Outcomes Following Repair of Radial, Mid-Body Tears of the Lateral Meniscus in Adolescents

Abstract

Background: Radial tears of the lateral meniscus result in increased contact forces in the knee and may expedite the development of arthritis. Due to the technically difficult repair and poor healing potential, partial or complete lateral meniscectomy is often performed, even in young, active patients. There is a paucity of literature regarding clinical outcomes after repair of radial tears of the lateral meniscus. The purpose of this study is to review outcomes of a cohort of adolescent patients who have undergone repairs of mid-body radial lateral meniscus tears. Our hypothesis is that the repairs will be successful in terms of PRO outcomes, return to an active lifestyle, and low rate of re-operation in short-term follow-up. Methods: A retrospective review of subjects under the age of 18 years that underwent repair of mid-body, lateral meniscus tears with potential for 2 years of follow-up were identified. These patients were identified by CPT code and subsequent chart review for tear pattern and repair technique. Patients were then prospectively contacted by email or phone and completed patient-reported outcome surveys including the International Knee Documentation Committee (IKDC) score, the Knee Osteoarthritis Outcome Score (KOOS), Marx activity scale, and SPORTS score. Results: Of the 17 total patients retrospectively reviewed, eight completed the prospective portion of PROs which were collected at a mean of 55.8 months postoperatively. Six knees (35.3%) had postoperative MRI at mean 14 months postop, with five of the six (83.3%) suggestive of preserved integrity of the repair. There were five (29.4%) complications, all requiring subsequent surgical procedures. Four patients had meniscus tears at locations distinct from initial injury requiring partial meniscectomies at mean 13.8 months (range, 7-35 months); however, all radial mid-body tears from index procedures were completely healed under arthroscopic visualization. Mean 2-year IKDC score was 91.67 ± 10.72, and the mean Marx score was 11.63 ± 3.25. Six of eight (75%) reported performance at the same level of sport with one reporting pain during sport. Three respondents of the SPORTS score reported continued participation in organized sport with one patient participating at the collegiate intramural level. Conclusions: Repairs of radial mid-body tears in the lateral meniscus may provide a clinical benefit in the adolescent population. The majority of patients were able to return to their prior activity levels without complication, with evidence of healing on repeat evaluation. Level of Evidence: Level IV, case series Key Concepts•Return to sport is feasible for the majority of adolescent patients undergoing lateral, mid-body meniscal repair at approximately 6 months following surgery.•Re-operation was common with 5/17 (29.4%) patients undergoing re-operation with 4/5 returning for partial meniscectomy. Two of these were at sites distinct from the initial repair with complete healing of repair at radial tear site from index procedure. One showed a majority healed radial repair. One was completed at an outside hospital with insufficient detail to characterize.•If feasible, repair of radial tears of the mid-body of the lateral meniscus in adolescent patients should be attempted.

Figure 1

Preoperative (A) sagittal and (B) axial T2-weighted MRI images demonstrating (C) mid-body, radial tear of the lateral meniscus with (D) extension to the red-white zone. (E) Intraoperative image of completed inside-out repair using hashtag suture technique.

Figure 2

Schematic of step-by-step repair process including both all inside and inside-out components. (A) Radial tear pattern, (B-D) Placement of inside-out rip stop sutures, (E-G) Placement of inside-out reduction sutures, H) Final tied construct.

Figure 3

Patient selection diagram.

Figure 4

Intraoperative imaging of a (A) radial, mid-body lateral meniscus tear and (B) subsequent inside-out repair with parallel horizontal mattress sutures. Second-look arthroscopy performed 2.6 years status post index procedure with interval healing and maintained repair.