Summary

Meniscus tear repair within 3 weeks after trauma shows better results than later repairs, as can be concluded from our series of 112 repairs in two groups. In the first group, 92/95 repairs within 3 weeks were successful, with three failures; in the second group, 14/17 later repairs were successful, with three failures. The difference between these two groups is statistically significant.

Abstract

Introduction

Tendon repair surgery within 3 weeks of injury yields better results than later procedures. This study confirms that arthroscopic meniscus repair surgery performed within 21 days of injury yields better results than repairs made after 3 weeks. Successful repair of a rupture can prevent early onset of knee arthrosis.

Method

The posterior and middle third of the meniscus was repaired using standard arthroscopic methods. The posterior third was repaired using Meniscus Arrows® (Conmed-Linvatec, Largo, FL, USA) and the middle third was repaired by inserting PDS 2.0 stitches using a Meniscus Mender® outside-in device (Smith & Nephew, London, UK). All ruptures occurred in the red-red and red-white zones. Sport was the predominant cause. Patients were followed-up for a mean of 5 years (range: 2–12 years). This prospective series included two groups: in group 1, the rupture was repaired within 3 weeks, and in group 2, the repair was made later than 3 weeks. Group 1 comprised 91 patients (57 men, 34 women) who underwent 95 meniscus tear repairs from 2002–2013. The mean age was 29 years (range: 12–66 years). In four patients, both knees required surgery. All repairs were performed within 21 days (range: 1–21 days; mean: 11 days) of injury. Group 2 comprised 15 patients (10 men, 5 women) who underwent 17 repairs (both menisci in two cases). The mean age was 27 years (range: 15–39 years). Repair was performed between 22 and 540 days (mean: 68 days) after injury. To compare the success rate in both groups, the number of patients was used instead of the number of surgeries to assure independent observations. Fisher' exact Chi-Square tests were used because of the small patient numbers.

Results

Of the 95 repaired menisci in group 1, 92 (97%) healed without complications. Although previously asymptomatic, one (1.1 %) patient was re-injured within 11 months of initial surgery while playing unrestricted soccer. Arthroscopic examination revealed complete inertness of the initial, unhealed, tear. Resection of this part of the meniscus followed. In two other cases (2.2%), both of whom were asymptomatic, repair proved to be only partially successful, as revealed by arthroscopic examination following re-injury at 31 months post-repair in one case, and during an ACL reconstruction procedure at 12 months post-repair in the second case. In both cases, only the non-healed part of the meniscus was removed, preventing further rupture and preserving most of the meniscus. In group 2, rasping of the rupture surfaces was conducted during the procedure and multiple perforations were performed to improve healing. In three cases, the repair was unsuccessful and partial meniscectomy was performed due to persistent complaints. The success rate in group 1 (97%) was significantly better than that of group 2 (82%; p-value=0.04).

Conclusion

The overall success rate of meniscus repair within 3 weeks after trauma was 97%, compared with 82% after 3 weeks. Therefore, early repair of meniscus tears is beneficial (as seen for early tendon repairs) and can prevent failure of meniscus repair surgery and early knee arthrosis.