Meniscal Repair Outcomes at Greater Than 5 Years: A Systematic Review and Meta-Analysis
Jeffrey J Nepple1, Andrew M Block1, Matthew T Eisenberg1
1Washington University School of Medicine, St. Louis, Missouri.
Background:
The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair.
Methods:
We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model.
Results:
A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54).
Conclusions:
Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Insights
Modern meniscal repair failure rates at 5 years are 19.5%. Lateral repairs succeed more than medial ones, and newer all-inside techniques improve outcomes compared to older devices. Outcomes are similar with or without anterior cruciate ligament (ACL) reconstruction.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Meniscal repair techniques are evolving to improve healing rates.
- Long-term outcomes (≥5 years) are crucial for assessing true meniscal repair failure rates.
- This study systematically reviews long-term failure rates of meniscal repair.
Purpose of the Study:
- To assess the failure rate of meniscal repair at a minimum of 5 years postoperatively.
- To compare failure rates across different meniscal repair techniques and patient factors.
- To evaluate the impact of anterior cruciate ligament (ACL) status on meniscal repair success.
Main Methods:
- Systematic review and meta-analysis of studies reporting meniscal repair outcomes at ≥5 years.
- Defined failure as recurrent symptoms or reintervention.
- Analyzed outcomes based on ACL status, sex, age, and rehabilitation protocols using random-effects models.
Main Results:
- Pooled overall failure rate was 22.6%; modern repairs had a 19.5% failure rate.
- Medial repairs failed more often than lateral repairs (23.9% vs. 12.6%).
- Modern all-inside repairs (15.8%) showed improved success over early-generation devices (30.2%); inside-out repairs had a 14.2% failure rate.
Conclusions:
- Modern meniscal repair exhibits a 19.5% failure rate at 5 years.
- Advanced all-inside techniques enhance meniscal repair success compared to earlier versions.
- Lateral repairs are more successful than medial repairs; ACL status does not significantly impact meniscal repair failure.
