Patient-reported Outcomes After Medial Meniscus Root Tear Repair Versus Other Medial Meniscus Repairs: An Exploratory Meta-analysis of Single-arm Cohorts

Abstract

Introduction: This study aimed to (1) compare patient-reported outcome measures between patients who underwent medial meniscus root tear (MMRT) repair and those who underwent other types of medial meniscus repair, and (2) identify factors associated with observed differences.

Methods: A literature search identified studies reporting PROMs-knee injury and osteoarthritis outcome score (KOOS) or visual analog scale (VAS) for pain-after repair of the medial meniscus. Studies were excluded if outcomes were not separated by tear type or reported graphically, different or no outcomes reported, no repair or repair with a sutureless method, follow-up greater than 72 months, case report, and systematic review. Patient-reported outcome measures and demographics were summarized as sample-weighted means and compared using t-tests. Mixed model linear regressions were fit predicting postoperative PROMs adjusted for tear type, preoperative PROMs, and follow-up time. F statistics of type III tests of fixed effects were compared.

Results: Eighteen articles were included, n = 10 received MMRT repair and n = 8 other tear repairs. Postoperative values for all KOOS scores were less for the MMRT repair group compared with the other tear repair group, VAS pain was not statistically different. Tear type was a stronger predictor for postoperative PROMs than the preoperative score and duration of follow-up for all KOOS scores, but not VAS pain. On average, the MMRT repair group had shorter follow-up, more women, older age, and greater BMI.

Discussion: All postoperative PROMs except for VAS pain were worse for patients who underwent MMRT repair compared with patients who underwent other types of medial meniscus repair. Tear type was a better predictor of postoperative PROMs despite intergroup differences in preoperative PROMs and duration of follow-up. Relative risk factors for MMRT compared with other types of medial meniscus tears include older age, greater BMI, and female sex.

Figure 1

CONSORT flow diagram illustrating the grouping of articles and study arms for the MMRT repair group and other tear repair group. ¹Bucket handle, horizontal, longitudinal, radial, and complex tears. N = number of articles, arms = number of study arms, MMRT = medial meniscus root tear, preop = preoperative, postop = postoperative.

Figure 2

Graph showing the risk of bias assessment using the MINORS criteria to evaluate quality of nonrandomized observational studies. Red diamond (0) = not reported, yellow triangle (1) = reported but inadequate, green circle (2) = reported and adequate. Total MINORS score 0 to 8 = poor quality, 9 to 14 = moderate quality, 15 to 16 = good quality.

Figure 3

Graph showing the preoperative PROMs for patients who underwent MMRT repair versus other types of medial meniscus repair. ¹PROMs reported as mean ± SD, *P = 0.019, **P ≤ 0.001. ²Bucket handle, horizontal, longitudinal, radial, and complex tears. PROMs = patient-reported outcome measures, MMRT = medial meniscus root tear, KOOS = knee injury and osteoarthritis outcome score, ADL = activities of daily living, Rec = recreation, QOL = quality of life, VAS = visual analog scale.

Figure 4

Graph showing the postoperative PROMs for patients who underwent MMRT repair versus other types of medial meniscus repair. ¹PROMs reported as mean ± SD, **P < 0.001. ²Bucket handle, horizontal, longitudinal, radial, and complex tears. PROMs = patient-reported outcome measures, MMRT = medial meniscus root tear, KOOS = knee injury and osteoarthritis outcome score, ADL = activities of daily living, Rec = recreation, QOL = quality of life, VAS = visual analog scale.

Figure 5

Graph showing the preoperative to postoperative mean differences in PROMs in patients who underwent MMRT repair versus other types of medial meniscus repair. ¹Mean differences in PROMs reported as mean ± SD, **P < 0.001. ²Bucket handle, horizontal, longitudinal, radial, and complex tears. PROMs = patient-reported outcome measures, MMRT = medial meniscus root tear, KOOS = knee injury and osteoarthritis outcome score, ADL = activities of daily living, Rec = recreation, QOL = quality of life, VAS = visual analog scale.