2023 ISAKOS Biennial Congress ePoster
Meniscal Repair Is A Solution In “Older” Patients: A Systematic Literature Review with Meta-Analysis
Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, London, ON CANADA
Chris Saunders, PhD MBChB BMedSci (Hons) UNITED KINGDOM
Matthew Sedgwick, Ph.D., Goole, United Kingdom UNITED KINGDOM
Fowler Kennedy Sport Medicine Clinic, London, Ontario, CANADA
FDA Status Cleared
Summary
Due to older age often being considered a criterion to not perform meniscal, a meta-analysis was performed to establish outcomes of meniscal repair in older patients: a low failure rate and good patient-reported outcomes in older patients receiving meniscal repair was observed and these outcomes were not lower than following meniscal repair in younger patients.
ePosters will be available shortly before Congress
Abstract
Background
Meniscectomy has been demonstrated to lead to long-term deterioration in function and a high risk of osteoarthritis and total knee arthroplasty. These negative effects can be reduced through meniscal preservation. However, despite the long-term benefits of meniscal repair, it appears to be less commonly adopted in “older” populations due to a concern that they are less likely to be successful.
Purpose
To establish the success rates and patient outcomes of meniscal repair in “older” patients (=40 years) and how this compares to “younger” patients (<40 years).
Methods
A systematic literature review was performed to identify published English-language studies that reported on meniscal repair in =5 patients aged =40 years. Outcomes of interest were success/failure (as defined by the study), revision meniscus procedures and patient-reported outcomes. Meta-analyses were used to synthesize outcomes across all studies in older patients. Meta-analyses were also used to provide a comparison in outcomes between older and younger patients across studies providing data on both age groups.
Results
Sixteen articles (15 studies) were identified. Meniscal repair in older patients was identified to have a success rate of 87.5% (95% confidence interval (CI): 80.9 – 92.0; 14 studies) and a revision meniscus procedure rate of 10.0% (95% CI: 7.4 – 13.4; 9 studies). Post-operative International Knee Documentation Committee scores were 76.9 (95% CI: 69.2 – 84.5; 4 studies) and Lysholm scores were 86.7 (95% CI: 81.7 -91.7; 4 studies). Older patients were less likely to experience a failure (relative risk [RR], 0.60; 95% CI: 0.44 – 0.83; p = 0.002; 10 studies) or revision meniscus procedure (RR, 0.60; 95% CI: 0.43 – 0.84; p = 0.003; 7 studies) and had similar Lysholm scores (?2.3; 95% CI: -4.7 – 9.2; p = 0.5278, 3 studies) compared with younger patients.
Discussion
Meniscal repair in older patients can be performed successfully with a low failure rate and good patient-reported outcomes. Included studies may have inherent selection bias with selected older patients having tears that may be most amenable to repair. However, this study does demonstrate that repair can be performed in at least a portion of older patients and that age per se should not be a sole determining factor in the selection to perform a meniscal repair or not.