The repair of horizontal cleavage tears yields higher complication rates compared to meniscectomy: a systematic review

  • Ajaykumar Shanmugaraj
  • Tushar Tejpal
  • Seper Ekhtiari
  • Chetan Gohal
  • Nolan Horner
  • Beate Hanson
  • Moin KhanEmail author
  • Mohit Bhandari



Horizontal cleavage tears of the meniscus (HCTs) are primarily degenerative in nature, and, however, can be the result of trauma. Such tears account for 12–35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. The purpose of this review was to systematically assess the outcomes and complications for patients undergoing the surgical treatment of HCTs.


This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses. The electronic databases PubMed, MEDLINE, and EMBASE were searched from data inception to December 30, 2018 for articles addressing the surgical treatment of HCTs. The Methodological Index for Non-randomized Studies was used to assess study quality. Data are presented descriptively.


Overall, 23 studies were identified, comprising of 702 patients (708 knees) with a mean age of 36.6 ± 9.9 years and a mean follow-up of 33.6 ± 19.6 months. The majority of patients were treated with a partial meniscectomy (59.0%), followed by repair (32.8%) and total meniscectomy (8.2%). Both meniscectomy and repair patients had improvements which surpassed minimal clinically important differences with regard to clinical (e.g. pain, function, daily living) and radiographic outcomes. The overall complication rate was 5.1%, primarily involving patients undergoing meniscal repair (12.9% of all knees undergoing a repair).


Although meniscal repair theoretically may provide improvement in biomechanical loading, patients undergoing repair had higher complication rates than those undergoing partial meniscectomy. Clinicians should consider the available implants in determining which tear patterns to repair and future studies with long-term follow-up are needed to investigate complications (e.g. secondary meniscal procedures) as well as the potential for delay in the development of osteoarthritis.

Level of evidence

Level IV.


Horizontal cleavage tear Avascular zone Meniscus Knee Arthroscopy 



Magnetic resonance imaging


Horizontal cleavage tears


Preferred reporting items for systematic reviews and meta-analyses


Revised assessment of multiple systematic reviews


Journal of bone and joint surgery


Methodological Index for Non-Randomized Studies


Confidence interval


Intraclass correlation coefficient


Randomized controlled trial


International knee documentation committee


Minimal clinically important difference


Visual Analog Score


Knee Injury and Osteoarthritis Outcome Score


Author’s contribution

NS performed the literature search. AS and TT performed the title, abstract, and full-text screening, the hand-search of references, data extraction, and wrote several drafts of the manuscript. SE, NS, CG, MK, MB, and BH thoroughly edited and provided guidance with respect to preparation of the manuscript. MK conceived the study and participated in its design and coordination. All authors read and approved the final manuscript.


No funding was received for the implementation of this study.

Compliance with ethical standards

Conflict of interest

The authors have no potential conflicts of interest to declare.

Ethical approval

Ethical approval is not required.


