TYPE AND PATTERN OF MENISCUS TEARS CORRELATE WITH FUNCTION AND ACTIVITY LEVELS AT LEAST TWO YEARS AFTER PARTIAL MENISCECTOMY

Abstract

Objective: Various tear types and patterns of meniscus injuries have been described. We record meniscus tear type and pattern in a standard manner for every knee arthroscopy in our database of more than 17,000 knee surgeries. We determined if meniscus tear type and pattern correlate with function and activity levels at least two years after partial meniscectomy.

Methods: Two hundred six (206) patients underwent partial medial meniscectomy and 117 underwent partial lateral meniscectomy by a single surgeon (average age=49 years; range, 18 to 80). At index surgery, the type and pattern of meniscus tear was recorded. Tears were designated as bucket handle/vertical longitudinal (BV), flap/radial (FR), or complex (CH) which includes horizontal cleavage tears. Patients not in neutral or near-neutral alignment and those undergoing concurrent procedures for microfracture or ACL reconstruction were excluded. Patients were followed for a minimum of two years (average=4.6 yrs) after partial meniscectomy. Patients completed questionnaires including Lysholm and Tegner scores to assess function and activity.

Results: For the medial meniscus, there was significant correlation between tear type and patient age. The BV lesion group (n=35) was significantly younger (41 years) than the FR (n=65) (50 years) and CH (n=193) (53 years) groups (p=0.01). The BV group had significantly higher Lysholm (89) scores versus FR (80) and CH (77) (p=0.04). The BV group also had higher Tegner activity levels (5.8) than FR (4.6) and CH (4.5) (p=0.04). For lateral meniscus, the BV (n=15) (40 years) and FR (n=37) (48 years) groups were significantly younger than the CH group (n=45) (56 years); p=0.03. FR patients had higher Lysholm and Tegner scores, but not significantly different. Twenty-five percent (25%) of BV medial meniscus tears required further surgery while less than 15% of other types of medial or lateral tears required further surgery. Average time to second surgery for all patients was 2.4 years, with medial being 2.6 years and lateral being 1.5 years.

Conclusions: In this series, BV medial meniscus tears had better function and activity levels at least two years post-meniscectomy, perhaps due to younger age. This group also required more reoperations during the first two years after index meniscectomy than any other group, perhaps as a result of higher activity levels. Overall, partial lateral meniscectomy patients required reoperation sooner than medial meniscectomies. Tear type did not significantly influence outcomes after lateral meniscectomy. Therefore, meniscus tear type and pattern correlated with function and activity levels for medial but not lateral > 2 years after partial meniscectomy.