What Is The Success Rate Of Meniscus Repair

• Research article
• Open Admission
• Published: 21 December 2022

Isolated revision meniscal repair – failure rates, clinical event, and patient satisfaction

• Ferdinand Kloos^ane,
• Gerrit Bode¹,
• Kaywan Izadpanah^one,
• Norbert P. Südkamp¹ &
• Matthias J. Feucht^1,2

BMC Musculoskeletal Disorders book 19, Commodity number:446 (2018) Cite this article

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Abstruse

Background

Failure of isolated primary meniscal repair must be expected in approximately 10–25% of cases. Patients requiring revision surgery may benefit from revision meniscal repair, nonetheless, the results of this procedure remain underreported. The purpose of this study was therefore to evaluate the consequence and failure rates of isolated revision meniscal repair in patients with re-tears or failed healing after previous meniscal repair in stable articulatio genus joints.

Methods

A chart review was performed to identify all patients undergoing revision meniscal repair between 08/2010 and 02/2016. Only patients without concomitant procedures, without ligamentous insufficiency, and a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about principal and revision surgery. Follow-up evaluation included failure rates, clinical outcome scores (Lysholm Score, KOOS Score), sporting activeness (Tegner scale), and patient satisfaction.

Results

A total of 12 patients with a mean age of 22 ± 5 years were included. The mean time between primary repair and revision repair was 27 ± 21 months. Reasons for failed primary repairs were traumatic re-tears in 10 patients (83%) and failed healing in two patients (17%). The mean follow-up period after revision meniscal repair was 43 (± 23.4) months. Failure of revision meniscal repair occurred in 3 patients (25%). In two of these patients, successful re-revision repair was performed. At final follow-upward, the mean Lysholm Score was 95.ii (± four.2) with a range of 90–100, representing a good to excellent result in all patients. The terminal cess of the KOOS subscores likewise showed good to excellent results. The mean Tegner calibration was half dozen.8 ± i.8, indicating a relatively high level of sports participation. Ten patients (83%) were either satisfied or very satisfied with the consequence.

Decision

In patients with re-tears or failed healing afterwards previous isolated meniscal repair, revision meniscal repair results in good to fantabulous knee function, high level of sports participation, and high patient satisfaction. The failure charge per unit is slightly higher compared to isolated principal meniscal repair, merely all the same adequate. Therefore, revision meniscal repair is worthwhile in selected cases in lodge to relieve as much meniscal tissue as possible.

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Groundwork

The menisci of the knee joint play an important role in load transmission, stupor absorption, proprioception, cartilage lubrication, and joint stability [one]. Therefore, integrity of the menisci is crucial for long term knee joint function. For several decades, total or partial meniscectomy was the handling of choice for symptomatic meniscus tears [ii]. However, with the growing understanding of meniscal function and an increasing number of studies reporting suboptimal results afterwards meniscectomy [3] meniscal repair has become widely accepted [four]. Compared to partial meniscectomy, meniscus repair has shown to result in better knee function, college activity levels, less progression of osteoarthritis, and cost saving [5,6,7,8,9]. However, the reoperation rate after meniscal repair is higher [5] and according to recent systematic reviews, a failure charge per unit of approximately eleven–23% must be excepted [10,11,12]. With the increasing numbers of meniscal repairs performed during the concluding decade [13], the number of failed meniscus repairs will also increment. Until now, meniscectomy seems to be the preferred technique to address failed meniscus repairs [14,15,xvi,17]. However, revision meniscal repair may provide ameliorate long-term outcomes than meniscectomy, just the results of this procedure remain underreported [18,19,twenty,21]. Information technology is therefore unclear if revision meniscal repair is worthwhile.

The purpose of this study was to evaluate the clinical outcome and failure rates of isolated revision meniscal repair in patients with re-tears or failed healing after previous meniscal repair in stable human knee joints. We hypothesized that revision meniscal repair would demonstrate expert clinical outcomes and an adequate failure rate.

