Paper 67: Meniscal Repair in the Elite Athlete: Results of 45 Repairs with a Minimum 5 Year Follow-up

Abstract

We have an aggressive approach to meniscal repair, including repairing tears other than those classically suited to repair. Elite athletes represent the subgroup of patients who place the most demand on the menisci and as a result, place maximum stress on any meniscal repair. Here we present the medium to long-term outcome of meniscal repair (inside-out) in the elite athlete. 42 elite athletes underwent 45 meniscal repairs between January 1990 and July 1997 were identified from a prospective database. All repairs were performed using an arthroscopically assisted inside-out technique. All patients returned a completed questionnaire (Lysholm and IKDC) to determine their current function and any symptoms or interventions that we were unaware of. The mean age was 23.2 (range 15 to 38). 67% medial and 33% lateral menisci were repaired (3 patients had both medial and lateral menisci repaired) with an average of 3.7 sutures (range 1 to 12). 83.3% of these repairs were associated with simultaneous ACL reconstruction. The average time from injury to surgery was 11 months (range 0-45 months). Follow-up time was a mean of 8.5 years (range 5.4 to 12.6 years). In general, function was good with an average Lysholm and subjective IKDC scores of 89.6 and 85.4 respectively. 81% of patients returned to their main sport and most to a similar level at a mean time of 10.4 months post-repair, reflecting the high level of ACL reconstruction in this group. We identified 11 definite failures, 10 medial and 1 lateral meniscus that ultimately required arthroscopic excision, this represents a 24% failure rate. We identified one further patient who had possible failed repairs, giving a worse case failure rate of 26.7% at a mean of 42 months post surgery. However, 7 of these failures were associated with a further injury, and 2 of the 7 failures ruptured their ACL reconstruction. Therefore the repairs had healed and were torn with reinjury. Age, size and location of tears were not associated with a higher failure rate. ACL reconstruction did not affect the failure rate although no tears were repaired as isolated procedures in ACL deficient knees. In this series medial meniscal repairs were significantly more likely to fail than lateral meniscal repairs, with a failure rate of 36.4% and 5.6% respectively (p<0.05). This series reflects an aggressive approach to meniscal repair with repair of tears in a high demand elite group of patients. Despite this, on a worst case analysis 73% were intact at a mean of 8.5 years post repair. We conclude that meniscal repair and healing is possible and that most patients can return to preinjury level of activity.