Meniscal Repair: Failure rate and clinical outcomes with minimum two years follow-up

摘要

Objectives The purpose of our study was to evaluate the clinical outcomes and failure rate of a series of patients who underwent meniscal repair with a minimum two-years of follow-up. Methods We retrospectively reviewed patients treated with meniscal repair between 2004 and 2016. We included patients with at least 2 years of follow-up. Surgical details such as the affected menisci, type of rupture and meniscal repair technique used were analyzed. Clinical and functional outcomes were evaluated using Lysholm and IKDC scores. Patients were studied with x-rays and magnetic resonance imaging (MRI). We analyzed the failure rate (defined as a re-rupture that required surgery). We compared failure rate for isolated meniscal repair vs associated with Anterior cruciate ligament reconstruction (ACLR). Also we compared patients operated before and after 2014. Results One hundred sixty nine patients were operated during that period of time. Ten patients did not meet inclusion criteria and forty were lost in follow-up. Out of the 119 patients evaluated, 35 had bucket-handle lesions, 25 tears in the posterior horn treated with all inside sutures and 59 body and posterior horn lesions treated with a combined suture technique. The mean postoperative Lysholm score was 85 (SD 14) and IKDC 70 (SD 10). The mean return to sports time was 8 months (range 2-19). An MRI was performed in 71 patients. The overall failure rate was 21% (24 /119) at a mean time of 20 months (range 2-60 months) and 26% (9/35) for bucket-handle lesions at a mean time of 21 months (range 2-60 months). Failure rate for the 48 isolated lesions was 20% at a mean of 23 months and 19% for 70 associated to ACLR at a mean of 17 months (p=0.53). Isolated bucket-handle lesions had failure rate of 27% at a mean of 27 months and when associated to ACLR this was 23% at a mean of 12 months (p=1.0) Overall failure rate for patients treated before 2014 was 27% (18/67) and 12% after 2014 (6/52) (p=0.03). For bucket-handle lesions before 2014 was 36% (8/23) and 8% after 2014 (1/12) (p=0.03). Isolated bucket-handle lesions failure rate was 45% (5/11) before 2014 and 0% (0/7) after 2014 (p=0.01) and when associated to ACLR, it was 25% (3/12) before 2014 and 20% (1/5) after 2014 (p=0.09). Conclusion Overall failure rate of our series was 21%. We found no differences between isolated lesions and associated to ACLR. There was a statistically significant difference regarding failure rate results for those operated before and after 2014. This might be the result of an improvement in the surgical devices, modifications in the technique and the number of sutures for each procedure.