Revision Meniscus Surgery in Children And Adolescents: the Effect Of Skeletal Immaturity

Abstract

Objectives:The purpose of this study was to investigate the incidence and risk factors for revision meniscus surgery in a pediatric population as well as to describe mechanisms of failure and subsequent operative management.Methods:A retrospective review was performed of all patients under 20 years who had arthroscopic management for meniscus pathology at a single institution between 2008 and 2012. Demographic data and intraoperative findings at the time of the initial surgery were documented. All patients undergoing a second procedure on the same meniscus were further analyzed to calculate the incidence and risk factors for revision surgery. The mechanism and date of reinjury as well as subsequent surgical management were documented. Patients with persistent pain following the initial operation were considered a non-traumatic surgical failure. Multivariate logistic regression with purposeful selection was performed to identify independent risk factors for revision meniscus surgery.Results:Arthroscopic knee surgery was performed on 293 patients and 324 menisci, including 129 repairs, 149 meniscal debridements, and 46 discoid saucerizations. With a minimum follow-up period of 17 months, 13% of the cohort required a revision procedure. The primary repair group had the highest failure rate (18%) followed by the discoid saucerization group (15%) and the meniscus debridement group (7%). Multivariate analysis indicated that meniscus repair was predictive of re-tear (OR = 2.04, 95%CI 1.01-4.1, p=0.046), and children with an open physis and a bucket handle tear had the highest retear rate of 46% (p=0.039). Independent variables shown to have no significant relationship to revision meniscus surgery included: age, gender, BMI, laterality, time to repair, tear location, and associated ligament injury. The most common indication for revision surgery was an acute traumatic re-injury during physical activity. Revision procedures were performed at an average of 14 months after the index surgery and the majority of failures (69%) were identified within a year. 44% of patients undergoing a revision surgery underwent a further debridement whereas 56% underwent a repair.Conclusion:Revision meniscus surgery is not uncommon in pediatric and adolescent patients especially those undergoing a primary repair of a bucket-handle meniscus tear when the physes are still open. Most failures are the result of a traumatic injury and nearly half will require further debridement of the torn meniscus. Surgeons treating meniscal lesions in this young population, as well as children and their families, should be aware of the short-term rate of revision meniscus surgery, especially when they are still skeletally immature.