Circumferential Repair of Horizontal Cleavage Meniscus Tears: 82% of Patients With Sustained Improvement and 15% Reoperation Rate at Mean 6-Year Follow-up
Gavin H. Ward, Jason Ina, Sanathan Iyer, Bruce A. Levy, Adam J. Tagliero, Christopher L. Camp, Mario Hevesi, Aaron J. KrychBackground:
Historically, horizontal cleavage meniscus tears (HCTs) have been debrided with single leaflet preservation, but increasing attention has been turned to repair. While circumferential meniscus repair with all-inside and inside-out instrumentation has been described, clinical outcomes for this technique remain underreported.
Purpose:
To assess reoperation rate, patient-reported outcome measures, and return to sport after primary circumferential meniscal repair for HCTs, at a minimum of 2 years of follow-up.
Study Design:
Case Series, Level of evidence, 4.
Methods:
Patients with isolated HCTs of the meniscus undergoing primary circumferential meniscus repair at a single institution (2015-2022) were retrospectively reviewed and included. Patient demographics, surgery details, and clinical findings were extracted from the institutional electronic medical records. Visual analog scale (VAS) for pain, Tegner, International Knee Documentation Committee (IKDC) scores, and return-to-sport data were collected at a minimum 2-year follow-up and analyzed.
Results:
A total of 27 patients (63% male; 63% right knees; mean age 30 ± 12 years; mean BMI, 27.7 ± 5.5 kg/m 2 ) who underwent circumferential meniscal repair of an HCT (63% right knees; 52% lateral menisci) were included and followed for a mean of 6.0 years (range, 2.1-8.6 years). Four (15%) patients failed primary repair and underwent a subsequent procedure (one meniscal repair and subsequent high tibial osteotomy and three partial meniscectomies). Patients reported mean Tegner activity scores of 6 ± 2.3, VAS for pain at rest of 1.3 ± 2.3 and with functional use of 2.8 ± 2.7, and IKDC of 77.4 ± 22.6. When asked, using a 5-point VAS, how their knee is currently compared to before surgery, 22 (81%) patients reported feeling better than before surgery. Twenty-one patients were involved in sports before surgery, and 18 (86%) returned to sport.
Conclusion:
At an average of 6 years of follow-up, circumferential repair of horizontal cleavage tears sustained subjective clinical improvement, reoperation rates at only 15%, and 86% returned to sport. Therefore, circumferential meniscus repair should be considered at the time of surgery in select patients with symptomatic tears amenable to repair.