MENISCUS REPAIR

Six low quality studies (Gan, 2020; Lu, 2020; Mao, 2022; Sochacki, 2020; Stein, 2010; Zhou, 2019) evaluating meniscal repair and meniscectomy were reviewed. One study (Gan) demonstrated improved postoperative patient reported outcome scores in patients with complex tears who underwent repair versus partial meniscectomy. Another (Stein) showed improved results in repair versus partial meniscectomy in regard to osteoarthritis progression and sports activity recovery. When comparing meniscectomy and meniscus repair in a large national insurance database (Sochacki), repairs were found to have lower reoperation rates with higher rates of both complications and total cost.

The primary limitation of this body of evidence is that the majority of studies were retrospective in nature. Surgical decision making should be based on the clinical scenario (e.g. the extent, type and location of the initial meniscal trauma), thus there are ethical implications that limit the ability to conduct randomized clinical trials in meniscus patients. Therefore, while there is a preponderance of evidence indicating that meniscal tears in general and surgical removal of a larger amount of meniscal tissue are associated with a greater risk of joint degeneration, the supporting evidence is inherently limited by the nature of the investigations. Additionally, these studies generally did not distinguish the potential influences of the location, type, or extent of the meniscal injury on clinical and radiographic outcomes, thus generalizability of the findings to specific meniscal cases is limited.

Benefits/Harms of Implementation
There is evidence to suggest that repair of some tears has benefit in regard to decreased reoperation rates and improved outcomes while meniscectomy may have lower costs and complications, but a higher rate of osteoarthritis progression.

Outcome Importance
Mitigating degenerative change in the knee is one of the most important outcomes in the treatment of acute meniscal tears. The potential benefit of meniscal repair over meniscectomy in this area may outweigh disadvantages in terms of cost, complications, and short-term outcomes. Identifying tears more amenable to repair versus meniscectomy, such as peripheral longitudinal tears, can help to guide treatment.

Cost Effectiveness/Resource Utilization
While there is evidence that meniscal repair is cost effective (Deviandri, 2023), determining the optimal tears for repair versus partial meniscectomy may lead to lower costs and decreased complications.

Acceptability
Both treatments are widely acceptable with means to easily perform either.

Feasibility
Both are feasible and should be used according to the appropriate tear pattern.

Future Research
Larger studies with patients stratified by age, activity level, and tear type comparing meniscal repair versus partial meniscectomy are needed.

Additional References:
1. Deviandri, R., Daulay, M. C., Iskandar, D., Kautsar, A. P., Lubis, A. M. T., & Postma, M. J. (2023). Health-economic evaluation of meniscus tear treatments: a systematic review. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 31(9), 3582–3593. https://doi.org/10.1007/s00167-022-07278-8