Orthopedic study finds medial meniscus repairs and those performed with ACL reconstruction raise odds for meniscal suture failure

SAN DIEGO — Medial meniscus repairs and meniscus repairs with concurrent ACL reconstruction in younger patients are likely to result in the failure of suture repair within the meniscus, according to a recently presented study.

The findings were presented by William G. Rodkey, DVM, Diplomate ACVS, here at the 28th Annual Meeting of the Arthroscopy Association of North America.

High rates of repeat surgery have been reported in meniscus repairs, and researchers to this point have been unable to determine a cause. According to Rodkey, the study was an attempt to figure out that cause.

“Many factors can influence the success of meniscus repairs,” Rodkey said. “We observed that medial meniscus repairs have higher rates of repeat surgery than lateral, and they fail earlier … meniscus repairs done concurrently with ACL reconstruction have higher rates of repeat surgery. This study supports performing meniscus repair and ACL reconstruction as two separate-stage operations in appropriate patients.”

In the study, a single surgeon performed inside-out suture meniscus repairs on 177 men and 106 women with an average age of 31 years. One hundred thirty-seven of the patients had an ACL reconstruction along with the meniscal repair, with 93 undergoing concurrent reconstructions and 44 undergoing two-stage reconstructions. The surgeon repaired 181 medial menisci and 201 lateral mensici.

According to Rodkey, 28 of the patients (10%) required repeat surgery on their repaired meniscus within 2 years of the original surgery with an average time of 12 months between surgeries. No differences based on age, gender or location were reported. Thirteen percent of medial repairs and 4% of lateral repairs failed, with medial meniscus repairs failing sooner than lateral repairs — 5.6 months compared to 12.9 months, respectively.

Age was a factor for patients who underwent ACL reconstruction concurrent with meniscus repair, as the average age for patients with failed repairs was 22 years and the average age for nonfailed repair patients was 29.

Having a concurrent ACL reconstruction was also a factor, as patients who underwent two-stage repairs showed a failure rate of 2%, while concurrent ACL reconstruction patients showed a failure rate of 11%, Rodkey said.

Reference:
Briggs KK, Rodkey WG, Steadman JR. Specific factors are associated with failure of meniscus suture repair. Presented at the 28th Annual Meeting of the Arthroscopy Association of North America. April 30-May 3, 2009. San Diego.