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Arthroscopic repair of degenerative medial meniscus tears in patients aged over 45 years resulted in favorable clinical outcomes and low clinical failure rates at a minimum 2-year follow-up

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to investigate clinical and radiological results of arthroscopic repair for isolated medial degenerative meniscus tears (DMTs) in patients over 45 years old at a minimum 2-year follow-up.

Methods

From 2013 to 2017, patients aged over 45 years with isolated medial DMT refractory to conservative management or with true mechanical symptoms who had undergone arthroscopic repair were retrospectively reviewed. Arthroscopic meniscus repair was performed using all-inside or all-inside and inside-out technique in combination with bone marrow venting procedure. Tear patterns were classified according to arthroscopic findings. Magnetic resonance imaging (MRI) and outcome evaluations, including Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) score, were evaluated preoperatively and at the final follow-up. International Cartilage Repair Society grades of the medial compartments and MRI signal at tear sites were assessed preoperatively and at the final follow-up. A grade 0 to 2 signal at the repair site suggested a healed meniscus, whereas a grade 3 signal suggested an unhealed meniscus. Clinical failure was determined according to Barrett criteria.

Results

Twenty-seven patients (mean age, 57.7 ± 7.4 years) were enrolled. The mean follow-up was 52.0 ± 15.6 months. Among tear patterns, 48% were complex tears, 30% were horizontal tears, and 22% were other patterns. The mean Lysholm score and IKDC score significantly improved from 53 ± 25 to 89 ± 15 (p < 0.001) and 34 ± 24 to 72 ± 15 (p < 0.001) at the final follow-up, respectively. The median Tegner activity score significantly improved from 1 (range 1–4) to 4 (range 2–7, p < 0.001). Three (11%) patients were considered clinical failures, and five patients (19%) had cartilage lesion progression. At the final follow-up, MRI showed grade 0 in one (4%) patient, grade 1 in nine (33%) patients, grade 2 in six (22%) patients, and grade 3 in eleven (41%) patients.

Conclusion

Arthroscopic repair of isolated medial DMT refractory to conservative management or with true mechanical symptoms in patients aged over 45 years had good to excellent clinical outcomes with low clinical failure rates, despite unhealed menisci being observed on MRI in 41% of patients at a mean 4.3-year follow-up. Arthroscopic repair could be a treatment option for these patients.

Level of evidence

IV.

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Abbreviations

DMT:

Degenerative meniscus tear

MRI:

Magnetic resonance imaging

IKDC:

International knee documentation committee

ICRS:

International cartilage repair society

ICC:

Intraclass correlation coefficient

HKA:

Hip–knee–ankle

MFC:

Medial femoral condyle

MTP:

Medial tibial plateau

MCID:

Minimal clinically important difference

TMT:

Traumatic meniscal tear

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Acknowledgements

Thanks for the great help of the radiology department of the Xinhua Hospital.

Funding

This work was not supported by any foundation.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No.1665 Kongjiang Road, Shanghai, People’s Republic of China

    Siyuan Zhu, Chenglong Wang, Peng Wang, Xiexiang Shao & Jianhua Wang

  2. Sports Medicine and Shoulder Surgery, Department of Orthopaedic, Surgery, Boston University School of Medicine, Boston, MA, USA

    Xinning Li

  3. Department of Orthopaedic Surgery, Wuxi Hospital of TCM Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China

    Zhenfei Lu

  4. Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Jason L. Koh

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  1. Siyuan Zhu
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Contributions

SZ made substantial contributions to the conception and design of the study, acquisition and analysis of the radiological and clinical data of the patients, drafting, editing, and revising the manuscript. XL made substantial contributions to the design of the study, drafting, editing, revising the manuscript and interpretation of the re-analyzed data. ZL made substantial contributions to acquisition and analysis of the radiological data, drafting, editing and revising the manuscript. JK made substantial contributions to drafting, editing and revising the manuscript. CW made contributions to drafting, editing and revising the manuscript. PW made contributions to drafting, editing and revising the manuscript. XS made substantial contributions to the conception and design of the study editing and revising the manuscript. JW made substantial contributions to the conception and design of the study, editing and revising the manuscript.

Corresponding authors

Correspondence to Xiexiang Shao or Jianhua Wang.

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Conflict of interest

All authors have no potential conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Shanghai, China, No.XHEC-D-2021–149).

Informed consent

All patients enrolled in this study have signed the broad consent, which permits the researchers to engage in research use of patients’ identifiable data during the hospitalization period and future follow-up without the requirement to obtain additional consents for the future storage, maintenance, or research usage, so long as the future activities are within the scope of the broad consent. The study protocol as well as the application form were fully reviewed, and we have certified that this study does not raise any issues of patient risk or cause any harm to patients. We have also certified that the study was strictly in accordance with the Declaration of Helsinki and International Ethical Guidelines for Health-related Research Involving Humans.

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Zhu, S., Li, X., Lu, Z. et al. Arthroscopic repair of degenerative medial meniscus tears in patients aged over 45 years resulted in favorable clinical outcomes and low clinical failure rates at a minimum 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 31, 1815–1823 (2023). https://doi.org/10.1007/s00167-022-07133-w

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