Surgeries to treat meniscus tears are among the most common procedures performed by orthopaedic surgeons. Meniscus tears affect all age groups and non-athletic people. They often occur along with other injuries, such as ACL tears. Since relief of pain and other symptoms is unpredictable at best with non-operative treatment, most of these injured people choose to undergo arthroscopic surgery.
More orthopaedic surgeons have become skilled with arthroscopic techniques. New implants have been created to allow “all-inside” meniscal repairs instead of open or arthroscopic-assisted surgeries. Are more meniscal repairs and fewer partial meniscectomies performed today as a result?
A study published online recently in the American Journal of Sports Medicine looked at the statistics on meniscus surgery in the United States between 2005 and 2011. Geoffrey D. Abrams, MD, and others, collected data from insurance records of roughly 25 million people per year.
- The incidence of meniscectomies performed increased slightly – 14% – over that period.
- On the other hand, meniscus repairs increased 100% during that same period.
- Meniscus repairs were mostly performed on patients under 25 years old.
- Partial meniscectomies were most commonly performed in the 45- to 54- year age group.
- Using the number of partial meniscectomies performed on patients with a prior meniscus repair, the authors calculated the failure rate of meniscal repairs. They found a failure rate of 9.8% after isolated meniscal repairs (without simultaneous ACL reconstructions) and 8.2% when performed with ACL reconstructions.
Is this data surprising?
Honestly, it’s not. In the past, meniscus repairs involved mini-open incisions on the medial or lateral sides of the knee as part of “inside-out” repairs. Fellowship-trained sports medicine surgeons usually performed these surgeries. The new meniscal anchors and other repair devices have made “all-inside” repairs much easier. I expect that more general orthopaedic surgeons perform them now.
Since younger patients often tear the meniscus in the portion with a blood supply, it is not surprising that meniscal repairs peaked among patients under 25. With more research showing the potential development of osteoarthritis when significant portions of the meniscus is removed, surgeons are increasingly performing meniscal repairs when possible.
Finally, the failure rates of meniscus repair in this study are fairly low. Many studies have suggested that up to 20-40% of isolated meniscus repairs re-tear. It is hard to know if these rates are impacted by insurance or surgeon changes. Regardless, low failure rates are encouraging for surgeons trying to return patients to sports and exercise and assist them with a good quality of life.