Methods

Written report design and patient selection

A retrospective instance series was conducted to written report the clinical outcome and failure rates of isolated revision meniscal repair in patients with re-tears or failed hailing after previous isolated meniscal repair in stable knee joints at our establishment. The study was approved by the institutional review board, and the study was performed in accord with the Declaration of Helsinki. Informed consent was obtained from all patients.

A chart review was performed using our electronic medical record organisation to identify all patients undergoing meniscal repair betwixt 2022 and 2022. For further patient selection, just patients without concomitant procedures and without ligamentous insufficiency were included.

A full of 196 patients were finally identified. Of those, 31 patients presented to our clinic with a symptomatic re-tear or failed healing as determined by clinical exam and magnetic resonance imaging (MRI). All patients underwent revision surgery. Partial meniscectomy was performed in 19 patients and 12 patients underwent isolated revision meniscal repair. Revision meniscal repair was indicated for unstable tears located in the ruddy-red or red-white zone and proficient tissue quality. Partial meniscectomy was indicated in patients with meniscal tears located in the white-white zone, severely degenerated meniscal tissue, and tears which could technically not be stabilized.

For the purpose of this report, just patients after isolated revision meniscal repair with a minimum follow-up of 24 months were included. The records of all patients were reviewed to collect patient demographics, injury patterns of the meniscus, and details about primary and revision surgery.

Surgical technique and postoperative rehabilitation

Revision meniscal repair was performed using a routine arthroscopic setup. A probe was used to confirm the preoperative diagnosis and characterize the meniscus tear. Suture material from the previous repair was removed if necessary and the tear side was debrided with a shaver or rasp. Depending on the tear morphology and localization, revision repair was performed with either an all-inside technique (FasT-Set®, Smith & Nephew, Andover, USA, or Meniscal Viper®, Arthrex, Naples, USA), an inside-out technique (SharpShooter®, Ivy Sports Medicine, Montvale, United states of america), or the combination of both. A combination of horizontal and vertical suture configuration was used and the number of sutures depended on the tear size. In general, sutures were added until the tear was considered stable past probing. Root tears were repaired using a transtibial pull-out suture technique.

Postoperatively, patients were restricted to partial weight bearing (20 kg) for 6 weeks, followed by gradual increase of weightbearing over the following 2–4 weeks. During the offset 6 weeks, flexion was limited to 90°. Full squatting was permitted 4 months after surgery and return to sporting activities was allowed afterward 6 months.

Follow-up evaluation

Failure of revision meniscal repair was defined as repeat surgery on the aforementioned meniscus during the follow-up period or meniscal symptoms such as pain, catching, or locking. To appraise the functional outcome, the Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used. Sporting activity was assessed with the Tegner action scale. Patients satisfaction with revision meniscal repair was assessed by asking the patients if they were very satisfied, satisfied, partially satisfied, or dissatisfied. Furthermore, the patients were asked if they would undergo the surgery once again. In patients who failed revision meniscal repair and underwent subsequent surgery, follow-up evaluation was conducted after re-revision surgery.

Results

Patient demographics and surgical details

A total of 12 patients were included. The mean patient historic period at revision meniscal repair was 22 ± 5 years (range, 17–34 years) and the mean trunk mass index was 22.three ± 2.6 kg/chiliad² (range, xix.0–29.3 kg/thouⁱⁱ). Nine patients were male person (75%) and the left knee was affected in eight patients (67%).

Injury specific data and surgical details of each patient are provided in Table 1.

