Meniscal repair associated with a partial meniscectomy for treating complex horizontal cleavage tears in young patients may lead to excellent long-term outcomes.

Abstract

While open repair of horizontal meniscal tears in young active patients has shown good results at mid- and long-term follow-up, complex horizontal tears (cleavage associated with meniscal flaps) are often treated by arthroscopic subtotal meniscectomy. The aim of this study was to evaluate long-term outcomes after arthroscopic removal of meniscal flaps associated with an open meniscal repair for treating complex lesions in young active patients. The hypothesis was that this salvage procedure would be efficient in such rare cases. Fourteen patients underwent an arthroscopic partial meniscectomy associated with an open meniscal repair to treat a painful complex horizontal meniscal cleavage between 2005 and 2010. There were two females and 12 males with a median age of 28.4years (range 15-48years). Patients were assessed by KOOS and IKDC scores, return to sport and the need for a secondary meniscectomy. Thirty patients were evaluated at a median follow-up of 8.5years (range 7-12years). One patient required revision of a partial meniscectomy and one other a meniscal replacement (15% failure rate). All other patients showed improvement with regard to their symptoms and returned to sports, ten (91%) of them at the same level. The mean IKDC subjective score was 86.1 (± 10.9). The mean KOOS scores were: pain 91.4 (± 7.5), symptoms 91.4 (± 10.2), daily activity 97.1 (± 4), sports 84.4 (± 20.7) and quality of life 84 (± 14.2). For six patients, scores at median follow-up of 2.6years were available and compared to newly obtained data. IKDC score at 8.6years follow-up was not significantly different. KOOS scores for daily activity and sports were maintained. Even in the presence of a complex lesion, horizontal cleavage can be repaired in young patients with good subjective and objective outcomes and a low rate of long-term failure as with other meniscal lesions in young active patients. IV.