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Meniscus Repair in Children and Adolescents: A Systematic Review of Treatment Approaches, Meniscal Healing, and
Márcio Balbinotti Ferrari1,2, Colin P Murphy3, João Luiz Ellera Gomes1,2
1Department of Orthopaedics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Insights
Meniscal tears in children can be effectively treated with repair, showing good to excellent outcomes and minimal complications. Further high-quality studies are needed to confirm these findings for pediatric meniscus repair.
Area of Science:
- Orthopedic Surgery
- Pediatric Sports Medicine
- Knee Injuries
Background:
- Meniscal repair outcomes are established in adults but less understood in pediatric populations.
- Traumatic meniscus tears are an increasing concern in young individuals.
- Evidence is needed to guide treatment decisions for pediatric meniscal tears.
Purpose of the Study:
- To systematically review the outcomes of traumatic meniscal tears in patients 18 years old or younger.
- To evaluate factors influencing treatment success in pediatric meniscus repair.
- To assess the safety and efficacy of pediatric meniscal repair.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
- Searched Cochrane, MEDLINE Ovid, and PubMed databases for studies on pediatric meniscal repair (patients ≤18 years).
- Included 8 studies (Level IV evidence) evaluating 287 pediatric patients with a minimum 12-month follow-up.
Main Results:
- The majority of pediatric patients (287) reported good to excellent outcomes after meniscal repair.
- Clinical signs of meniscal healing were common, with few subsequent meniscectomies (44 cases).
- Anterior cruciate ligament tears were the most frequent associated injury; all-inside and inside-out techniques were predominant.
Conclusions:
- Pediatric meniscus tears are prevalent and amenable to surgical repair.
- Meniscal repair in children yields favorable outcomes across various tear types and techniques.
- Minimal complications were reported, but higher-quality research is recommended to validate these findings.
Abstract:
Although the consequences of traumatic meniscus tears and the importance of meniscal repair are well-established in adults, the same cannot be said for the young population. Better evidence regarding the outcomes following traumatic meniscal tears in children would improve our understanding of this increasing pathology and help define important factors in deciding the best treatment option. A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines using the Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, and MEDLINE PubMed databases. Inclusion criteria were as follows: studies reporting the outcomes of meniscal repair in patients 18 years old or younger, with a minimum mean follow-up of 12 months, Portuguese, Spanish, or English languages, and human studies including 10 or more patients. Our search identified 2,534 individual titles. After application of the inclusion and exclusion criteria, 8 studies were included, evaluating 287 patients with repaired meniscal tears. All eight studies were classified as level of evidence IV. The mean methodological index for nonrandomized studies score was 8.6 ± 1.4. Meniscal repair included all meniscal zones and tear patterns. Anterior cruciate ligament tear was the most common associated injury. The all-inside and inside-out techniques were predominantly reported. The majority of the patients reported good to excellent outcomes and had clinical signals of meniscal healing; meniscectomies following meniscal repair were performed in just 44 cases. In conclusion, meniscal tears in pediatrics are not uncommon. Repairs of this injury were associated with good to excellent outcomes in most patients, regardless of the injury pattern, zone, or technique. Reported complications were minimal; however, higher quality studies are needed to confirm the findings of this systematic review. This is a systematic review study with Level IV.
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