Peter R Kurzweil1, Nancy M Lynch2, Sheldon Coleman3, Brian Kearney4. 1. Southern California Center for Sports Medicine, Long Beach, California, U.S.A.. Electronic address: pkurzweil@aol.com. 2. Advisorthopædics, Belmont, California, U.S.A. 3. Private Practice, Los Angeles, California, U.S.A. 4. Private Practice, Oakland, California, U.S.A.
Abstract
PURPOSE: Despite the well-documented advantages of meniscal repair over meniscectomy, horizontal cleavage tears (HCTs) are often not repaired. Reported reasons include difficulty performing the repair, potential suture failure due to mechanical stresses, and poor healing rates. In addition, many surgeons have the perception that debriding the tear until the superior and inferior laminae are stable results in a good clinical outcome. Furthermore, many of the tears occur in patients who are older than the generally accepted indicated age for repair and may also have a degenerative component, making them potentially less likely to benefit from repair. This review was performed to evaluate the published outcomes of HCT repairs and test the hypothesis that surgically repaired HCTs have an unacceptably low rate of success. METHODS: A systematic search of the PubMed and Embase databases was performed in December 2013 to identify studies in which meniscal HCTs were repaired. Inclusion criteria for the analysis were English language, reference to a patient with an HCT repaired by any method, and a report of at least 1 postoperative outcome. For the purposes of this review, a failed outcome was defined as the need for reoperation. RESULTS: More than 16,000 abstracts were returned in the search. From these abstracts, we identified 210 articles for further review, of which 9 met the inclusion criteria. A total of 98 repairs of horizontal tears were evaluated in these studies. By use of reoperation as the criterion for treatment failure, 77 of the repairs were successful, for an overall success rate of 77.8%. CONCLUSIONS: The literature does not support the hypothesis that surgically repaired HCTs have an unacceptably low rate of success. Rather, our results show that existing studies of repaired HCTs show a comparable success rate to repairs of other types of meniscal tears. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.
PURPOSE: Despite the well-documented advantages of meniscal repair over meniscectomy, horizontal cleavage tears (HCTs) are often not repaired. Reported reasons include difficulty performing the repair, potential suture failure due to mechanical stresses, and poor healing rates. In addition, many surgeons have the perception that debriding the tear until the superior and inferior laminae are stable results in a good clinical outcome. Furthermore, many of the tears occur in patients who are older than the generally accepted indicated age for repair and may also have a degenerative component, making them potentially less likely to benefit from repair. This review was performed to evaluate the published outcomes of HCT repairs and test the hypothesis that surgically repaired HCTs have an unacceptably low rate of success. METHODS: A systematic search of the PubMed and Embase databases was performed in December 2013 to identify studies in which meniscal HCTs were repaired. Inclusion criteria for the analysis were English language, reference to a patient with an HCT repaired by any method, and a report of at least 1 postoperative outcome. For the purposes of this review, a failed outcome was defined as the need for reoperation. RESULTS: More than 16,000 abstracts were returned in the search. From these abstracts, we identified 210 articles for further review, of which 9 met the inclusion criteria. A total of 98 repairs of horizontal tears were evaluated in these studies. By use of reoperation as the criterion for treatment failure, 77 of the repairs were successful, for an overall success rate of 77.8%. CONCLUSIONS: The literature does not support the hypothesis that surgically repaired HCTs have an unacceptably low rate of success. Rather, our results show that existing studies of repaired HCTs show a comparable success rate to repairs of other types of meniscal tears. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.
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