  1. 1.
    Accadbled F, Cassard X, Sales De Gauzy J, Cahuzac JP (2007) Meniscal tears in children and adolescents: results of operative treatment. J Pediatr Orthop B 16:56–60CrossRefGoogle Scholar
  2. 2.
    Ahn J-HH, Kwon O-JJ, Nam T-SS (2015) Arthroscopic repair of horizontal meniscal cleavage tears with marrow-stimulating technique. Arthroscopy 31:92–98CrossRefGoogle Scholar
  3. 3.
    Atsumi S, Hara K, Arai Y, Yamada M, Mizoshiri N, Kamitani A, Kubo T (2018) A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes. Medicine 97:e9888CrossRefGoogle Scholar
  4. 4.
    Baker BE, Peckham AC, Pupparo F, Sanborn JC (1985) Review of meniscal injury and associated sports. Am J Sports Med 13:1–4CrossRefGoogle Scholar
  5. 5.
    Baratz ME, Fu FH, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. a preliminary report. Am J Sports Med 14:270–275CrossRefGoogle Scholar
  6. 6.
    Beamer BS, Walley KC, Okajima S, Manoukian OS, Perez-Viloria M, DeAngelis JP, Ramappa AJ, Nazarian A (2017) Changes in contact area in meniscus horizontal cleavage tears subjected to repair and resection. Arthroscopy 33:617–624CrossRefGoogle Scholar
  7. 7.
    Beaufils P, Pujol N (2017) Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res 103:S237–S244CrossRefGoogle Scholar
  8. 8.
    Biedert RM (2000) Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods. Knee Surg Sport Traumatol Arthrosc 8:104–108CrossRefGoogle Scholar
  9. 9.
    Biedert RM (1993) Intrasubstance meniscal tears—clinical aspects and the role of MRI. Arch Orthop Trauma Surg 112:142–147CrossRefGoogle Scholar
  10. 10.
    Billières J, Pujol N (2018) Meniscal repair associated with a partial meniscectomy for treating complex horizontal cleavage tears in young patients may lead to excellent long-term outcomes. Knee Surg Sport Traumatol Arthrosc 27:343–348CrossRefGoogle Scholar
  11. 11.
    Bin S-II, Jeong S-II, Kim J-MM, Shon H-CC (2002) Arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus. Knee Surg Sport Traumatol Arthrosc 10:20–24CrossRefGoogle Scholar
  12. 12.
    Binfield PM, Maffulli N, King JB (1993) Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Injury 24:557–561CrossRefGoogle Scholar
  13. 13.
    Brelin AM, Rue J-PH (2016) Return to play following meniscus surgery. Clin Sports Med 35:669–678CrossRefGoogle Scholar
  14. 14.
    Christoforakis J, Pradhan R, Sanchez-Ballester J, Hunt N, Strachan RK (2005) Is there an association between articular cartilage changes and degenerative meniscus tears? Arthroscopy 21:1366–1369CrossRefGoogle Scholar
  15. 15.
    Chuang L-HH, Garratt A, Brealey S (2013) Comparative responsiveness and minimal change of the Knee Quality of Life 26-item (KQoL-26) questionnaire. Qual Life Res 22:2461–2475CrossRefGoogle Scholar
  16. 16.
    Doral MN, Bilge O, Huri G, Turhan E, Verdonk R (2018) Modern treatment of meniscal tears. EFORT Open Rev 3:260–268CrossRefGoogle Scholar
  17. 17.
    Englund M (2004) Meniscal tear—a feature of osteoarthritis. Acta Orthop 75:1–45CrossRefGoogle Scholar
  18. 18.
    Erdil M, Bilsel K, Sungur M, Dikmen G, Tuncer N, Polat G, Elmadag NM, Tuncay I, Asik M (2013) Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study. Arthroscopy 29:232–237CrossRefGoogle Scholar
  19. 19.
    Ferkel RD, Davis JR, Friedman MJ, Fox JM, Del Pizzo W, Snyder SJ, Berasi CC (1985) Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results. Arthroscopy 1:44–52CrossRefGoogle Scholar
  20. 20.
    Fox AJS, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA (2015) The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat 28:269–287CrossRefGoogle Scholar
  21. 21.
    Haemer JM, Wang MJ, Carter DR, Giori NJ (2007) Benefit of single-leaf resection for horizontal meniscus tear. Clin Orthop Relat Res 457:194–202Google Scholar
  22. 22.
    Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefGoogle Scholar
  23. 23.
    Irrgang JJ, Anderson AF, Boland AL, Harner CD, Neyret P, Richmond JC, Shelbourne KD, Bergfeld J, Feagin J, Fulkerson J, Kocher M, Howell S, Staubli H, Hefti F, Hoher J, Jacob R, Mueller W, Chan KM, Kurosaka M, International Knee Documentation Committee (2006) Responsiveness of the international knee documentation committee subjective knee form. Am J Sports Med 34:1567–1573CrossRefGoogle Scholar
