2021 ISAKOS Biennial Congress Paper
All-Cause Repair Failure Rates Increase With Time Following Meniscal Repair Despite Favorable Outcomes: A Systematic Review And Meta-Analysis
Zachariah Gene Wing Ow, MBBS (Candidate), Singapore SINGAPORE
Michelle Shi Ni Law, BSc (Candidate), Singapore SINGAPORE
Cheng Han Ng, MBBS (Candidate), Singapore SINGAPORE
Aaron J. Krych, MD, Rochester, MN UNITED STATES
Daniel Saris, MD, Prof., Rochester, MN UNITED STATES
Pedro Debieux, MD, PhD, São Paulo, SP BRAZIL
Keng Lin Wong, MBBS, MMed(Orth), MCI (NUS), FRCSEd (Orth), FAMS, Singapore SINGAPORE
Heng An Lin, MBBS, FRCSEd(Orth), Singapore SINGAPORE
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SINGAPORE
FDA Status Not Applicable
Due to the large variation in reported failure rates of meniscal repairs, we performed a meta-analysis of all-cause meniscal repair failure rates. We found that the pooled rates of failure increased with respect to time, despite other favorable outcomes such as increased return to sport. Rates of failure when adjusted for concomitant ACL reconstruction were comparable.
Current literature reporting the failure rate of meniscus repairs is varied, with little information reporting the incidence of meniscal repair failure at specific timepoints post-surgery. Hence, we propose that a pooled analysis of studies on meniscus repair outcomes will provide an accurate estimate of what outcomes can be expected following a meniscal repair at specific postoperative timepoints.
A meta-analysis of meniscal repair failure (defined as persistent symptoms, lack of healing on MRI or revision surgery) and other clinical outcomes was performed following meniscal repair. Patient included had traumatic, non-degenerative meniscal tears, were skeletally mature, and had specific time-points after surgery. Repairs included were performed either in isolation, or with concomitant ACL reconstruction. Prior to pooling, binary outcome data underwent a Freeman-Tukey double arcsine transformation in order to stabilize the variance, as well as to account for zero events. Due to the inherent heterogeneity of single-arm meta-analyses, pooled analyses were performed utilizing the DerSimonian and Laird random-effects model.
Rates of all-cause meniscal repair failure was pooled to be 12% at 0-1 years (95% CI: 0.09-0.16), 15% at 2-3 years (95% CI: 0.11-0.20), and 19% at 4-6 years (95% CI: 0.13-0.24). After sensitivity analysis, pooled rates of failure incidence were relatively comparable at 11% at 0-1 years (95% CI: 0.08-0.13) and 15% at 2-3 years (95% CI: 0.08-0.22) following surgery. Development of osteoarthritis (OA), in patients with knees previously free from articular pathologies, was 4% at 2-3 years (95% CI: 0.02-0.07), and 10% at 4-6 years (95% CI: 0.03-0.25). Rates of reoperation were observed to be 12% at 0-1 years (95% CI: 0.08-0.17), 15% at 2-3 years (95% CI: 0.05-0.28). The return to pre-injury levels of activity in patients was 46% at 0-1 years (95% CI: 0.30-0.62), 88% at 2-3 years (95% CI: 0.79-0.95), and 96% beyond six years (95% CI: 0.81-0.99).
Meniscus repair for traumatic injuries have an all-cause failure rate that increases from 12% to 19% through one to six years following surgery. With these pooled estimates of outcomes following meniscus repair, a case can be made for more prospective studies to be performed, investigating the long-term final outcomes following meniscus repair.