Summary

Patients over the age of 40 years old, regardless of concomitant ACL reconstruction, have similar 2-year IKDC scores, return to sport rates, and reoperation rates following meniscus repair compared to patients younger than 40 years old.

Abstract

Background

Meniscus tears are a common cause of knee pain in young, active patients. These injuries may occur in the setting of concomitant ACL pathology or in isolation. Historically, meniscal tears are treated by either repair or partial meniscectomy, with meniscus repair associated with good post-operative outcomes and a better long-term prognosis compared to partial meniscectomy in young patients. However, recent studies have also supported meniscus repair instead of partial meniscectomy in patients older than 40 years old. The purpose of this study was to compare patient reported outcomes, return to sport rates, and reoperation rates after meniscus repair in patients older and younger than 40 years of age.

Methods

All cases of meniscus repair performed at a single tertiary care center between December 2010 and August 2021 were retrospectively reviewed from a prospectively collected institutional registry. Demographic, perioperative and clinical data were obtained from the electronic medical record. SANE scores, IKDC scores, Marx scores, return to sport data, and reoperation data were obtained either via electronically administered surveys. Subjects were classified into four groups for comparison: (1) less than 40 years old with isolated meniscus repair, (2) greater than or equal to 40 years old with isolated meniscus repair, (3) less than 40 years old with concomitant meniscus repair and ACL reconstruction, and 4) greater than or equal to 40 years old with concomitant meniscus repair and ACL reconstruction.

Results

One hundred thirty patients were included for analysis, 91 (70%) of which were younger than 40 years of age and 39 (30%) of which older than 40 years of age. Table 1 demonstrates demographic data for included patients. Seventy-three patients (56%) were male, and the average age was 33.6 +/- 10.7 years. Ninety-nine patients (76%) underwent concomitant meniscus repair and ACL reconstruction, while 31 patients (24%) underwent isolated meniscus repair. Eighty-six patients (66%) underwent medial meniscus repair, 35 patients (27%) underwent lateral meniscus repair, and 9 patients (7%) underwent both medial and lateral meniscus repairs. When comparing between age groups in patients with concomitant ACL reconstruction, there were no statistically significant differences in 2-year IKDC scores (85.9 for <40, 84.2 for ≥40, p=0.58), return to sport rates (70% for <40, 75% for ≥40, p=0.80), or reoperation rates (20% for <40, 21% for ≥40, p=0.99) (Table 2). Marx scores at 2 years post-operatively were significantly higher for < 40 years old group (9.0 vs. 7.6, p<0.001). When comparing between age groups with isolated meniscus repairs, there were no statistically significant differences in 2-year IKDC scores (81.7 for <40, 83.7 for ≥40, p=0.72), return to sport rates (50% <40, 80% ≥40, p=0.24), or reoperation rates (11% for <40, 0% for ≥40, p=0.54) (Table 3). Marx scores at 2 years post-operatively were also significantly higher for < 40 years old group (7.95 vs. 5.5, p<0.001).

Conclusions

Our findings suggest that patients over the age of 40 years old, regardless of concomitant ACL reconstruction, have similar 2-year IKDC scores, return to sport rates, and reoperation rates following meniscus repair compared to patients younger than 40 years old. Marx scores, however, were significantly higher for patients less than 40 years old in both the concomitant ACL group and the isolated repair group. Despite a limited sample size, this data suggests that meniscus repair may be successfully performed in patients over the age of 40, with outcomes comparable to patients younger than 40. Thus, surgeons may consider meniscus repair in patients over the age of 40 years old if the tear type is amenable to repair, with good associated clinical outcomes.