Kurt P. Spindler, MD, Todd A. Warren, ACNP, Jason Connor, MS,
Clinton Devin, BS, and Eric C. McCarty, MD
Objective:
Entirely arthroscopic techniques of meniscus repair are common as a result of
reduced postoperative morbidity and easier insertion than arthroscopically-guided
inside-out repair with sutures. However, no prospective comparative manuscripts
of clinical success have been published. Meniscus repair technique was prospectively
switched in June 1996 from inside-out (PDS sutures) to entirely arthroscopic
(arrows) keeping rehabilitation and weight-bearing constant.
Methods:
As the first component of the Multicenter Orthopaedic Outcomes Network (MOON)
initiated in August 1991, all ACL reconstructions were prospectively entered
into a database. A Single surgeon’s medial meniscus repairs with ACL reconstruction
from 8/91-12/99 were evaluated. 47 consecutive patients (8/91-6/99) had arthroscopically
assisted inside-out repair utilizing PDS sutures. 98 consecutive patients (6/96-12/99)
had entirely arthroscopic technique with bioabsorbable arrows. Clinical success
was defined as no reoperation for medial meniscus debridement of failed repair
site documented on scale diagrams. Kaplan-Meier curves were investigated comparing
time to reoperation between patients with two techniques. A Cox proportional
hazards model was fit to compare times to reoperation and proportional hazards
assumptions verified.
Results:
The inside-out suture technique had 85% follow-up (40/47) with median 65 months.
Follow-up in the entirely arthroscopic arrows was 86% (84/98) with median 26
months. There were 6 failures for the inside-out group and 5 failures in arrows.
Kaplan-Meier curves demonstrate no difference and never differ by more than
2% in the first 5 years. The Cox proportional hazards model shows no difference
in time to reoperation between techniques (p=0.88). The risk of reoperation
is 0.90 times (95% CI 0.23-3.47) as high in the arrows group than inside-out
suture at any point in time after meniscus repair. Three-year success rates
(proportions with no reoperations) were 90% (suture) vs 91% (arrows). While
the observed difference was just 1% at 3 years, the current sample sizes offer
80% power to detect a statistically significant difference of 28% at 3 years.
Conclusions:
Medial meniscus repair with concomitant ACL reconstruction (NWB 5-6 wks postop)
has a clinical success of 90% at 3 years. No significant differences were observed
between techniques with our protocol.