgery in Children?

Patel

Mundluru

Beck

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Meniscal injuries in children can pose treatment challenges, as the meniscus must maintain its biomechanical function over a long lifetime while withstanding a high activity level. While the adult literature contains a plethora of studies regarding risk factors for failure of meniscal surgery, such reports are scarcer in children. Purpose: To determine the rate at which children undergoing meniscal surgery require subsequent reoperation as well as to define risk factors for reoperation in this population. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective institutional database of 907 first-time meniscal surgical procedures performed between 2000 and 2015 was reviewed. All patients were <18 years old. Demographic and intraoperative information was recorded, as were concurrent injuries or operations and subsequent procedures. Univariate analysis consisted of chi-square and independent-samples t tests. Multivariate logistic regression with purposeful selection was then performed to adjust for confounding factors. Results: The mean ± SD patient age was 13.2 ± 2.1 years, and 567 (63%) were male. The mean postoperative follow-up duration was 20.1 ± 10.1 months. Overall, 83 patients (9%) required repeat surgery at a mean of 23.2 months after the index operation. After adjustment for confounders in a multivariate model, meniscal repair resulted in 3.1-times higher odds of reoperation when compared with meniscectomy (95% CI, 1.2-8.3; P = .02), while white-white zone tears had 2.8-times lower odds of reoperation (95% CI, 1.01-7.7; P = .04) versus red-red and red-white zone tears. Conclusion: Approximately 9% of children undergoing meniscal surgery will require reoperation at a mean 23.2 months after the index operation. Repair carried approximately 3-times higher odds of reoperation than meniscectomy, while white-white zone tears had nearly 3-times lower odds of requiring repeat surgery when compared with tears in other zones.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Which Factors Increase the Risk of Reoperation After Meniscal Surgery in Children?

Patel

Mundluru

Beck

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Similarly to primary meniscal repair, revision meniscal repair may provide better functional outcomes and less progression of osteoarthritis than meniscectomy [5–8]. However, meniscectomy seems to be the preferred treatment option since results of revision meniscal repair remain underreported [14–17]. To the best of our knowledge, only three studies have specifically analysed the results of revision meniscal repair so far [18–20].…”

Section: Discussionmentioning

confidence: 99%

“…With the increasing numbers of meniscal repairs performed during the last decade [13], the number of failed meniscus repairs will also increase. Until now, meniscectomy seems to be the preferred technique to address failed meniscus repairs [14–17]. However, revision meniscal repair may provide better long-term outcomes than meniscectomy, but the results of this procedure remain underreported [18–21].…”

Section: Introductionmentioning

confidence: 99%

Isolated revision meniscal repair – failure rates, clinical outcome, and patient satisfaction

Fuchs

Kloos

Bode

et al. 2018

BMC Musculoskelet Disord

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BackgroundFailure of isolated primary meniscal repair must be expected in approximately 10–25% of cases. Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported. The purpose of this study was therefore to evaluate the outcome and failure rates of isolated revision meniscal repair in patients with re-tears or failed healing after previous meniscal repair in stable knee joints.MethodsA chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activity (Tegner scale), and patient satisfaction.ResultsA total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 (± 23.4) months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, successful re-revision repair was performed. At final follow-up, the mean Lysholm Score was 95.2 (± 4.2) with a range of 90–100, representing a good to excellent result in all patients. The final assessment of the KOOS subscores also showed good to excellent results. The mean Tegner scale was 6.8 ± 1.8, indicating a relatively high level of sports participation. Ten patients (83%) were either satisfied or very satisfied with the outcome.ConclusionIn patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. The failure rate is slightly higher compared to isolated primary meniscal repair, but still acceptable. Therefore, revision meniscal repair is worthwhile in selected cases in order to save as much meniscal tissue as possible.

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“…Meniscal repair should be performed whenever possible in the paediatric patient because of the deleterious effects of meniscectomy and the positive outcomes of meniscal repair (i.e., the improved healing potential of the meniscus) [ 4 , 74 , 113 ]. This is especially important for bucket-handle, root and radial meniscal tears, and ramp lesions.…”

Section: Section 4: Treatment Decision Modifiersmentioning

confidence: 99%

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

Ardern

Ekås

Grindem

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.Electronic supplementary materialThe online version of this article (10.1007/s00167-018-4865-y) contains supplementary material, which is available to authorised users.

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Revision Meniscal Surgery in Children and Adolescents

Cited by 45 publications

References 38 publications

Which Factors Increase the Risk of Reoperation After Meniscal Surgery in Children?

Which Factors Increase the Risk of Reoperation After Meniscal Surgery in Children?

Isolated revision meniscal repair – failure rates, clinical outcome, and patient satisfaction

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

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