Summary

Repairable tears and meniscal repair have increased in the last 20 years

Abstract

Aim

To analyze the evolution in the indications of arthroscopic surgery on repairable meniscal tears in the last 20 years and the treatment peformed.

Hypothesis

An increase in the indication of surgical treatment on repairable meniscal tears would be found in the last 20 years, as well as an increase of meniscal repairs.

Material And Methods

A large database of arthroscopically operated meniscal tears in the last 20 years was reviewed to analyze the characteristics of each meniscal tear: sex, age, knee and meniscus affected were recorded. Furthermore, the morphology, the location on the axial plane and the vascularization of the tear were registered. Repairable tears were those longitudinal in zones 1 and 2, ramp lesions, root avulsions (except those with very degenerative tissue) and those radial and horizontal in zone 1. Other types of meniscal tear were only considered repairable when they were repaired. The moment of the surgery, stratified in 4 groups (2002-2006, 2007-20011, 2012-2016 and 2017-2021), and the characteristics of the meniscal tears were compared according to it and to the presence of degenerative tissue on the meniscal tear. Student’s T and ANOVA tests were used to compare means. Categorical data were represented in contingency tables and compared using the ?2 test for significance of differences. Statistical significant differences were set at p<0.05.

Results

1892 records met the criteria for inclusion. A total of 49.1% of the meniscal tears were found to be repairable; an increase was found through the years, from a 1.6% in 2002-2006 to a 82.3% (p<0.001) in 2017-2021. Both sexes experimented over an 80% increase in the presence of repairable tears, which surpassed the 95% in patients under 30 years old. Patients over 45 years experimented a 50% increase (p<0.001). Injuries to the left knee were found to be more repairable (85.2% vs 80.3%; p<0.001). More repairable tears were found in the medial meniscus (83.1 vs 80.9%; p<0.001) and the posterior horn was the most common location for those tears (86.4%; p<001). Regarding the surgical procedures performed, meniscectomies decreased from a peak 91.4% in 2007-2011 to a 17.7% in 2017-2021 (p<0.001) while meniscal repair increased from a 0.4% in 2002-2006 to a 81.3% in 2017-2021 (p<0.001), matching the percentage of repairable tears.

Conclusion

A significant increase in the indication of arthroscopic surgery on repairable tears has been found in the last 20 years, as well as the percentage of meniscal repair performed. This data may encourage other surgeons to increase their indications on repairable tears and match the repair procedures that they perform.