Surgeon details the role of meniscectomy for the treatment of meniscal tears

WAILEA, Hawaii – Although there has been an increased number of isolated meniscus repairs, meniscectomy is still an appropriate procedure for the treatment of meniscal tears, according to a presenter at Orthopedics Today Hawaii 2014, here.

Jack M. Bert

“The trend is to have an increased number of isolated meniscal repairs being performed in the United States during the past 7 years without an increase in meniscectomies,” Jack M. Bert, MD, said.

The PearlDiver patient record database, which represents approximately 9% of the U.S. population younger than age 65 years, indicates a significant increase in the total number of isolated meniscus repairs performed and a doubling of the incidence of repairs performed from 2005 to 2011. Meniscal repairs represent 6.1% of all meniscal surgeries, Bert, who is an Orthopedics Today Editorial Board member, said.

“[After] a review of the literature, the most consistent, successful results of repair in multiple series by multiple surgeons are [for] peripheral longitudinal tears in stable knees in the red-red or red-white zones with less than 4 mm of meniscal rim remaining,” he said.

The accepted indications for meniscal repair, he said, include the longitudinal, vascular zone with central substance intact. Experimental indications for meniscal repair are radial tears, avascular zone repairs and tears with meniscus degeneration. Bert said recent studies indicate better long-term results with re-repair than meniscectomy with a decrease in osteoarthritis.

“For experimental cases, you have to have a long discussion with patients to make them understand they may need a second operation. But, in the long run, it is better for them,” he said.

Bert said that indications for resection include oblique and flap tears in the white zone, except perhaps in very young patients, and patients with bucket handles with degenerative, unstable remnants. Unstable portions of horizontal cleavage tears back to a stable remnant; displaced, symptomatic, degenerative tears; complex tears back to a stable remnant are also indicated for resection. White-on-white tears are indicated for resection, unless the patient is willing to accept a relatively high risk of failure. – by Kristine Houck, MA, ELS

Reference:

Bert JM. Is meniscectomy such a bad thing compared to meniscal repair? Presented at: Orthopedics Today Hawaii 2014; Jan. 19-23, 2014; Wailea, Hawaii.

Disclosure: Bert is a consultant for Smith & Nephew, Exactech, Wright Medical Technology, Arthrex, Sanofi, LINK and Exscribe.