Tabular array i Injury specific information and surgical details

Total size table

In 10 patients (83%), a traumatic re-tear was the reason for revision meniscal repair. Traumatic re-tears occurred during sports in 8 patients (67%) and during activities of daily living in 2 patients (17%). Failed healing (biologic failure) was considered the primary reason for revision repair in ii patients (17%). The mean fourth dimension betwixt primary repair and revision meniscal repair was 26.6 ± 21 months (range, 3–70 months). The re-tear involved the primary repair site in all cases. The medial meniscus was affected in viii patients (67%) and the lateral meniscus in 4 patients (33%). All tears were located in the red-red (three patients, 25%) or red-white zone (9 patients, 75%). At the time of the chief repair, 5 patients (42%) had displaced bucket-handle tears, v patients (42%) had longitudinal tears, and two patients (17%) had root tears. At the time of revision repair, 3 patients (25%) had displaced bucket-handle tears, 3 patients (25%) had longitudinal tears, 3 patients (25%) had circuitous tears, two patients (17%) had vertical tears, and 1 patient (eight%) had a root tear. The tear type changed betwixt primary and revision repair in 7 cases (58%; cases 2, 3, four, vi, 8, xi, and 12).Revision meniscal repair was performed using an inside-out technique in 3 patients (25%), an all-inside technique in 4 patients (34%), a combination of inside-out and all-within techniques in iv patients (34%), and a transtibial pullout suture technique in 1 patient (8%). The mean number of sutures was ii.4 ± one.2 (range, 1–iv) at chief repair and 2.8 ± 1.7 (range, 1–6) at revision repair. Compared to primary repair, the number of sutures required for revision repair increased in five patients (42%), remained unchanged in 4 patients (33%), and decreased in 3 patients (25%).

Failure rates, clinical results, and patient satisfaction

All patients were bachelor for follow-upward evaluation. The mean follow-up catamenia after revision meniscal repair was 43 ± xx.iv months (range, 24–78 months). Failure of revision meniscal repair occurred in 3 patients (case 2, 3, and five), therefore, the overall failure rate was 25%. In two of these patients, re-revision repair was performed (example iii and v), whereas another patient underwent fractional meniscectomy (case 2). The follow-up catamenia of both patients undergoing re-revision repair was more than 24 months later on the last operation. At final follow-up, both patient had no meniscus-specific symptoms and excellent functional scores. Therefore, the combined success rate of revision and re-revision repair was 92% (xi of 12 cases).

The detailed outcomes of each patient are shown in Tabular array ii. Ten patients (83%) were either very satisfied or satisfied with the outcome. Only two patients (17%) were partially satisfied with the result, and only two patients stated that they would non undergo the same surgery again. In both patients, failure of revision repair occurred. The hateful Tegner scale was 6.8 ± one.eight (range, iv–x), indicating a relatively high level of sports participation. The mean Lysholm Score was 95.2 ± four.two with a range of 90–100, representing a good to excellent result in all patients. The terminal cess of the KOOS subscores likewise showed good to excellent results with the post-obit mean values: KOOS symptoms 95.5 ± 4.four (range, 85.7–100), KOSS hurting 97.0 ± 3.1 (range, 94.4–100), KOOS ADL 99.5 ± 1.one (range, 96.9–100), KOOS Sport/Rec 92.5 ± 10.three (70–100), KOOS QOL 81.8 ± 12.1 (range, 56,3–100).

Table 2 Result of revision meniscal repair in each patient

Full size table

Give-and-take

The most important findings of this written report were that isolated revision meniscal repair results in good to fantabulous human knee office, high level of sports participation, and high patient satisfaction in patients with re-tears or failed healing after previous isolated meniscal repair. The failure rate of 25% is slightly higher compared to isolated primary meniscal repair, but still acceptable. Therefore, revision meniscal repair seems to exist a valuable treatment option in selected cases.

