Summary

High percentage of clinical failure was observed after meniscal repair of bucket-handle tears. However, successful treatment led to lower rates of knee osteoarthritis development at mean 10-years follow-up

Abstract

Purpose

Repair of bucket-handle meniscal tears, is commonly performed when indicated, in an attempt to preserve meniscal tissue and maintain knee function and to avoid early knee cartilage degeneration. The aim of this study is to assess long-term follow-up outcomes, after repair of bucket-handle meniscal tears focusing on failure rate and knee osteoarthritis development.

Methods

This was a retrospective cohort study, including all patients with bucket-handle tears between January 2004 and May 2014, having undergone meniscal repair either isolated or combined with anterior cruciate ligament reconstruction at our department. A combination of all-inside with inside-out and outside-in repair techniques was used in all our patients. Patients over 40 years old, concomitant multi-ligamentous injuries, tears beyond 5 mm of the menisco-synovial junction, and intraoperatively severe cartilage lesions or documented OA, were exclusion criteria. During the follow up, clinical assessment took place using Barrett’s criteria, while knee osteoarthritis evaluation was performed according to Kellgren-Lawrence classification, using knee standing x-rays. Patients were assessed in term of knee function using International Knee Documentation Committee (IKDC) score, Lysholm score and Knee injury and Osteoarthritis Outcome Score (KOOS).

Results

In total, 66 patients met our inclusion criteria. Mean age at the time of the operation was 21.8 years (13-45). Average time from the time of the injury to the time of the operation was 11 (1-35) weeks. Mean follow-up was 114 (60-176) months. Total failure rate was approximately 33% (22 out of 66 patients) at a mean time of 19 (9-39) months.
Patients with medial meniscus repair had 4.8 higher relative likelihood of failure compared to lateral meniscus [p = .014, OR= 4.81 (95% Cl: 1.24, 18.68)]. Patients over 16 years old, had 5.71 higher relative likelihood of failure [p = .016, OR=0.175 (95% Cl: .04, .85)]. Concurrent anterior cruciate ligament reconstruction or gender, did not have a significant effect on the postoperative outcomes.
Statistically significant difference regarding KOOS score was observed between patients treated successfully (mean 89.66, SD± 6.65) and patients with failure (mean 80.86, SD±4.92) p = 0.032. There was also significant difference for IKDC score between successfully treated patients (mean 88.22, SD±5.17) and failures (mean 79.26 SD±5.29), p = 0.028 as well as for Lysholm score [success: mean 86.30, SD±5.33, failure: mean 78.41, SD±7.90) p = 0.030]. Knee osteoarthritis was more pronounced in patients failed repairs. More specifically, patients with successful repairs had significantly lower Kellgren-Lawrence score (mean 0.54, SD±0.45) in comparison to patients with failures (mean 2.09, SD±0.61) p = 0.019.

Conclusion

High percentage of clinical failure was observed after meniscal repair of bucket-handle tears. However, successful treatment led to significantly lower rates of knee osteoarthritis development at mean 10-years follow-up. Thus we recommend meniscal repair of bucket-handle tears in patients younger than 40 years without evidence of preexisting knee osteoarthritis.