Comparative Outcomes of Arthroscopic Versus Open Meniscus Repair: An Observational Study

Meniscal tears are among the most frequent knee injuries requiring surgical intervention. Arthroscopic repair has largely supplanted open repair due to its minimally invasive nature, yet long-term comparative outcomes remain poorly characterized. This study compared clinical outcomes of arthroscopic versus open meniscus repair using a large multicenter electronic health record database.

We performed a retrospective cohort analysis using the TriNetX US Collaborative Network, including adult patients (18-60 years) who underwent meniscus repair between 2010 and 2025. Cohorts were defined by surgical approach: Open repair (CPT 27427-27429) and arthroscopic repair (CPT 29882-29883). Outcomes assessed within two years post-surgery were meniscal repair failure/re-tear, revision meniscus surgery, knee osteoarthritis (OA) progression, and venous thromboembolism (VTE). Propensity score matching (1:1) balanced demographics and comorbidities, yielding 17,925 patients per group. Risk ratios (RR), hazard ratios (HR), and Kaplan-Meier analyses were calculated.

Before matching, the arthroscopic cohort (n = 48,101) was older and more frequently male compared with the open cohort (n = 17,966). After matching (n = 17,925 each), groups were well balanced across demographics and comorbidities (Table 1). Median follow-up was 22 months in both groups.Meniscal failure was significantly higher after arthroscopic repair (51.4%) than open repair (16.2%) (RR 0.32, 95% confidence interval [CI] 0.30-0.33; HR 0.24, 95% CI 0.23-0.25; P < 0.001). Revision surgery occurred in 3.4% of arthroscopic versus 1.0% of open repairs (RR 0.30, 95% CI 0.25-0.35; HR 0.29, 95% CI 0.25-0.35; P < 0.001). Conversely, OA progression was slightly more frequent in open repair patients (6.1% vs. 4.9%; RR 1.23, 95% CI 1.12-1.34; HR 1.23, 95% CI 1.12-1.34; log-rank P < 0.001). VTE incidence was low overall but higher after open repair (1.9% vs. 1.4%; RR 1.42, 95% CI 1.20-1.67; HR 1.41, 95% CI 1.20-1.66; P < 0.001).

In this large matched cohort, open meniscus repair was associated with markedly lower risks of meniscal failure and revision surgery compared with arthroscopic repair. However, open repair carried modestly higher risks of knee OA progression and VTE. These findings suggest open repair offers superior meniscal durability but at the expense of slightly increased long-term joint degeneration and thromboembolic risk. Shared decision-making should incorporate both durability and complication profiles, and prospective studies with longer follow-up are warranted.