  24. 24.
    Jang K-M, Ahn JH, Wang JH (2012) Arthroscopic partial meniscectomy of a posteriorly flipped superior leaflet in a horizontal medial meniscus tear using a posterior transseptal portal. Orthopedics 35:e430–e433Google Scholar
  25. 25.
    Kamimura T, Kimura M (2011) Repair of horizontal meniscal cleavage tears with exogenous fibrin clots. Knee Surg Sport Traumatol Arthrosc 19:1154–1157CrossRefGoogle Scholar
  26. 26.
    Kamimura T, Kimura M (2014) Meniscal repair of degenerative horizontal cleavage tears using fibrin clots: clinical and arthroscopic outcomes in 10 cases. Orthop J Sport Med 2:2325967114555678CrossRefGoogle Scholar
  27. 27.
    Katz JN, Meredith DS, Lang P, Creel AH, Yoshioka H, Neumann G, Fossel AH, de Pablo P, Losina E (2006) Associations among preoperative MRI features and functional status following arthroscopic partial meniscectomy. Osteoarthr Cartil 14:418–422CrossRefGoogle Scholar
  28. 28.
    Katz NP, Paillard FC, Ekman E (2015) Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res 10:24CrossRefGoogle Scholar
  29. 29.
    Kaya A, Ulku TK, Kocaoğlu B, Gereli HA, Akan B (2014) Arthroscopic repair of horizontal meniscus tears by vertical sutures with packing technique. Orthop J Sport Med 2:2325967114S00262Google Scholar
  30. 30.
    Kijowski R, Woods MA, McGuine TA, Wilson JJ, Graf BK, De Smet AA (2011) Arthroscopic Partial meniscectomy: MR imaging for prediction of outcome in middle-aged and elderly patients. Radiology 259:203–212CrossRefGoogle Scholar
  31. 31.
    Kim J-MM, Il BS-I, Kim E (2009) Inframeniscal portal for horizontal tears of the meniscus. Arthroscopy 25:269–273CrossRefGoogle Scholar
  32. 32.
    Kim JG, Lee S-Y, Chay S, Lim HC, Bae J-H (2016) Arthroscopic meniscectomy for medial meniscus horizontal cleavage tears in patients under age 45. Knee Surg Relat Res 28:225–232CrossRefGoogle Scholar
  33. 33.
    Kim JR, Kim BG, Kim JW, Lee JH, Kim JH (2013) Traumatic and non-traumatic isolated horizontal meniscal tears of the knee in patients less than 40 years of age. Eur J Orthop Surg Traumatol 23:589–593CrossRefGoogle Scholar
  34. 34.
    Kim SJ, Lee SK, Kim SH, Jeong JH, Kim HS, Lee SW, Lee JH, Jung M (2015) Does decreased meniscal thickness affect surgical outcomes after medial meniscectomy? Am J Sports Med 43:937–944CrossRefGoogle Scholar
  35. 35.
    Kim Y-MM, Joo Y-BB, Cha S-MM, Hwang J-MM (2012) Role of the mechanical axis of lower limb and body weight in the horizontal tear and root ligament tear of the posterior horn of the medial meniscus. Int Orthop 36:1849–1855CrossRefGoogle Scholar
  36. 36.
    Krause WR, Pope MH, Johnson RJ, Wilder DG (1976) Mechanical changes in the knee after meniscectomy. J Bone Joint Surg Am 58:599–604CrossRefGoogle Scholar
  37. 37.
    Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL (2008) Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. Am J Sports Med 36:1283–1289CrossRefGoogle Scholar
  38. 38.
    Kung J, Chiappelli F, Cajulis OO, Avezova R, Kossan G, Chew L, Maida CA (2010) From systematic reviews to clinical recommendations for evidence-based health care: validation of revised assessment of multiple systematic reviews (R-AMSTAR) for grading of clinical relevance. Open Dent J 4:84–91Google Scholar
  39. 39.
    Kurzweil PR, Lynch NM, Coleman S, Kearney B (2014) Repair of horizontal meniscus tears: a systematic review. Arthroscopy 30:1513–1519CrossRefGoogle Scholar
  40. 40.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159CrossRefGoogle Scholar
  41. 41.
    Lauder TD, Baker SP, Smith GS, Lincoln AE (2000) Sports and physical training injury hospitalizations in the Army. Am J Prev Med 18:118–128CrossRefGoogle Scholar
  42. 42.
    Lee C-H, Song I-S, Jang S-W, Cha H-E (2013) Results of arthroscopic partial meniscectomy for lateral discoid meniscus tears associated with new technique. Knee Surg Relat Res 25:30–35CrossRefGoogle Scholar
  43. 43.
