The results of meniscus repair within 3 weeks after trauma (1.1 % total failure, 2.2 partial failure) in this series are promising, compared to the results, published in the literature, suggesting that an early repair procedure is beneficial and should be considered, or even become the standard procedure, as is already in tendon- and some anterior cruciate ligament repair procedures.
Tendon repair and anterior cruciate ligament (ACL) repair surgery within 3 weeks of injury has yielded better results than later procedures. This study hypothesized that arthroscopic meniscus repair surgery performed within 21 days would yield better results than historical controls.
Standard arthroscopic methods were used to repair the posterior and middle thirds of the meniscus. The posterior third was repaired using Meniscus Arrows® (Conmed-Linvatec, Largo, FL, USA), and the middle third was repaired by inserting PDS 2.0 stitches through Meniscus Mender® outside-in devices (Smith & Nephew, London, UK).
This prospective series included 91 patients, 57 men and 34 women, who underwent 95 meniscus tear repairs from 2002 to 2013. Mean patient age was 29 years (range, 12–66 years). The right meniscus was repaired in 43 patients and the left meniscus in 48, with four knees requiring repair of both menisci. All ruptures occurred in the red-red and red-white zones. Sports were the predominant cause (67/91), most while playing soccer (36/67). Patients were followed-up for a mean of 5 years (range, 2–12 years). All repairs were performed arthroscopically within 21 days (range: 1–21 days; mean: 11 days) after the trauma. Of the 91 repaired menisci, 88 (92.6%) healed without complications and did not require further surgery during the follow-up period. Although asymptomatic, one (1.1 %) patient experienced a new accident 11 months after the initial surgery, while again playing unrestricted soccer. Arthroscopic examination found that the initial tear was completely inert and unhealed, leading to resection of this part of the meniscus. In two other patients (2.2%), both asymptomatic, repair was only partially successful, as revealed by arthroscopic examination of one of these patients after a second trauma, 31 months post-operatively, and during ACL reconstruction in the second patient 12 months after the first surgery. In both, only the non-healed part of the meniscus was removed, preventing further rupture and preserving most of the meniscus. Four other asymptomatic patients (4.2%) experienced re-rupture of their previously mended menisci due to trauma while again participating in their contact sport, as shown by a fresh hematoma along the rupture site. One underwent minimal resection due to local meniscus deformation, and three underwent a second repair of the previously healed tear. None of these four patients experienced any adverse events during the follow-up period.
The overall success rate of meniscus repair within 3 weeks of trauma was 96.7%, higher than previously published results. Early repair of meniscus tears is as beneficial as early tendon and ACL repair procedures.