Long-term Results of Partial Meniscectomy Reported to Equal Meniscal Repair
Long-term Results of Partial Meniscectomy Reported to Equal Meniscal Repair
abstract & commentary
Synopsis: A consecutive series of 30 patients with open meniscal repair were retrospectively compared to 30 patients who had undergone a partial or subtotal meniscectomy. Although the incidence and severity of arthrosis after 13 years were similar, one must be careful not to draw direct comparisons in the outcome of the patient groups, as they were not identically matched.
Source: Rockborn P, Messner K. Long-term results of meniscus repair and meniscectomy: A 13-year functional and radiographic follow-up study. Knee Surg Sports Traumatol Arthrosc 2000;8:2-9.
The meniscus has been shown in numerous studies to play a vital role in the successful performance and well being of the knee. Loss of the meniscus, in part or in total, significantly alters joint function and predisposes the articular cartilage to degenerative changes. As a result, there has been a tremendous amount of time and effort spent over the past couple of decades to repair and, when possible, preserve damaged or torn menisci. Unfortunately, there are still only a limited number of studies on the outcome of meniscal repair reported in the literature with varying results.
Rockborn and Messner retrospectively compared the long-term results of open meniscal repair to arthroscopic meniscectomy in two consecutive series of patients (n = 30). The groups were matched according to sex, age, meniscus lesion, and follow-up time. Subjective (visual analogue scale) and objective assessment of knee function including activity level (using the Tegner and Lysholm activity scores) were assessed at a mean of 13 years (range, 11-17). In addition, the patients underwent radiographic examination and joint fluid analysis. The data of a subgroup of 22 pairs of patients who had been previously examined in a seven-year follow-up study were available for comparison. At seven years, the patients with the open repair had shown improved knee function and less radiographic signs of premature arthrosis than the meniscectomy group. It was anticipated that the superior results of open meniscal repair over arthroscopic meniscectomy should be even more prominent with longer-term follow-up.
Interestingly, the incidence and severity of arthrosis did not differ significantly between the two groups at 13 years. Most of the patients in the repair group who developed arthrosis between the two follow-up sessions had undergone meniscectomy because of non-healing or rerupture of the meniscus. However, none of the patients in either group had radiographic changes (according to Fairbank) higher than grade-2 arthrosis. Furthermore, there were no differences in knee function, subjective evaluation, range of motion, or muscle strength between groups. The initial superiority of meniscal repair previously reported at seven years was not as evident between the groups at longer-term follow-up.
COMMENT BY CHRISTOPHER D. HARNER, MD
Successful meniscal repair has been reported in the literature to vary anywhere from 63-91%. The results are not easily compared between studies due to different patient populations (i.e., patient age, chronicity, tear pattern, rim width, etc.) and techniques of surgical repair. Rim width is considered the most important predictive factor for healing, because tears closest to the meniscocapsular junction (0-3 mm) have the greatest capacity to heal due to their rich vascular supply. Furthermore, experimental studies have shown that partial meniscectomy significantly increases joint contact pressures (meniscal resection of as little as 15-34% has increased contact pressures > 350%).
Although the groups in this study were matched for several variables, there was no randomization, and the decision for the choice of surgical treatment was dependent upon the type of meniscal tear and quality of the tissue. Meniscectomy was performed in cases with obviously degenerative intrasubstance tears; meanwhile, well vascularized longitudinal peripheral tears were treated exclusively with open repair. Furthermore, the repair group had higher levels of activity in terms of sport participation, both pre- and post-operatively and sustained more trauma at the time of the initial injury.
As the groups are not identically matched and are relatively small in number, it is difficult to draw direct comparisons between the long-term outcome of meniscectomy and open meniscal repair. However, the study does provide important information in that the development of arthrosis in both treatment groups is relatively slow and did not yet result in significant subjective complaints or limit the ability of the patients to participate in the sport. This study reaffirms what is already known about meniscal injury; that is, loss of meniscal function leads to degenerative articular changes. However, the time interval over which this occurs is lengthy and variable in nature.
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