The repair of horizontal cleavage tears yields higher complication rates compared to meniscectomy: a systematic review

Abstract

Purpose Horizontal cleavage tears of the meniscus (HCTs) are primarily degenerative in nature, and, however, can be the result of trauma. Such tears account for 12-35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. The purpose of this review was to systematically assess the outcomes and complications for patients undergoing the surgical treatment of HCTs. Methods This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses. The electronic databases PubMed, MEDLINE, and EMBASE were searched from data inception to December 30, 2018 for articles addressing the surgical treatment of HCTs. The Methodological Index for Non-randomized Studies was used to assess study quality. Data are presented descriptively. Results Overall, 23 studies were identified, comprising of 702 patients (708 knees) with a mean age of 36.6 ± 9.9 years and a mean follow-up of 33.6 ± 19.6 months. The majority of patients were treated with a partial meniscectomy (59.0%), followed by repair (32.8%) and total meniscectomy (8.2%). Both meniscectomy and repair patients had improvements which surpassed minimal clinically important differences with regard to clinical (e.g. pain, function, daily living) and radiographic outcomes. The overall complication rate was 5.1%, primarily involving patients undergoing meniscal repair (12.9% of all knees undergoing a repair). Conclusion Although meniscal repair theoretically may provide improvement in biomechanical loading, patients undergoing repair had higher complication rates than those undergoing partial meniscectomy. Clinicians should consider the available implants in determining which tear patterns to repair and future studies with long-term follow-up are needed to investigate complications (e.g. secondary meniscal procedures) as well as the potential for delay in the development of osteoarthritis. Level of evidence Level IV.

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses

“…143 Kurzweil et al 72 found that the success rate after repair of horizontal meniscal tears was 79%, although the results may have been biased toward younger patients since the median age was 23 years among a total of 98 repairs. Shanmugaraj et al 122 found that the complication rate was 12.9% after meniscal repair for horizontal cleavage tears, and clinical outcomes showed improvement. Moulton et al 93 found good outcomes, satisfactory healing, and no serious complications after repair of radial meniscal tears in the short term.…”

Is radiofrequency use in arthroscopic treatment of isolated medial meniscus horizontal cleavage tears more effective than mechanical debridement in young adults?

“…Horizontal cleavage tears are meniscus tears extending from the avascular zone to the vascular zone and considered degenerative meniscus tears [11]. Previous studies Shanmugaraj et al found that repair of horizontal cleavage tears has a higher complication rate than repair with partial meniscectomy [19]. Since a meniscus repair group was not present in our study, our findings are somewhat limited.…”

Natural history of new horizontal meniscal tears in individuals at risk for and with mild to moderate osteoarthritis: data from osteoarthritis initiative

“…According to new trends in orthopedic surgery, saving the meniscus is a priority and partial meniscectomies are considered as potentially promoting progressive knee joint degeneration [43]. Surprisingly, repair of horizontal cleavage tears show higher complication rates than meniscectomy [45]. Although some studies suggest that surgeons still favor an arthroscopic approach and partial meniscectomy, despite the reported lack of its long-term benefits in degenerative knees [46], the trend to change clinical practice towards a conservative approach has been reported in the last decade [47].…”