Meniscus repairs in the adolescent population-safe and reliable outcomes: a systematic review

Abstract

Purpose: The purpose of this study was to determine the outcomes of meniscus repair in the adolescent population, including: (1) failure and reoperation rates, (2) clinical and functional results, and (3) activity-related outcomes including return to sport.

Methods: Two authors independently searched MEDLINE, Cochrane Central Register of Controlled Trials & Cochrane Library, and CINHAL databases for literature related to meniscus repair in an adolescent population according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No meta-analysis was performed in this qualitative systematic review.

Results: Thirteen studies, including no Level I, one Level II, one Level III, and eleven Level IV studies yielded 466 patients with 503 meniscus repairs. All defined meniscal re-tear as a primary endpoint, with a reported failure rate ranging from 0 to 42% at a follow-up ranging from 22 to 211 months. There were a total of 93 failed repairs. IKDC scores were reported in four studies with a mean improvement ranging from 24 to 42 (P < 0.001). Mean post-operative Lysholm scores were reported in seven studies, ranging from 85 to 96. Additionally, four of those studies provided mean pre-operative Lysholm scores, ranging from 56 to 79, with statistically significant mean score improvements ranging from 17 to 31. Mean post-operative Tegner Activity scores were reported in nine studies, with mean values ranging from 6.2 to 8.

Conclusion: This systematic review demonstrates that both subjective and clinical outcomes, including failure rate, Lysholm, IKDC, and Tegner activity scale scores, are good to excellent following meniscal repair in the adolescent population. Further investigations should aim to isolate tear type, location, surgical technique, concomitant procedures, and rehabilitation protocols to overall rate of failure and clinical and functional outcomes.

Level of evidence: IV.

Keywords: Adolescent; Meniscus; Meniscus repair; Meniscus tear; Paediatric; Repair; Revision.

Figure 1 –

Flow diagram of the literature database search performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Thirteen studies were ultimately included in this qualitative synthesis.

Figure 2 –. Percentage Failure (Re-Tear)

Each study is listed along with the follow-up period (months). Red circles represent the percentage rate of failure (re-tear) for the included studies. The 95% confidence intervals (thin blue line with bars) were calculated utilizing the adjusted Wald method for measure of dispersion.[2]

Figure 3 –. Mean Pre- and Post-operative IKDC Scores

Red circles represent mean post-op IKDC scores whereas blue circles represent mean pre-op IKDC scores. In one case (Schmitt et al. 2016), only post-op IKDC scores were reported.[47] (*Standard deviation was reported in one study and is represented by thin lines with bars. ^Range was reported in two studies and is represented by thin lines with square bullets.)

Figure 4 –. Mean Pre- and Post-operative Lysholm Scores

Red circles represent mean post-op Lysholm scores whereas blue circles represent mean pre-op Lysholm scores. In three cases only post-op IKDC Lysholm scores were reported. (*Standard deviation was reported in one study and is represented by thin lines with bars. ^Range was reported in four studies and is represented by thin lines with square bullets.)

Figure 5 –. Mean change in Tegner Score

Black dots represent the mean change in Tegner score from pre-op to post-op