Summary

This study identified the rates of pediatric meniscal failed repairs from >5000 meniscus repairs from a large surgeon-driven, multi-center prospective quality improvement registry to be 2.7%, with higher failure rates associated with isolated meniscus repairs and medial repairs, and no differences in failed repair rates were identified amongst different meniscus tear types or repair techniques.

Abstract

Objective

The incidence of meniscal tears in the pediatric population continues to rise. The rates of failed meniscus repair in this population have been reported between 0-42% in small cohort studies. The purpose of this study is to establish the incidence of failed meniscus repair and factors associated with failed meniscus repair utilizing a large surgeon-driven, multi-center prospective quality improvement registry.

Methods

A prospective, multi-center quality improvement registry (27 institutions and 43 surgeons) monitoring complications of pediatric meniscus repairs between 2018-2024 was queried to identify a cohort of isolated meniscus repairs and meniscus repairs with concomitant ACL (Anterior Cruciate Ligament) reconstruction (ACLR). These were then analyzed to determine the incidence of failed meniscus repairs. Participating sites logged consecutive cases with CPT code 29882 or 29883 on all patients <19 years old into a HIPAA‐compliant electronic platform. Patient characteristics, tear patterns (type, displacement, location, tear zone), surgical technique, and postoperative rehabilitation were included in the analysis. Failure rate was defined as the proportion of failed meniscus repairs within their respective category. These factors were analyzed for their association with failed repair in the isolated meniscus repair group, meniscus repairs with concomitant ACLR group, and in the combined isolated meniscus and meniscus with concomitant ACLR group. Chi-square and Bonferroni post-hoc analyses were performed.

Results

5088 meniscus repairs (3703 meniscus repair with ACLR, 1386 isolated meniscus repair) were identified. The mean age was 15.2 years (range, 4-19 years), and 55.4% were male. In the combined meniscus repair with ACLR and isolated meniscus repair group, the overall failed repair rate was 2.7%. Higher rates of failed repair were seen with isolated meniscus repairs (p<0.001), medial meniscus repair (4.5%, p<0.001) - especially those of the posterior horn + body (8.0%, p<0.001) and with anterior displacement (8.5%, p<0.001), lateral tears of the posterior horn + body (3.5%, p<0.001) and with anterior displacement (3.8%, p=0.001). In the isolated meniscus repair group, the incidence of failed repair was 5.3%. Higher rates of failed repair were seen in the medial meniscus repairs (7.8%, p=0.012) - especially, repairs of medial meniscus tears located in the posterior horn + body (13.3%, p<0.001), and those having a lower BMI (5.5%, p=0.038). In the meniscus repair with concomitant ACLR group, the overall failed repair rate was 1.8%. Rates of failure were again higher in the medial meniscus repairs (3.0%, p=0.012); especially, repairs of medial meniscus with anterior displacement (6.9%, p <0.001). Across all the groups, rates of failed repair did not differ amongst meniscal tear types and repair techniques.

Conclusion

In this large, prospective, multicenter registry, the overall failed meniscus repair rate was 2.7% in a pediatric population, with isolated meniscus repairs being more likely to fail than those with concomitant ACLR. Our findings suggest that all meniscus tear types in the medial and lateral meniscus can be safely repaired with similar rates of failed repairs. Moreover, all meniscus repair techniques performed similarly.