Zicaro JP, Garrido N, Garcia-Mansilla I, Yacuzzi C, Costa-Paz M. Failure rate, return-to-sports and magnetic resonance imaging after meniscal repair: 119 patients with 7 years mean follow up. World J Orthop 2023; 14(8): 612-620 [PMID: 37662662 DOI: 10.5312/wjo.v14.i8.612]
Corresponding Author of This Article
Ignacio Garcia-Mansilla, MD, Surgeon, Department of Knee, Hospital Italiano de Buenos Aires, Peron 4190, Buenos Aires 1109, Argentina. ignaciogarciamansilla@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Aug 18, 2023; 14(8): 612-620 Published online Aug 18, 2023. doi: 10.5312/wjo.v14.i8.612
Failure rate, return-to-sports and magnetic resonance imaging after meniscal repair: 119 patients with 7 years mean follow up
Juan Pablo Zicaro, Nicolas Garrido, Ignacio Garcia-Mansilla, Carlos Yacuzzi, Matias Costa-Paz
Juan Pablo Zicaro, Nicolas Garrido, Ignacio Garcia-Mansilla, Carlos Yacuzzi, Matias Costa-Paz, Department of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
Author contributions: Zicaro JP and Garrido N analyzed the data and wrote the manuscript; Garcia-Mansilla I contributed with research and data analysis; Yacuzzi C and Costa-Paz M contributed to the number of patients operated on; Costa-Paz M is the head of the sector; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the "Ethics Committee of the Hospital Italiano" (CEPI) Institutional Review Board, No. 5458.
Informed consent statement: Due to the retrospective nature of our study no informed consent was required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data were required (retrospective study).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ignacio Garcia-Mansilla, MD, Surgeon, Department of Knee, Hospital Italiano de Buenos Aires, Peron 4190, Buenos Aires 1109, Argentina. ignaciogarciamansilla@gmail.com
Received: January 14, 2023 Peer-review started: January 14, 2023 First decision: March 14, 2023 Revised: April 18, 2023 Accepted: June 14, 2023 Article in press: June 14, 2023 Published online: August 18, 2023 Processing time: 214 Days and 18.4 Hours
Abstract
BACKGROUND
One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature.
AIM
To evaluate failure rates, return to sports (RTS) rate, clinical outcomes and magnetic resonance image (MRI) evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up.
METHODS
We conducted a retrospective review of meniscal repairs between January 2004 and December 2018. All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction (ACL-R) were included. Meniscal ramp lesions, radial and root tears, associated with multiligament injuries, tibial fracture and meniscal allograft transplants were excluded. Surgical details and failure rate, defined as symptomatic patients who underwent a revision surgery, were analyzed. As isolated bucket handle tears (BHTs) were usually associated with higher failure rates, we compared BHTs and not BHTs associated or not with an ACL-R. Since 2014, the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate. In addition, the number of stitches per repair was increased. In view of differences in surgical technique, we compared two different cohorts: before and after 2014. We recorded the RTS according to the level achieved and the time to RTS. Lysholm and IKDC scores were recorded. Patients were studied with x-rays and MRI as standard postoperative control.
RESULTS
One hundred and nineteen patients were included with a mean follow up of 7 years (SD: 4.08). Overall failure rate was 20.3% at a mean 20.1 mo. No statistically significant differences were found when comparing failure for medial and lateral meniscal repair (22.7% and 15.3%, P = 0.36), BHTs and not BHTs (26% and 17.6%, P = 0.27), isolated or associated with an ACL-R (22.9% and 18%, P = 0.47), or when comparing only BHTs associated with an ACL-R (23% and 27.7%, P = 0.9) or not. When comparing cohorts before and after 2014, we found a significant decrease in the overall failure rate from 26% to 11% (P < 0.03). Isolated lesions presented a decrease from 28% to 6.6% (P = 0.02), BHTs from 34% to 8% (P = 0.09) and those associated with an ACL-R from 25% to 10% (P = 0.09). Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R. Overall, 56% of patients returned to the same sport activity level. Mean pre and postoperative Lysholm scores were 64 and 85 (P = 0.02), and IKDC 58 and 70 (P = 0.03). Out of 84 asymptomatic patients evaluated with MRI, 39% were classified as “not healed” and 61% as “healed”.
CONCLUSION
Even though the overall failure rate of our series was 20.3%, we found a statistically significant decrease from 26% to 11%, not only for isolated lesions, but also for BHT’s and those associated with an ACL-R when comparing our series in two different cohorts, most probably due to improvements in surgical technique.
Core Tip: One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the literature. In this retrospective cohort we observed that new and improved suturing techniques have shown significantly lower failure rates, encouraging the need for meniscal repair whenever possible.
