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Meniscus Repair or Meniscectomy? Comparison of Long Term Outcomes

Posted Jun 28 2010 3:00am

image There is an interesting study about to come out in an upcoming article in the American Journal of Sports Medicine comparing the outcomes of arthroscopic meniscus repair and partial meniscectomy. 

The authors compared 42 patients undergoing meniscal repair to 39 patients undergoing partial meniscectomy at a mean of 8.8 years after surgery.  The authors specifically evaluated osteoarthritic progress, loss of knee function, and influence on sports activities.  The authors did a good job controlling the study by excluding knees with instability and only including medial meniscus tears.  However, the study was no completely randomized, the decision to perform a repair versus meniscectomy was based on the type of meniscus tear present.

 

Arthroscopic Meniscus Repair Surgery Video

There are some pretty neat videos on YouTube of meniscus repairs, thought this would be a good place and time to include one here:

 

Results

Results of the study were interesting:

  • 81% of patients having a meniscus repair did not show any significant osteoarthritis at the time of follow up, while 60% of meniscectomy patients did show osteoarthritic changes.
  • Functional scores showed no difference between the two procedures, however 94% of meniscal repair patients returned to their previous level of sport activity compared to only 44% of the meniscectomy group.
  • There was a significant drop in sport activity in the meniscectomy group only.

 

Clinical Implications

Personally, I wasn’t very surprised at the large difference between groups.  It is obvious that the mensical repair procedures are fair superior to partial meniscectomy.  It is well established that preserving as much as the meniscus as possible will yield greater results over time.  The menisci play a very important role in shock absorption and the normal biomechanics of the knee. 

There are many pros and cons to both procedures, and the postoperative recovering is certainly longer following meniscal repair, however the results of this study certainly show that pros should outweigh the cons.  It should be noted that sometimes a repair is not always feasible and meniscal damage of this nature will likely result in osteoarthritic changes over time, potentially explaining the results of this study.

What I take away from this study is more educational that clinical.  I am not sure that there is anything we can do differently to enhance outcomes in meniscectomy patients based on this study, but the results do underscore the dramatic importance of the meniscus on knee function.

Imagine that it was fairly common to perform a COMPLETE meniscectomy only a few decades ago!

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