Clinical and radiological results 21 years following successful, isolated, open meniscal repair in stable knee joints

Abstract

The long-term results over 20 years following meniscal repair in stable knees have not been described yet. The objective was therefore to analyze the clinical and radiological outcomes of successful, isolated, open meniscal repairs with an intact ACL after a mean follow-up of 20.6 years (range, 16-25) retrospectively in 26 patients. Clinical evaluation included objective (Lysholm, IKDC, Tegner) and subjective scores. Standard radiological assessment according to Ahlbäck's osteoarthritis classification and weight-bearing full-leg radiography for alignment were performed. Eight patients were excluded due to a re-rupture of the meniscus. In the 18 remaining patients (12 male, 6 female), the mean Lysholm and IKDC score was 97.8 points (range, 85-100) and 93% (range, 77-100) at the most recent follow-up, respectively. The Tegner activity scale averaged 4.2 (range, 3-7). Subjectively, 13 patients rated their outcome excellent, 4 good, and 1 fair. The radiological evaluation demonstrated an average development of "+1" grade (range, 0-"+2") osteoarthritic changes versus preoperatively; however, the contralateral healthy knee also revealed comparable (on average "+1" grade) degenerative changes reflecting natural history. The alignment was not significantly different between the operated and the contralateral leg. Overall, isolated open meniscal repair in stableness has the potential of a successful surgery with good to excellent long-term results. The development of osteoarthritic changes within the femorotibial compartments is mild and comparable to contralateral and the alignment of the axis is preserved. Therefore, repair of a ruptured meniscus is recommended whenever possible, even in isolated meniscal tears. However, a re-rupture rate of approximately 30% in isolated meniscal tears has to be acknowledged, which still reflects the need for biological enhancement of meniscal healing.