Summary
All-inside medial meniscus repair failed at a higher rate (58%) compared to inside-out medial meniscus repair (23%) in elite athletes.
Abstract
Background
The popularization of all-inside meniscal repair devices has led to a shift away from the historical gold standard of inside-out meniscus repair without comparative studies to support the change.
Purpose
To compare the failure rate and time to failure of all-inside and inside-out meniscus repair performed in elite athletes.
Study Design: Cohort study; Level of evidence, III.
Methods
A retrospective review was performed of all professional and national/international level amateur athletes who underwent meniscal repair, with a minimum of two-year follow-up between January 2013 and September 2019. Repairs were classified as all-inside or inside-out depending on the type of repair performed. Failure was defined as undergoing a subsequent surgery to address a persistent meniscal tear following repair. Cox proportional hazards modeling was used to determine if meniscal repair failure rates differed by location and technique of meniscal repair. Models were controlled for known risk factors such as age, gender, sport, and concurrent cruciate ligament reconstruction.
Results
192 (135 lateral and 57 medial) meniscal repairs were performed on elite athletes during the study period. Overall, 41 (21%) meniscus repairs met criteria for failure during the study period. Medial meniscus tears repaired with the all-inside technique failed at a significantly higher rate (58%) than medial meniscus tears repaired with the inside-out (23%) or lateral meniscus tears repaired with the all-inside (12%) or inside-out (14%) technique (p<.001). Cox proportional hazards modeling revealed that a medial meniscus tear repaired with the all-inside technique had an almost 8 times greater hazard of failure than a lateral meniscus tear repaired with the all-inside technique (p<.001). At 1 year following repair, 8% of lateral meniscus repairs had failed (regardless of technique), while medial meniscus repairs failed at a rate of 16% for inside-out technique and 42% for all-inside technique. By 2 years, 53% of all-inside medial meniscus repairs had failed and by 5 years 63% had failed.
Conclusion
All-inside medial meniscal repair led to a higher rate of failure than inside-out medial or lateral meniscus repair in elite athletes. Medial meniscus repairs failed at a high rate than lateral meniscal repairs.