Integrity of the menisci is vital to maintain knee articulation health, and the management of meniscal tears has evolved over the last decades [2]. Electric current evidence suggests that meniscus repair should be preferred over meniscectomy whenever possible in order to preserve as much meniscus tissue equally possible [5,six,vii,eight]. Nevertheless, failure of principal meniscal repairs must be expected in approximately 11–23% of patients [ten,11,12]. Kurosaka et al. demonstrated that repaired menisci may tear again even after arthroscopically confirmed healing [22]. In their study, stable healing of the repaired meniscus was observed in 90 of 111 patients during second-await arthroscopies at a mean of 13 months later on repair. Of the 90 patients with stable repairs, however, xiii patients sustained a re-tear of the meniscus, which was always located at the primary repair site. This finding corresponds well to the findings of our report. Nearly of our patients sustained a traumatic re-tear during sporting activities. Given the fact that most patients were able to perform sports afterward the primary repair and the relatively long fourth dimension menstruum between primary repair and revision repair, it tin can exist hypothesized that healing occurred after primary meniscal repair. Similarly to the findings of Kurosaka et al., the re-tear in our series occurred at the master repair site in all cases [22]. This may be attributed to the mechanically less stable scar tissue at the repair side observed in beast studies [23, 24].

With the increasing numbers of meniscal repairs observed during the last decade [13], failed repairs volition get a more common problem. Therefore, recommendations for appropriate treatment of these cases will become more than important. Similarly to primary meniscal repair, revision meniscal repair may provide better functional outcomes and less progression of osteoarthritis than meniscectomy [5,six,7,8]. Even so, meniscectomy seems to be the preferred treatment option since results of revision meniscal repair remain underreported [14,fifteen,sixteen,17]. To the best of our noesis, but three studies have specifically analysed the results of revision meniscal repair and so far [18,nineteen,20]. Despite differences in patient population, meniscal tear patterns, concomitant procedures, and follow-up menstruation, the results of these studies are generally comparable to our results (Tabular array three): Voloshin et al. reported on a series of 18 echo meniscal repairs performed over an 11-year catamenia. Afterwards a mean follow-upwardly of vii years, the clinical success charge per unit was 72% [twenty]. Imade et al. analyzed the results of revision meniscal repair in 15 patients. The success rate was 67%, and all failed revision repairs had degeneration of the meniscal tissue. The authors therefore ended that revision meniscal repair should be considered in the setting of a re-torn meniscus without degenerative changes [18]. Krych et al. retrospectively investigated 34 patients at 2 to 17 years later on revision meniscal repair. In 13 of these cases, concomitant ACL reconstruction was performed. The clinical success rate was 79%. Younger age was associated with an increased risk of revision repair failure, whereas tear zone, tear pattern, meniscal side, surgical technique, and combined ligament reconstruction were not significant predictors of failure [nineteen]. The main departure between the present and the above stated studies is that we did not include patients who underwent concomitant reconstructive procedures, specially ACL reconstruction. It has been demonstrated that concomitant ACL reconstruction at the time of meniscal repair improves healing rates of the repaired meniscus [fourteen]. We therefore excluded patients with concomitant procedures in gild to reduce confounding factors. The nowadays study is therefore the beginning to focus on isolated revision meniscal repair in stable knee joints.

Table 3 Outcome of revision meniscal repair as reported in the literature

Full size table

Revision meniscal repair seems to have slightly higher failure rates compared to primary repairs. Nepple et al. [ten] performed a systematic review of studies reporting the outcome of chief meniscal repair at a minimum of five years postoperatively. A total of 566 knees were included and the pooled rate of meniscal repair failure was 23%. Grant et al. [12] conducted a systematic review to compare the effectiveness of within-out and all-inside repair techniques for isolated unstable peripheral longitudinal meniscal tears. The rate of clinical failure was 17% for inside-out repairs and 19% for all-inside repairs. In a more recent systematic review, Fillingham et al. [11] analyzed the results of within-out and mod all-within repairs for isolated meniscal tears. The overall clinical failure rate was 11% with no statistically significant differences between the 2 techniques. In the present study, the failure rate after isolated revision meniscal repair was 25%, which is slightly higher compared to the above reported failure rates later chief repairs. Furthermore, in ii of the 3 failures, re-revision repair was performed, with clinically success in both patients. Therefore, the meniscus could be saved in a full of 92% of our patient cohort.

