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Isolated meniscal injuries in paediatric patients: outcomes after arthroscopic repair
G Lucas1, F Accadbled2, P Violas1
1Service de chirurgie pédiatrique, hôpital Sud, boulevard de Bulgarie, 35200 Rennes, France.
Insights
Arthroscopic repair of pediatric meniscal tears shows good outcomes, improving knee function. Routine repair is recommended over meniscectomy due to osteoarthritis risks.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Sports medicine
Background:
- Management of pediatric meniscal tears lacks standardization.
- Partial meniscectomy is linked to poor outcomes and premature osteoarthritis.
- Limited data exists on pediatric meniscal tear treatment.
Purpose of the Study:
- To evaluate the outcomes of arthroscopic repair for isolated meniscal tears in pediatric patients.
- To determine if routine arthroscopic repair is a viable treatment option.
Main Methods:
- Retrospective review of 19 arthroscopic repairs in 17 pediatric patients (mean age 14).
- Assessment included physical exams, pre-operative MRI, Tegner and Lysholm scores.
- Mean follow-up was 22 months; post-operative MRI in 10 cases.
Main Results:
- Good outcomes in 70% of patients (12/17).
- Significant improvements in mean Tegner (3.9 to 7.1) and Lysholm (55.9 to 85.4) scores.
- Outcomes were not associated with repair timing, gender, lesion site, or type.
Conclusions:
- Arthroscopic repair of pediatric meniscal tears yields good results.
- Routine repair is supported for isolated tears in this age group.
- Post-operative MRI is unnecessary for asymptomatic patients; clinical follow-up suffices.
Background:
The management of isolated meniscal tears in paediatric patients is poorly standardised, and few published data are available. Nevertheless, there is widespread agreement that meniscectomy, even when partial, produces poor outcomes including the premature development of osteoarthritis.
Hypothesis:
Arthroscopic repair of isolated meniscal tears in paediatric patients yields good outcomes and should be attempted routinely.
Materials And Methods:
We retrospectively assessed 19 arthroscopic repair procedures performed between 2006 and 2010 by a single surgeon in 17 patients with a mean age of 14 years. In every case, the knee was stable and the meniscus normal before the meniscal tear, which was the only injury. Mean follow-up was 22 months. In all 19 cases, the evaluation included a physical examination, pre-operative magnetic resonance imaging (MRI), and determination of the Tegner and Lysholm scores. Post-operative MRI was performed in 10 cases.
Results:
The outcome was good in 12/17 (70%) patients with significant improvements in the mean Tegner score, from 3.9 to 7.1, and mean Lysholm score, from 55.9 to 85.4, between the pre-operative and post-operative assessments. The clinical outcomes were not significantly associated with time to arthroscopic repair, gender, lesion site, or lesion type. Neither was any correlation demonstrated between clinical outcomes and meniscal healing as assessed by MRI.
Discussion:
The known poor outcomes after meniscectomy in paediatric patients, the results of our study, and previously published data support routine arthroscopic repair of isolated meniscal tears in this age group, regardless of the site and type of injury. In addition, in asymptomatic patients, clinical follow-up is sufficient and post-operative MRI unnecessary.
Level Of Evidence:
Level IV. Retrospective study.
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