Short-Term Outcomes Of Meniscus Repair Are Not Clinically Worse Than Arthroscopic Partial Meniscectomy: A Retrospective Cohort Study Of 219 Patients

Short-Term Outcomes Of Meniscus Repair Are Not Clinically Worse Than Arthroscopic Partial Meniscectomy: A Retrospective Cohort Study Of 219 Patients

Glen Liau , MBBS, MRCS, MMed, FRCS, FAMS, MBA, SINGAPORE Thirukumaran Kamaraj, MBBS, SINGAPORE Ying Ren Mok, MBBS, MRCS, MRCS, MSpMed, SINGAPORE Kennan Yeo, MBBS, SINGAPORE Yee-Han Dave Lee, MBBS, FRCS(Ortho), SINGAPORE

National University Hospital , Singapore, Singapore, SINGAPORE


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Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Ligaments

ACL

Sports Medicine


Summary: This study compared short-term outcomes of meniscus repair (MR) vs. arthroscopic partial meniscectomy (APM) during ACLR. Analyzing 219 patients, MR and APM both showed significant improvements at 2 years. However, although APM had better scores in various PROMs, MR was not clinically significantly worse than APM as there is minimal difference in the rates of achievement of MCID.


Introduction 
Anterior cruciate ligament reconstruction (ACLR) with concomitant meniscus injuries are extremely common. Studies that examine the surgical methods to repair or resect the meniscus next to an ACLR have presented varying outcomes in the short term. As such, this paper aims to evaluate the short-term outcomes of meniscus repairs (MR) and arthroscopic partial meniscectomies (APM) concurrent with ACLR, as well as the clinical significance in these outcomes using the concept of minimally clinically important difference (MCID). 
  
Methods 
A retrospective study was conducted involving 219 patients who underwent ACLR between 2000 and 2022. There were 92 concurrent APMs and 145 meniscal repairs MRs. Patients were graded pre-operatively and post-operatively using the Lysholm and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores. MCID is a measure of clinical significance and was measured by the percentage of individual patients who passed the threshold value attained from a previous study with similar population demographics. The percentage of patients who passed MCID will be compared between both populations to assess whether there is a significant difference in patients who have clinically significant outcomes. 
 
Results 
All APM and MR groups had statistically significantly better outcomes at 2 years postoperatively. APMs had statistically significantly better outcomes 2 years postoperatively for Lysholm score (95.2 vs 92.8), KOOS Symptoms (94.7 vs 91.0), KOOS Pain (97.5 vs 95.9), KOOS ADL (98.3 vs 97.2), KOOS Sports (90.8 vs 84.2), and KOOS QoL (85.5 vs 79.8). However, when assessing the absolute differences between 2 year and preop groups for APM and MR groups, there was no statistically significant difference, except for in KOOS QoL (p = 0.022). The percentage of patients who successfully achieved MCID between both groups did not have a significant difference between APM and MR groups as well, except for KOOS Symptoms (p = 0.027).  
  
Conclusions 
APM and MR concurrent with ACLRs have significant improvements at 2 years. Despite APM patients experiencing statistically significantly better PROMs 2 years postoperatively, when accounting for the improvement of outcome measures over 2 years and the clinical significance of results, where the differences between APM and MR are insignificant, we have determined that MR is not clinically worse than APM in the short term