    Lee S-WW, Chun Y-MM, Choi C-HH, Kim S-HJS-JH, Jung M, Han J-WW, Kim S-HJS-JH (2016) Single-leaf partial meniscectomy in extensive horizontal tears of the discoid lateral meniscus: does decreased peripheral meniscal thickness affect outcomes? (mean four-year follow-up). Knee 23:472–477CrossRefGoogle Scholar
  44. 44.
    McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg 88:1549–1556CrossRefGoogle Scholar
  45. 45.
    Metcalf MH, Barrett GR (2004) Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med 32:675–680CrossRefGoogle Scholar
  46. 46.
    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, PRISMA-P Group (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1CrossRefGoogle Scholar
  47. 47.
    Nguyen JC, De Smet AA, Graf BK, Rosas HG (2014) MR Imaging–based diagnosis and classification of meniscal tears. RadioGraphics 34:981–999CrossRefGoogle Scholar
  48. 48.
    Noble J, Hamblen DL (1975) The pathology of the degenerate meniscus lesion. J Bone Joint Surg Br 57:180–186CrossRefGoogle Scholar
  49. 49.
    Piontek T, Ciemniewska-Gorzela K, Naczk J, Jakob R, Szulc A, Grygorowicz M, Slomczykowski M (2016) Complex meniscus tears treated with collagen matrix wrapping and bone marrow blood injection: a 2-year clinical follow-up. Cartilage 7:123–139CrossRefGoogle Scholar
  50. 50.
    Poehling GG, Ruch DS, Chabon SJ (1990) The landscape of meniscal injuries. Clin Sport Med 9:539–549Google Scholar
  51. 51.
    Pujol N, Bohu Y, Boisrenoult P, Macdes A, Beaufils P (2013) Clinical outcomes of open meniscal repair of horizontal meniscal tears in young patients. Knee Surg Sport Traumatol Arthrosc 21:1530–1533CrossRefGoogle Scholar
  52. 52.
    Pujol N, Salle De Chou E, Boisrenoult P, Beaufils P (2014) Platelet-rich plasma for open meniscal repair in young patients: any benefit? Knee Surg Sport Traumatol Arthrosc 23:51–58CrossRefGoogle Scholar
  53. 53.
    Renström P, Johnson RJ (1990) Anatomy and biomechanics of the menisci. Clin Sports Med 9:523–538Google Scholar
  54. 54.
    Sallé de Chou E, Pujol N, Rochcongar G, Cucurulo T, Potel J-FF, Dalmay F, Ehkirch F-PP, Laporte C, Le Henaff G, Seil R, Lutz C, Gunepin F-XX, Sonnery-Cottet B, d’Arthroscopie SF (2015) Analysis of short and long-term results of horizontal meniscal tears in young adults. Orthop Traumatol Surg Res 101:S317–S322CrossRefGoogle Scholar
  55. 55.
    Scott GA, Jolly BL, Henning CE (1986) Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing. J Bone Joint Surg 68:847–861CrossRefGoogle Scholar
  56. 56.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefGoogle Scholar
  57. 57.
    Spahn G (2003) Arthroscopic revisions in failed meniscal surgery. Int Orthop 27:378–381CrossRefGoogle Scholar
  58. 58.
    Terzidis IP, Christodoulou A, Ploumis A, Givissis P, Natsis K, Koimtzis M (2006) Meniscal tear characteristics in young athletes with a stable knee: arthroscopic evaluation. Am J Sports Med 34:1170–1175CrossRefGoogle Scholar
  59. 59.
    Tiftikçi U, Serbest S (2016) Repair of isolated horizontal meniscal tears with all-inside suture materials using the overlock method: outcome study with a minimum 2-year follow-up. J Orthop Surg Res 11:131CrossRefGoogle Scholar
  60. 60.
    Tsujii A, Matsuo T, Kinugasa K, Yonetani Y, Hamada M (2018) Arthroscopic minimum saucerization and inferior-leaf meniscectomy for a horizontal tear of a complete discoid lateral meniscus: report of two cases. Int J Surg Case Rep 53:372–376CrossRefGoogle Scholar
  61. 61.
    Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg 85(1):1–3CrossRefGoogle Scholar
  62. 62.
    Yim J-HH, Seon J-KK, Song E-KK, Choi J-II, Kim M-CC, Lee K-BB, Seo H-YY (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41:1565–1570CrossRefGoogle Scholar
  63. 63.
    Yocum LA, Kerlan RK, Jobe FW, Carter VS, Shields CL, Lombardo SJ, Collins HR (1979) Isolated lateral meniscectomy. A study of twenty-six patients with isolated tears. J Bone Joint Surg 61:338–342CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Division of Orthopaedic Surgery, Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  3. 3.University of WashingtonSeattleUSA

Personalised recommendations