Clinical presentation and management of meniscal injuries in Enugu, South-East Nigeria

Abstract

Background: Reports on any aspect of management of meniscal injuries are scarce in Nigeria, though the anecdotal experience is that occurrence of meniscal injuries is not rare. Meniscal repair is the preferred option following meniscal injury due to the long-term harmful effects attributed to partial meniscectomies. Meniscal repair in the setting of an isolated meniscal injury is also reputed to give a satisfactory return to preinjury levels of about 91.3%. Meniscectomy has been reported to be associated with long term symptoms and functional limitations. Current treatment trend involves conserving the meniscus where and if possible. Despite this, arthroscopic partial meniscectomy is said to be one of the most common orthopaedic procedures worldwide. Indications for meniscal repairs have been well developed over the years and include factors like duration and pattern of the tear among other features. We present a study of the management of 16 patients who had surgery for meniscal injury over 1 year. Aims and Objectives: To determine the difference in short term outcome for patients who had meniscal injuries following arthroscopic treatment using the Tegner Lysholm score. Materials and Methods: Our work was a retrospective, descriptive study of all our patients who had surgery for meniscal injuries from December 1, 2018 to November 30, 2019. We recruited qualified patients into the study and extracted relevant information from their records. Data retrieved included age, sex, aetiology, presenting complaint, duration before the presentation, intra-operative arthroscopic findings, the treatment offered and the difference in the patient's Tegner Lysholm knee score evaluated preoperatively and at 6 months post-treatment. Results: In the study period, 16 patients had arthroscopic surgery for complaints of persistent knee pain. The majority (75%) of the patients were aged between 20 and 40 years. Most were male (88%) and had their injuries playing football (63%). The presentation was late in most cases (75%), and most of the patients had complex, irreparable tears at arthroscopy. An associated rupture of the anterior cruciate ligament was found in 25% of the patients. Majority of the patients had partial meniscectomy alone. Only two patients (12.5%) qualified for and had meniscal repairs using the outside-in technique. Most of the patients had a poor Tegner Lysholm knee score preoperatively. Post-operatively, at 6 months follow-up, all the patients demonstrated a short-term improvement in the Tegner Lysholm score. Our study indicates that the presentation of meniscal injuries is often delayed in our environment. Most of the patients who present with these injuries do not qualify for meniscal repair as they often have complex, irreparable tears. These patients have partial meniscectomies with short term relief of their complaints. Conclusion: Despite the need for meniscal conservation, partial meniscectomy is still very relevant in our environment.