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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
KNEE

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Keywords

Horizontal cleavage tear Avascular zone Meniscus Knee Arthroscopy 

Abbreviations

MRI

Magnetic resonance imaging

HCT

Horizontal cleavage tears

PRISMA

Preferred reporting items for systematic reviews and meta-analyses

R-AMSTAR

Revised assessment of multiple systematic reviews

JBJS

Journal of bone and joint surgery

MINORS

Methodological Index for Non-Randomized Studies

CI

Confidence interval

ICC

Intraclass correlation coefficient

RCT

Randomized controlled trial

IKDC

International knee documentation committee

MCID

Minimal clinically important difference

VAS

Visual Analog Score

KOOS

Knee Injury and Osteoarthritis Outcome Score

Notes

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.

Funding

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.

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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

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