Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis

Nepple JJ, Dunn WR, Wright RW · The Journal of Bone and Joint Surgery. American Volume

The pooled failure rate — reoperation or clinical failure — was 23.1% (131 of 566). By technique it ran from 22.3% for inside-out repair to 24.3% for all-inside. By location it was 24.2% medial and 20.2% lateral, which a random-effects model did not separate (p = 0.17). By cruciate status it was 22.7% with an intact ligament and 22.1% with a deficient one (p = 0.86), with the reconstructed subset higher at 26.9% (18 of 67). Failures presenting more than two years after repair made up 29.0% of all failures. No five-year outcomes had been reported for modern all-inside devices; the all-inside figures are meniscal arrows.

Population

Thirteen studies reporting fourteen cohorts of meniscal repair followed a minimum of five to 11.9 years (mean 7.4), 566 knees, published 1989 to 2011

Intervention

Meniscal repair, all techniques

Limitations

Therapeutic Level IV: eleven of the thirteen studies are retrospective case series, there is no comparator arm, and clinical failure is whatever each study defined it as — which is part of why the rate is so flat across subgroups. Only three studies allowed a direct comparison of cruciate-deficient against cruciate-intact knees, with fifteen failures and four, so the null on cruciate status rests on very little. Follow-up averaged 88%, ranging from 70% to 100%.