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Amount of meniscal resection after failed meniscal repair
Nicolas Pujol1, Olivier Barbier, Philippe Boisrenoult
1Orthopedic Department, Centre Hospitalier de Versailles, Versailles-Saint Quentin University, Le Chesnay, France. npujol@ch-versailles.fr
Background:
The failure rate after arthroscopic meniscal repair ranges from 5% to 43.5% (mean, 15%) in the literature. But little is known about the amount of meniscal tissue removed after failed meniscal repair.
Hypothesis:
The volume of subsequent meniscectomy after failed meniscal repair is not increased when compared with the volume of meniscectomy that would have been performed if not initially repaired.
Study Design:
Case series; Level of evidence, 4.
Methods:
From January 2000 to December 2009, 295 knees underwent arthroscopic meniscal repair for unstable peripheral vertical tears. When present (219 cases), all anterior cruciate ligament (ACL) tears underwent reconstruction. Patients with multiple ligament injuries and posterior cruciate ligament injuries were excluded from the analysis. Thirty-two medial and 5 lateral menisci underwent subsequent meniscectomy after failed repair at a mean of 26 months postoperatively (range, 3-114 months). Five parameters were specifically evaluated: the amount of meniscectomy related to the initial tear, the ACL status, the appearance of chondral lesions, the time from the initial injury to meniscal repair, and the time from repair to meniscectomy.
Results:
The posterior segment of the meniscus was involved in all tears and retears. Among failures, resection of the meniscal segments primarily repaired occurred for 17 medial and 2 lateral meniscal tears (52%); the tear extended in 5 cases (all medial menisci), and healing of some repaired segments led to a partial resection of the initial lesion in 35% of cases (10 medial menisci, 3 lateral menisci). The time from injury to meniscal repair was correlated with an increasing volume of meniscus removed (P < .05) and with the presence of stage 2 or 3 chondral lesions at revision (P < .03). All knees with extended tears (5 cases) and/or with significant chondral degeneration (8 cases) occurred in ACL-reconstructed knees. Among them, 50% (6 of 12) of ACL-reconstructed knees were ACL deficient.
Conclusion:
There are few detrimental effects when repairing a repairable meniscal lesion, even if it fails. The amount of meniscectomy is rarely increased when compared with the initial lesion. This study supports the hypothesis that the meniscus can be partially saved and that a risk of a partial failure should be taken when possible.