Conversion to knee arthroplasty is more common after meniscectomy than meniscus repair in patients older than age 40

Armin Runer; Anil Özbek; Sahil Dadoo; Laura Keeling; Camila Grandberg; Ian Engler; James J Irrgang; Jonathan D Hughes; Volker Musahl

doi:10.1002/ksa.12216

Conversion to knee arthroplasty is more common after meniscectomy than meniscus repair in patients older than age 40

Knee Surg Sports Traumatol Arthrosc. 2024 Apr 28. doi: 10.1002/ksa.12216. Online ahead of print.

Authors

Armin Runer^{1

2}, Anil Özbek^{1

3}, Sahil Dadoo¹, Laura Keeling¹, Camila Grandberg¹, Ian Engler^{1

4}, James J Irrgang^{1

5}, Jonathan D Hughes¹, Volker Musahl¹

Affiliations

¹ Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
² Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
³ Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey.
⁴ Central Maine Healthcare Orthopedics, Central Maine Medical Center, Lewiston, Maine, USA.
⁵ Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA.

PMID: 38678394
DOI: 10.1002/ksa.12216

Abstract

Purpose: To describe rates of conversion to unicompartmental or total knee arthroplasty (KA) in patients over the age of 40 years (at initial surgery) after partial meniscectomy (ME) or meniscal repair (MR).

Methods: Patients over the age of 40 undergoing isolated ME or MR between 2016 and 2018 were extracted from a single healthcare provider database. Data on patient characteristics, type of initial surgery, number of returns to the operating room, as well as performed procedures, including conversion to KA, were recorded. Comparative group statistics as well as a Kaplan-Meier survival rate analysis were performed.

Results: A total of 3638 patients (47.8% female) were included, with 3520 (96.8%) undergoing ME and 118 (3.2%) MR. Overall, 378 (10.4%) patients returned to the OR at an average of 22.7 ± 17.3 months postoperatively. Conversion to KA was performed more frequently in patients after primary ME (n = 270, 7.7%) compared to those with MR (2.5%, n = 3, odds ratio [OR]: 3.2, p = 0.03). Compared to ME (2.3%, n = 82), two times as many patients undergoing MR returned for subsequent meniscus surgery (MR: 5.9%, n = 7, OR: 2.6, p = 0.02). Time from primary surgery to KA (ME: 22 ± 17 months, MR: 25 ± 15 months, p = 0.96) did not differ between the treatment groups. Survivorship was 95% for ME and 98.2% for MR after 24 months (p = 0.76) and 92.5% and 98.2% after 60 months (p = 0.07), respectively.

Conclusion: The overall reoperation rate after meniscal surgery was 10.4% in patients over the age of 40 years. Patients treated with primary ME have over three times higher odds to undergo subsequent KA compared to those treated with MR. However, patients with primary MR have a higher rate of subsequent meniscus surgery compared to those undergoing primary ME. This information is important when considering and treating a patient over the age of 40 and meniscal injury.

Level of evidence: Level III study.

Keywords: knee arthroplasty; meniscal repair; meniscectomy; meniscus; total knee joint.