A Lack of Joint Line Tenderness Is Consistent With a Healed Meniscus, But Positive Clinical Examination Findings and MRI Scans Are Inconsistent in Identifying Failure After Meniscal Repair: A Systematic Review and Subgroup Meta-analysis

Abstract

Background: The number of meniscal repairs being completed each year is increasing; however, the optimal, cost-effective postoperative assessment to determine the success or failure of a meniscal repair is not well known.

Purpose/hypothesis: The purpose of this systematic review was to identify the clinical examination testing that correlates with objective magnetic resonance imaging (MRI) or second-look arthroscopy (SLA) findings to determine an optimal clinical workup for assessing postoperative meniscal repair healing. It was hypothesized that specific clinical tests would correlate with meniscal repairs that did not heal.

Study design: Systematic review and meta-analysis; Level of evidence, 4.

Methods: This systematic review included all clinical studies investigating meniscal repairs, meniscal repair outcomes, and meniscal healing with clinical findings, MRI, and/or SLA, published in a peer-reviewed journal and with full English text available. All included studies were evaluated for bias using the Methodological Index for Non-Randomized Studies (MINORS). The clinical tests included those using "Barrett's criteria," with the assessment of effusion, joint line tenderness, locking, McMurray testing, and radiographs. This parameter has also been abbreviated to "modified Barrett's criteria" to include only joint line tenderness, effusion, and McMurray testing.

Results: No significant correlations were found between clinical tests and MRI or SLA. A subgroup meta-analysis between Barrett's and non-Barrett's studies reported no significant subgroup differences (χ₁² = 0.24; P = .62). A meta-analysis of diagnostic accuracy using a group of 7 studies that reported on true-positive, true-negative, false-positive, and false-negative data for SLA demonstrated that only a lack of joint line tenderness had a high specificity for a healed meniscal repair, with a log diagnostic odds ratio of 2.62 (95% CI, 0.47-4.76).

Conclusion: This study found no significant correlation with any specific clinical test for meniscal repair healing status using postoperative MRI and/or SLA findings. However, it was found that no healing (when compared with complete or incomplete healing) on MRI and joint line tenderness should be considered when assessing the status of postoperative meniscal repair healing. In addition, a subgroup meta-analysis found that a lack of joint line tenderness was highly correlated with a healed meniscal repair.

Keywords: joint line tenderness; knee, general; knee, meniscus; magnetic resonance images; meniscal repair; second-look arthroscopy.