High failure rate after medial meniscus bucket handle tears repair in the stable knee

Inside-out repair of bucket-handle meniscal tears in young patients: Long-term effectiveness in a high-risk population

OBJECTIVE

Bucket-handle meniscal tears (BHMT) represent a severe tear and are challenging to preserve. This study focused on BHMT repair with mainly inside-out vertical sutures using non-absorbable materials in stable knees (no associated anterior cruciate ligament tear) in patients under 18 years old, evaluating survival rates and clinical outcomes. We hypothesized that this technique could result in a low failure rate in this presumed at-risk population.

METHODS

This retrospective study included 31 patients (31 knees) with a mean age of 13.7 years old at time of arthroscopic meniscal repair for BHMT (19 lateral and 12 medial) between 2010 and 2019.

RESULTS

After a mean follow-up of 8.25 ± 2.9 years, seven clinical healing failures (22%) were observed, with 5-year survival rates of 77.4% for all lesions, 75% for medial menisci, and 78.9% for lateral menisci. The mean recurrence interval was 26.4 ± 18.8 mo. Clinical outcomes included mean pedi-IKDC scores of 83.7 ± 12.2 mean Kujala scores of 86.7 ± 10.9, Simple Value Test subjective functional scores of 82.5 ± 13.3, and Tegner scores of 6.4 ± 2.1.

CONCLUSION

This study demonstrates that sutured repair of bucket-handle meniscal tears in stable knees of patients under 18 years of age is associated with a relatively low failure rate, supporting the hypothesis that this technique is effective in a population traditionally considered at risk.

LEVEL OF EVIDENCE

IV; Retrospective study.

Failure rate of isolated medial meniscus repair in the stable knee: Systematic review and meta-analysis

PURPOSE

The present meta-analysis aims to determine the outcomes and failure rates for medial meniscus repairs in patients with stable knees.

METHODS

A literature search was conducted using PubMed and Scopus with the terms '(medial meniscus OR medial meniscal) AND (repair)'. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included 93 articles assessed for eligibility. The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analyses and case reports.

RESULTS

In total, 10 studies with 595 patients were included. Degenerative tears or studies reporting meniscus repair outcomes on root repairs, revision or primary anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. All studies included revision surgery and/or clinical symptoms as failure definitions. The overall medial meniscal repair failure rate was 26% with a 95% confidence interval (CI) [15%-37%]. The mean time to failure from isolated medial meniscus repair surgery was 27.7 months with 95% CI [18.5-36.9 months]. The postoperative Lysholm and IKDC scores were reported in three articles. At the final follow-up, the mean postoperative Lysholm and IKDC scores were 92.3 with 95% CI [84.5-100] and 88.6 with 95% CI [83.5-93.8], respectively.

CONCLUSION

The current meta-analysis revealed an overall failure rate of 26% in the case of medial meniscus repair in a stable knee. For these reasons, the patient should be aware of the substantial risk of revision surgery (one out of four cases). Medial meniscus repair in a stable knee yielded good clinical results.

LEVEL OF EVIDENCE

Level II.

First-in-human exploratory trial assessing safety, feasibility, and efficacy of artificial protein (silk-elastin) in promoting healing in patients with meniscus injuries

Meniscal tears, especially those in avascular regions, pose a significant risk for osteoarthritis if repair fails. While meniscal repair is the preferred method for preserving knee function, it often has a high failure rate in avascular zones. This study aimed to evaluate the safety and potential efficacy of silk-elastin (SE), an artificial protein with wound-healing properties, for enhancing meniscal repair. Eight patients with meniscal tears in avascular areas underwent arthroscopic repair followed by SE application, including cases of lateral and medial tears, discoid lateral meniscus, and bucket-handle tears. No adverse events or reactions were attributed to SE. At 3 months post-surgery, clinical outcomes and repair sites were evaluated using MRI and arthroscopy. Significant improvements were observed in Lysholm and visual analog scale scores (P < 0.05), with the knee injury and osteoarthritis outcome scores showing significant improvement in the symptom subscale. MRI findings indicated one patient with grade 1 healing, three with grade 2, and four with grade 3 (unhealed). Arthroscopically, six patients demonstrated completely healed menisci, while two showed incomplete healing; none were classified as "unhealed." These findings suggest that SE is safe and may support meniscal healing in avascular zones, indicating its potential to improve repair outcomes.