Date Published: June 4, 2012
Publisher: Informa Healthcare
Author(s): Tanja Kraus, Nima Heidari, Martin Švehlík, Frank Schneider, Matthias Sperl, Wolfgang Linhart.
Unstable meniscal tears are rare injuries in skeletally immature patients. Loss of a meniscus increases the risk of subsequent development of degenerative changes in the knee. This study deals with the outcome of intraarticular meniscal repair and factors that affect healing. Parameters of interest were type and location of the tear and also the influence of simultaneous reconstruction of a ruptured ACL.
We investigated the outcome of 25 patients (29 menisci) aged 15 (4–17) years who underwent surgery for full thickness meniscal tears, either as isolated lesions or in combination with ACL ruptures. Intraoperative documentation followed the IKDC 2000 standard. Outcome measurements were the Tegner score (pre- and postoperatively) and the Lysholm score (postoperatively) after an average follow-up period of 2.3 years, with postoperative arthroscopy and MRT in some cases.
24 of the 29 meniscal lesions healed (defined as giving an asymptomatic patient) regardless of location or type. 4 patients re-ruptured their menisci (all in the pars intermedia) at an average of 15 months after surgery following a new injury. Mean Lysholm score at follow-up was 95, the Tegner score deteriorated, mean preoperative score: 7.8 (4–10); mean postoperative score: 7.2 (4–10). Patients with simultaneous ACL reconstruction had a better outcome.
All meniscal tears in the skeletally immature patient are amenable to repair. All recurrent meniscal tears in our patients were located in the pars intermedia; the poorer blood supply in this region may give a higher risk of re-rupture. Simultaneous ACL reconstruction appears to benefit the results of meniscal repair.
We conducted a retrospective review of all children and adolescents who had undergone arthroscopic knee surgery over a 2-year period from June 2003 to October 2005, for meniscal lesions at our institution. Patients were identified through the hospital database. Inclusion criteria were: open physes; MRI verification of full-thickness meniscal tear (distorted or not) with or without a concomitant anterior cruciate ligament (ACL) rupture; availability of pre- and postoperative Tegner score (Tegner and Lysholm 1985) and postoperative Lysholm score (Lysholm and Gillquist 1982); and complete International Knee Documentation Committee intraoperative documentation (IKDC 2000) (Hefti et al. 1993, Schmitt et al. 2010). A meniscal tear was diagnosed in the presence of meniscal distortion or if the intrameniscal high signal was in communication with the surface of the meniscus. The pattern of meniscal tears and their location with respect to the vascular zones were classified according to Cooper et al. (1991) (Table).
The true incidence of meniscal injuries in children is unknown, but with increasing participation in competitive sports the number of knee injuries will inevitably rise. There are a multitude of reports on the results of repairing meniscal tears in adults or in a mixed population of adults and adolescents. In this population, the success of meniscal repair depends on the type of tear, location within the meniscus (particularly with regard to the vascular zone), tear length, rim width, and other factors (Bach et al. 2005, Kimura et al. 1995, Tenuta and Arciero 1994, Scott et al. 1986). Success rates for meniscal repairs in these groups are reported to be good to fair (Barber 1987, Eggli et al. 1995). Mintzer et al. (1998) reported 26 patients who were all asymptomatic at a follow-up after 5 years, and Anderson (2003) confirmed excellent outcomes from simultaneous ACL repair (8/12) at a follow-up time of 4 years. In a more recent study, Vanderhave et al. (year) reported 43 of 45 menisci to be clinically healed 2 years after meniscal repair.