Which factors are associated with the prevalence of meniscal repair?

Analyzing the Relationship Between Various Factors and Their Influence on the Success Rates of Meniscal Injury Procedures: A Prospective Cross-Sectional Study

BACKGROUND

Meniscal injuries pose a significant orthopedic challenge, demanding a thorough understanding of demographic and injury-related factors for successful treatment. The importance of age, body mass index (BMI), time from trauma to surgery, injury causes, patient occupation, and the presence of anterior cruciate ligament (ACL) injury in influencing postoperative outcomes prompted this prospective cross-sectional clinical study.

METHODS

Conducted from November 2022 to July 2023 with 30 patients, this study utilized rigorous methodologies, employing both analysis of variance and Spearman's correlation analyses. The aim was to comprehensively assess the relationships among these factors and postoperative results in meniscal surgery patients.

RESULTS

The study found that early surgical intervention significantly improved outcomes for meniscal injuries, with patients operated on within two months achieving 100% excellent and good results, compared to 50% for those treated after six months. Younger age, lower BMI, and sports-related injuries were associated with better postoperative Lysholm scores, while higher BMI and delayed surgery correlated with poorer outcomes. Patients with concurrent ACL injuries had a 95.4% rate of excellent and good results, compared to 50% for those with intact ACLs.

CONCLUSION

This study underscores the pivotal role of age, BMI, and ACL injury considerations in shaping effective treatment strategies for meniscal injuries. The nuanced insights gained from the analysis emphasize the critical importance of early surgical intervention, particularly in cases involving ACL injuries, to optimize postoperative outcomes.

Greater Rotational Knee Laxity Observed at Second-Look Arthroscopy in Patients With Failed Meniscal Repair Performed at the Time of Anterior Cruciate Ligament Reconstruction

PURPOSE

To evaluate the healing of meniscal repair performed concomitantly with anterior cruciate ligament reconstruction (ACLR) using second-look arthroscopy, as well as the relationship between meniscal healing and knee laxity using quantitative evaluation under anesthesia.

METHODS

This retrospective study included patients who underwent primary double-bundle ACLR with meniscal repair between June 2016 and June 2021, with a 2-year minimum follow-up. Meniscal healing was evaluated by second-look arthroscopy at least 1 year postoperatively, and knee laxity was measured under general anesthesia preoperatively, intraoperatively, and at second-look arthroscopy.

RESULTS

Of 562 knees treated with ACLR, 113 knees, with 137 meniscal repairs, were analyzed. Second-look arthroscopy classified 114 menisci (83.2%) as healed and 23 (16.8%) as failed. The side-to-side difference in anterior tibial translation (ATT) and the side-to-side ratios of tibial acceleration and external rotational angular velocity (ERAV) improved intraoperatively in both groups (ATT, 6.0 to -1.0 mm [P < .001] and 6.0 to -1.0 mm [P < .001]; acceleration, 5.1 to 1.2 and 4.9 to 1.1 [P < .001]; ERAV, 3.6 to 1.3 and 3.6 to 1.6 [P < .001]). There were no significant differences in ATT and patient-reported outcome measures, including the Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS), between the groups. The proportion of patients achieving the minimal clinically important difference for the Lysholm score and KOOS did not differ significantly between the groups. However, at 1 year postoperatively, acceleration and ERAV were higher in the failed group than in the healed group (P < .001).

CONCLUSIONS

Patients with failure of meniscal repair performed concomitantly with ACLR showed significantly greater rotational knee laxity at the time of second-look arthroscopy. These patients exhibited significantly higher preoperative and postoperative pivot-shift grades than those who did not experience failure of meniscal repair. There were no significant differences in ATT and patient-reported outcome measures between the groups.

LEVEL OF EVIDENCE

Level Ⅲ, retrospective comparative study.

Meniscal Lesions in Multi-Ligament Knee Injuries

Introduction

Multi-ligament knee injuries (MLKIs) are rare and complex knee lesions and are potentially associated with intra-articular injuries, especially meniscal tears. Understanding the meniscal tear patterns involved in MLKI can help the orthopedic surgeon treat these complex injuries.

Objective

The purpose of this study was to describe the incidence, classification, and treatment of meniscal injuries in a cohort of patients with MLKIs and carry out an updated review of the evidence available.

Materials and methods

Descriptive retrospective study. Patients with a history of reconstructive surgery for MLKI performed between 2013 and 2023 were included. Informed consent was obtained from all patients included in the study. Patient demographics, magnetic resonance imaging (MRI) study, and operative reports were reviewed. Groups were then formed based on ligament injury patterns. Meniscal tears were identified by MRI and through diagnostic arthroscopy for each patient. The association between meniscal lesions and injury patterns was calculated through Fisher's exact test. Agreement between the presence of meniscal tear on MRI and in diagnostic arthroscopy was measured using the kappa test. The sensitivity and specificity of MRI were calculated. We inferred the presence of a meniscal tear by injury pattern using the Agresti-Coull confidence interval. For the statistical analysis, a significance of 5% and a confidence interval of 95% were considered.

