Meniscus tears are common, and depending on the extent of the injury, your patient may be considering a meniscus repair or meniscectomy surgery.
We often try to focus on physical therapy before meniscus surgery, but that isn’t always the best option depending on the location of the meniscus tear.
Over the past few decades, the importance of preserving as much of the meniscus as possible has become increasingly evident. The meniscus plays a very important role in shock absorption and the normal biomechanics of the knee. A disruption of the meniscus can lead to a quicker progression of osteoarthritis in the knee due to increased contact pressures of the articular cartilage.
Meniscus Repair or Meniscectomy? Comparison of Long Term Outcomes
One article published in the American Journal of Sports Medicine in 2019 compared the outcomes (at a mean of 6.2 years after intervention) of 15 patients that received non-operative management, 15 patients that underwent a partial meniscectomy, and 15 patients that underwent a meniscus root repair.
Patient outcomes were evaluated by investigating osteoarthritic progression, identifying patients that required a subsequent total knee arthroplasty, and assessing subjective knee outcome scores. This was a retrospective review, so there was no randomization of the three groups. Treatment was instead based on the chronicity of the tear and quality of the meniscal tissue.
Results of this study found:
- The meniscal repair group had significantly fewer patients that needed a total knee arthroplasty and showed significantly less progressed osteoarthritis.
- 40% of the partial meniscectomy group, 27% of the conservatively managed group, and none of the meniscal repair group progressed to needing a total knee arthroplasty at a mean follow-up of 74 months.
- No significant differences were found in the subjective knee outcome scores between the three treatment groups.
Another study published in the American Journal of Sports Medicine in 2018 performed a meta-analysis also comparing meniscal root repairs to conservative management and meniscectomies.
This review included 355 patients (229 treated with a meniscus root repair, 74 underwent a medial meniscectomy, and 41 managed conservatively). The authors of this study investigated osteoarthritic progression, cost-effectiveness, and the rate of total knee replacements.
The authors found that at the 10 year follow up:
- The rate of osteoarthritis was 53% in the meniscal repair group, 99% in the meniscectomy group, and 95% in the non-operative group.
- The rate of total knee arthroplasty was 34% in the meniscal repair group, 52% in the meniscectomy group, and 46% in the non-operative group.
- The meniscectomy (40% higher) and the non-operative (11% higher) groups also had higher associated costs than the meniscal repair group.
Clinical Implications
Personally, I wasn’t very surprised at the large difference between groups. It is obvious that the meniscus repair procedures are far superior to a partial meniscectomy. It is well established that maintaining the integrity of the meniscus will yield greater results over time.
Here’s a quick video of a meniscus repair procedure where you can see how attempting to preserve as much meniscus as possible may be helpful. Note how keeping as much meniscus as possible can help with the normal function of the knee:
Meniscus Repair or Meniscectomy?
There are many pros and cons to both procedures. The postoperative recovering is certainly longer following a meniscal repair. If you want to learn more, be sure to see my article on meniscus repair rehabilitation.
However, the results of these studies certainly show that the pros outweigh the cons. It should be noted that sometimes a repair is not always feasible and that meniscal damage of this nature will likely result in osteoarthritic changes over time.
What I take away from these studies is more educational than clinical. I am not sure that there is anything we can do differently to enhance outcomes in meniscectomy patients based on these studies. Nonetheless, the results do underscore the dramatic importance of the meniscus on knee function.
Imagine that it was fairly common to perform a COMPLETE meniscectomy only a few decades ago!
Hopefully going forward we will be a little more proactive in handling these injuries and performing a meniscus repair so that we can maximize function as much as possible.
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