Indications are narrow for successful meniscal repair

KOHALA COAST, Hawaii — Because the risk for future surgery following meniscal repair is about the same as following meniscectomy, a former president of the Arthroscopy Association of North America recommends limiting repairs to narrow indications.

Jack M. Bert, MD, suggested considering repair for younger patients with peripheral longitudinal tears with stable knees in the red- zone and traumatic tears repaired early with less than 4 mm of the meniscal rim remaining.

“Timing is everything when you compare results of meniscal repair,” Bert said at Orthopedics Today Hawaii 2010, here. “Early repairs do the best. Ninety-one percent [healed] in one study and late repairs [do] the worst. Traumatic tears do much better than atraumatic, 73% vs. 42%.”

Bert, who is a section chair for the meeting, said many of the results seen are based on the anatomy of the meniscus. “The lateral meniscus carries about 70% of the load and if you look at the literature, you will se that is probably why it is reported that lateral meniscectomies do poorly over time in long-term follow-ups.

Jack M. Bert, MD
Jack M. Bert

“So should we feel good about a resecting oblique flat tears, most buckets, horizontal cleavage tears, complex white-white tears?” he asked. “The answer in two words is absolutely yes.”

He cited the following data from the literature:

the risk for further surgery after partial meniscectomy is about the same as after meniscus repair;
the long-term results of meniscus repair vs. partial meniscectomy appear to be about the same;
the long-term results of partial meniscectomy may be better than meniscal repair; and
the results of repair in the avascular zone has 38 to 50% failure rates when failure was defined as “lack of healing” when viewed arthroscopically.

Reference:
Bert JM. Is meniscal repair necessary? Presented at Orthopedics Today Hawaii 2010. Jan. 10-13, 2010. Kohala Coast, Hawaii.