Results

Seventy patients with MLKIs were included, with a mean age of 30.69 years (SD 10.65). Forty-seven patients had meniscal lesions (67.1%). Of them, 6 had only medial meniscus tears, 31 had only lateral meniscus tears, and 10 had lesions of both menisci, comprising 57 meniscal lesions in total. An anterior cruciate ligament (ACL) + medial collateral ligament/posteromedial corner (MCL/PMC) was the most common injury pattern (52.86% of all patients). Of these 37 patients, 78.38% had meniscal injuries, and most of them (68.97%) were only lateral meniscus injuries. The odds ratio (OR) of having a meniscal tear when having an ACL + medial-side injury was 4.83 (95% CI; 0.89-26.17). Patients with ACL + lateral-side injury pattern had meniscal tears in 42.86%. The lateral meniscus was involved in 100% of these patients. 62.5% of medial meniscus injuries were treated by meniscal repair, and 37.5% by partial meniscectomy. 58.54% of lateral meniscus injuries were treated by meniscal repair, and 39.02% by partial meniscectomy. Agreement calculated using the kappa test between MRI and diagnostic arthroscopy for medial meniscal lesions was 78.57%, and for lateral meniscal lesions was 84.29%.

Conclusion

The ligament injury pattern and the side of the injured collateral ligament influenced the incidence and laterality of meniscal damage. ACL + medial-side injuries were shown to have significantly greater meniscal damage compared to other injury patterns. It is crucial to have a high index of suspicion, obtain a high-quality MRI, and arthroscopically evaluate any possible meniscal lesions in MLKIs.

Costs and Timing of Surgery in the Management of Meniscal Tears

Background

Treatment strategies for meniscal tears range from nonoperative management to surgical intervention. However, national trends in cost-related outcomes and patient factors related to the failure of nonoperative management remain poorly understood.

Purpose

To describe the costs associated with nonoperative versus operative management of meniscal tears in the 2 years after diagnosis and examine the relationship between patient characteristics and timing of surgery.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

This study was conducted using the MarketScan databases. Patients diagnosed with a meniscal tear without concomitant knee osteoarthritis between January 1 and December 31, 2017, were included. The primary outcome was the total cost of meniscal tear-related procedures-including insurance deductibles, coinsurance, and net insurance payments-in the 2 years after diagnosis. Procedures included were as follows: (1) surgery-including meniscectomy or meniscal repair; (2) physical therapy; (3) medication-including nonsteroidal anti-inflammatories, opioids, and acetaminophen; (4) intra-articular injections-including professional fee, hyaluronic acid, and corticosteroids; (5) imaging; and (6) clinic visits to orthopaedic specialists. Patients were grouped as having undergone early surgery (ES) (≤3 months of diagnosis), late surgery (LS) (>3 months after diagnosis), or no surgery (NS). Multivariate logistic regression was performed to determine the likelihood of undergoing surgery early and failing nonoperative treatment.

Results

The study population included 29,924 patients with a mean age of 43.9 ± 12.9 years (ES: n = 9507 (31.8%); LS: n = 2021 (6.8%); NS: n = 18,396 (61.5%)). Complex (36.6%) and medial (58.8%) meniscal tears were the most common type and location of injuries, respectively. The mean cost of management per patient was $3835 ± $4795. Costs were lower in the NS group ($1905 ± $3175) compared with the ES group ($6759 ± $5155), while the highest costs were observed in the LS group ($7649 ± $5913) (P < .001). Patients who were men, >40 years, and with a bucket-handle or lateral meniscal tear were more likely to undergo surgery early. Patients who were men, <30 years, and with a complex tear or tear to the lateral meniscus were more likely to fail nonoperative management.

Conclusion

Nonoperative management had the lowest cost burden and should be recommended for patients with appropriate indications. However, if surgery is necessary, it should be performed earlier.

Incidence and type of meniscal tears in multilligament injured knees

PURPOSE

Meniscal injuries occurring during multi-ligament knee injuries (MLKI) are underreported. The purpose of this study was to compare the incidence and type of meniscal tears seen at the time of multi-ligament reconstruction surgery compared to those occurring during isolated anterior cruciate ligament (ACL) surgery.

METHODS

Patients undergoing surgical treatment for MLKI and ACL-only injuries between 2010 and 2020 were reviewed. Two-hundred and thirty-five patients were included in the MLKI group. There were 131 chronic injuries and 104 acute injuries. Two-hundred and twenty-two ACL-only chronic injuries were used as a control group for comparison with the chronic MLKI group. Demographic data, type of meniscal tears, ligament injury patterns (Schenck classification) and time from injury to surgery were recorded. A delayed procedure was defined by a 4-week interval after the knee injury.

RESULTS

A meniscus was torn in 69 knees (29.4%): 36 knees (15.3%) with an isolated medial meniscus tear, 33 knees (17.9%) with an isolated lateral meniscus tear,.Nine knees (3.8%) had both menisci torn. MLKI with medial or lateral-sided bicruciate ligament injuries (KDIIIM-KDIIIL) were significantly associated with a lower rate of meniscal tears than knee injuries involving the ACL-only and medial/lateral-sided ligament injuries (KDI) (medial-sided injuries p = 0.025; lateral-sided injuries p = 0.049). Lateral-sided injuries had significantly less meniscal damage than medial-sided injuries: 22/124 (17.7%) vs. 41/100 (41%); (p < 0.001). No significant differences were found for frequency, type and distribution of meniscal tears between acute and chronic MLKI surgery. ACL-only chronic injuries were associated with a higher rate of meniscal tears: 123/222 knees (55.4%) vs. 35/131 (26.9%) chronic MLKI; (p < 0.001), mainly involving the medial meniscus: 102/222 (46%) vs. 18/131 (13.7%); (p < 0.001).

CONCLUSIONS

Meniscal tears were less common in the MLKI group than in the isolated ACL injury group. The degree of ligament injury patterns and the side of the injured collateral ligament influenced the type and incidence of meniscal damage. Contrary to isolated ACL injuries, a delayed procedure was not associated with a higher rate of meniscal lesions but did influence the type of treatment. Understanding of meniscal tears patterns in MLKI helps to improve the treatment management of these complex injuries.