Despite a slightly higher failure rate, the clinical results observed in the present written report are comparable to those reported after principal repairs. In the systematic review of Fillingham et al. [11], the hateful Lysholm score was 89.0 and the mean Tegner score was five.seven. In the systematic review of Grant et al. [12], the Lysholm score was ninety.2 for all-inside repairs and 87.8 for inside-out repairs. Corresponding Tegner scores were 5.v and v.half-dozen. In our study, the mean Lysholm Score was 95.2 and the mean Tegner score was 6.8. Nosotros therefore conclude that revision meniscal repair can attain the same clinical results and same activity level as principal repair.

This study has several limitations. Offset, the written report population was relatively small, which limits the overall validity of our results. However, revision meniscal repair is performed only infrequently and merely patients without concomitant procedures were included. Therefore, our study accomplice represents a relatively homogenous collective with regard to surgical treatment. 2d, failure of revision meniscal repair was not evaluated by MRI or 2d-wait arthroscopy. Therefore, the actual failure rate may exist underestimated. Tertiary, no statistical analysis was performed because preoperative scores were not bachelor. However, the principal intention of this study was to clarify the failure rate and clinical outcome at a minimum of ii years after isolated revision meniscal repair. Fourth, no command group was analyzed. The present written report cannot respond the question whether revision meniscal repair is superior compared to conservative treatment or fractional meniscectomy. Farther studies are necessary to evaluate whether revision meniscal repair tin prevent or filibuster osteoarthritis.

Conclusions

In patients with re-tears or failed healing subsequently previous isolated meniscal repair, revision meniscal repair results in good to fantabulous knee office, high level of sports participation, and high patient satisfaction. Clinical outcome scores and activity level after revision repair are non inferior compared to primary repairs. The failure rate is slightly higher compared to isolated primary meniscal repair, but still adequate. Therefore, revision meniscal repair is worthwhile in selected cases in club to save as much meniscal tissue as possible.

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Acknowledgements

Not applicable.

Funding

The commodity processing charge was funded past the High german Enquiry Foundation (DFG) and the Albert Ludwigs University Freiburg in the funding program Open Admission Publishing.

Availability of data and materials

All information are provided within the manuscript. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Affiliations

1. Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany

   Andreas Fuchs, Ferdinand Kloos, Gerrit Bode, Kaywan Izadpanah, Norbert P. Südkamp & Matthias J. Feucht

2. Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany

   Matthias J. Feucht

Contributions

AF and MJF designed the study, nerveless information, performed the statistical analysis and wrote the manuscript. AF drafted the manuscript. FK, GB, and KI helped to design the study, assisted with statistical analysis and information interpretation, and critically reviewed the manuscript. NPS and KI conceived of the study, helped with information interpretation and critically reviewed the manuscript. All authors read and approved the last manuscript.

Corresponding writer

Correspondence to Andreas Fuchs.

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The study was approved by the institutional review board of the University Infirmary Freiburg and the study was performed in accordance with the Annunciation of Helsinki. Data were obtained by phone calls and, for organizational reasons and to minimize the drop out quote, oral consent was obtained from all patients before the interview. For the minors, oral consent to participate was given by their parents on their behalf. Oral consent was approved past the institutional review board.

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Fuchs, A., Kloos, F., Bode, M. et al. Isolated revision meniscal repair – failure rates, clinical outcome, and patient satisfaction. BMC Musculoskelet Disord nineteen, 446 (2018). https://doi.org/ten.1186/s12891-018-2368-0

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• Received: 24 Baronial 2022

• Accustomed: 03 December 2022

• Published: 21 December 2022

• DOI : https://doi.org/x.1186/s12891-018-2368-0

Keywords

• Meniscus
• Failure
• Revision
• Articulatio genus
• Arthroscopy

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