Summary

A study of 170 elite athletes demonstrated that all- inside medial meniscal repairs had a significantly higher failure rate when compared with inside-out medial meniscus repairs and all types of lateral meniscus repairs.

Abstract

Introduction

The two most common methods of meniscal repair are all-inside (AI) utilising arthroscopically placed suture devices and inside-out (IO) where sutures are passed through the meniscus and the capsule and tied on the external surface of the capsule. Even though few studies exist comparing the results of these two techniques there has been a shift away from the historic gold standard of IO towards more AI repairs.

The aim of this study was to compare the failure rate and the time to failure of all-inside and inside-out meniscus repair performed in elite athletes.

Methods

A retrospective review was performed of all elite athletes who underwent meniscal repair, under the care of the senior author, between 2013 and 2019. All meniscus repairs with a minimum of two-year follow-up were included in the study, including patients who underwent concurrent cruciate ligament reconstruction. If a patient had both medial and lateral menisci repaired during the same surgery, they were tracked separately for failure.

Meniscus repairs were classified as AI or IO depending on the type of repair performed. Failure was defined as undergoing a subsequent surgery to address a persistent meniscal tear.

The Fisher exact test was used to analyse categorical data while continuous variables were evaluated using analysis of variance (ANOVA) with Bonferroni adjustment for multiple comparisons. Survival analysis or specifically Cox proportional hazards modelling was used to determine if meniscal repair failure rates differed by location and technique of meniscal repair.

Results

170 elite athletes (192 repairs) with an average age of 23.1±4.9 years underwent meniscus repair.

55% played football, 37% played rugby and 8% participated in gymnastics, hockey, cricket, or other sports. Concurrent cruciate ligament reconstruction was performed in 59% of patients. 41 (21%) meniscus repairs failed during the study period. Medial meniscus tears repaired with the AI technique failed at a significantly higher rate (58%) than medial meniscus tears repaired with the IO (23%) or lateral meniscus tears repaired with the AI (12%) or IO (14%) technique (p<.001).

Overall, meniscus repair failure in patients with a medial meniscus tear repaired with the AI technique were almost 8 times higher at any point in time as compared to AI repair of the lateral meniscus. At 1 year following repair, 8% of lateral meniscus repairs had failed (regardless of technique), while medial meniscus repairs failed at rate of 16% for IO and 42% for AI. By 2 years, the failure rate of a medial meniscus tear repaired with the AI technique was 53% and at 5 years was 63%.

Conclusion

All-inside medial meniscal repair led to a higher rate of failure compared to inside-out medial or lateral meniscus repair in elite athletes. Medial meniscus repairs failed at a high rate than lateral meniscal repairs.