FACTORS ASSOCIATED WITH FAILURE OF MENISCUS SUTURE REPAIR

Abstract

Introduction: Meniscus repairs with sutures have become more common as the importance of preserving the meniscus has been established. Studies have shown a high rate of repeat surgery, but it is unclear what factors contribute to failure. The purpose of this study was to determine what factors lead to failure of suture meniscus repair. Failure was operationally defined as repeat surgery on the meniscus within 2 years of the repair.

Methods: Two hundred eighty-three (283) meniscus suture repairs were performed by a single surgeon. The average patient age was 31 years (range, 18 to 71). There were 177 males and 106 females. All repairs were completed with an inside-out suture technique. One hundred thirty-seven (137) had an ACL reconstruction and meniscus repair (93 concurrent reconstructions and 44 two-staged ACL reconstructions). One hundred eighty-one (181) medial menisci and 102 lateral menisci were repaired. Of the medial repairs, 80% were in the posterior third of the meniscus, 11% in the middle third, 1% in the anterior third, and 8% extended to all areas of the meniscus. Of the lateral meniscus repairs, 49% were in the posterior third, 26% in the middle third, 22% in the anterior third, and 3% extended to all areas.

Results: Twenty-eight (28) patients (10%) had required repeat surgery on the repaired meniscus within the first 2 years and were considered failures. The average time to repeat meniscus surgery was 12 months (range, 2.5 to 24 months). There were no differences based on age, gender or location. Thirteen percent (13%) of medial repairs and 4% of lateral repairs failed (p=0.012). Medial meniscus repairs failed significantly earlier (5.6 months) than lateral meniscus repairs (12.9 months) (p=0.001). For patients who had ACL reconstruction and meniscus repair, factors associated with failure included age (failed age=22; non-failure age=29; p=0.013), and concurrent ACL reconstruction (two-staged repair failures=2%; concurrent repair failures=11%; p=0.04).

Conclusion: Failure of suture repair of the meniscus within the first two years following index repair is more likely to occur in medial meniscus repairs and in young patients who had a repair and concurrent ACL reconstruction.