Meniscal Sutures are Superior to Bioabsorbable Arrows: Results After 918 Consecutive Meniscal Repairs in a Dual Center Analysis (2017)

Objectives: It has been long known that removal of the meniscus can lead to degenerative changes, and preserving surgery rather than meniscal resection is likely to have better long-term outcomes. Success rates after meniscal repair ranges from 60- 95%, but with most studies having small number of patients. The purpose of this study was to review all meniscal repairs, and potential predictors for failure, during a 12-year period. Methods: A dual center retrospective analysis was performed on two consecutive cohorts of meniscal repairs, during the period 1999-2011 and 1999-2010 respectively. Data from surgical protocols and follow up charts were reviewed including type of tear, location, associated injury to the knee, and surgery. Study endpoint was failure of repair, which was defined as a need for reoperation and secondary partial or total meniscal resection, within 3 years. Kaplan-Meier was used to assess repair device survival. Results were expressed as hazard ratios (HR) with 95% confidence intervals (CI) and were adjusted for confounding factors using cox regression. results: 954 meniscal repairs were performed on 918 patients (n = 536 males [58%] and 382 females [42%]) with a mean age of 23 years (12-60). 64% underwent medial meniscal repair and 36% underwent lateral meniscal repair. 4% were repaired both medially and laterally. 75% of the repairs were performed using meniscal sutures (predominantly Fast-Fix), and 25% of the meniscal tears were repaired using bioabsorbable arrows (Biofix). The median time from injury to surgery was 23 days (0-360). The reoperation rate in the whole cohort was 29%. 35% of the medial meniscal repairs failed and 17% failures were noted on the lateral side. Repair with bioabsorbable arrows on the medial meniscus resulted in reoperation in 44% of the cases, whereas the reoperation rate for meniscal sutures was 32% on the medial side. On the lateral side 18% failures were noticed when using arrows, and 17% when sutures were used. 62% of the patients had a simultaneous anterior cruciate ligament (ACL) injury. When medial meniscal repair was preformed with simultaneous ACL-reconstruction 26% of the meniscal repairs failed, when no simultaneous ACL- reconstruction was performed 37% of the meniscal repairs failed and with no associated ACL-injury 41% of the meniscal repairs failed. Analyzing failure in a multivariate cox regression, adjusted according to age, gender, meniscus, ACL-pathology and days- to-surgery, revealed a higher failure rate for medial meniscal repairs (HR 3.006 [2.074-4.355; p = 0.000). Bioabsorbable arrows had significantly more failures than meniscal sutures (HR 1.656 [1.207-2.273]; p = 0.002). With reference to no ACL injury, meniscal repairs performed with a simultaneous ACL-reconstruction resulted in less failure than when no simultaneous ACL-reconstruction was performed (HR 0.605 [0.413-0.885]; p = 0.010). Conclusion: The failure rate was significantly higher on the medial side, especially when using Biofix-arrows. Patients who underwent a simultaneous ACL-reconstruction had a significantly better healing than conservatively treated ACL-ruptures, and patients with no ACL-injury. Age and days-to-surgery were not significant factors for failure.