Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 8, pp 2289–2296 | Cite as

Meniscus repairs can be saved in the event of postoperative septic arthritis

  • Philipp Schuster
  • Markus Geßlein
  • Michael Schlumberger
  • Philipp Mayer
  • Hermann Josef Bail
  • Jörg Richter



No systematic studies on optimal treatment of postoperative septic arthritis following arthroscopic meniscus repair are available. The purpose of this study was to retrospectively evaluate the fate of repaired menisci in cases of postoperative septic arthritis, with treatment for infection focused on arthroscopic irrigation and debridement (I&D) and intention to maintain the meniscus.


Data of two sports orthopedics centers of the last 10 years were pooled (approximately 25,000 arthroscopic procedures of the knee). All cases of septic arthritis following arthroscopic meniscus repair were identified. These cases were retrospectively evaluated with regard to clinical course and management, especially the number of necessary I&Ds, if eradication was achieved, and if the repaired meniscus was retained or a partial resection was necessary (‘early failure’). Patients with initially maintained meniscus repairs were contacted if further meniscus surgery was performed in further follow-up (‘late failure’).


20 patients with 23 repaired menisci were included. In 65% (13 cases), a concomitant anterior cruciate ligament reconstruction was performed. A mean of 2.0 ± 1.0 (1–4) arthroscopic I&Ds were performed in the treatment of septic arthritis. In two cases, additional open surgery was performed (after outside-in sutures). Eradication was achieved in all cases. Four repaired menisci (17.4%) showed loosened fixation or substantial degradation and were consequently partially resected within treatment for septic arthritis (early failures). The follow-up rate for the 19 initially maintained menisci was 94.7% after 3.0 ± 2.2 years (median 2.8, 0.4–7.8). Three of these underwent further partial resection (13.0%). Cumulative 3-year survival rate (Kaplan–Meier method) of all repairs was 70.7% (95% CI 50.3–91.1%), and for the subgroup of initially maintained menisci 85.6% (95% CI 67.0–100.0%), respectively.


Septic arthritis following meniscus repair can be successfully treated with (sequential) arthroscopic I&Ds. There is a considerable rate of early failures, however, in a mid-term follow-up the failure rate of initially retained menisci is low and comparable to what we know from the literature for cases without infection. Therefore, it is generally recommended to try to save the repaired menisci in these cases.

Level of evidence

IV, therapeutic case series.


Infection Meniscus Repair Arthroscopy Complication Revision Resection Bacteria Suture Septic arthritis 



The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethical committee of the institution.

Informed consent

Patients were informed, and they consented to conduct the study.


  1. 1.
    Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41:2333–2339CrossRefPubMedGoogle Scholar
  2. 2.
    Albrecht-Olsen P, Kristensen G, Burgaard P, Joergensen U, Toerholm C (1999) The arrow versus horizontal suture in arthroscopic meniscus repair. A prospective randomized study with arthroscopic evaluation. Knee Surg Sports Traumatol Arthrosc 7:268–273CrossRefPubMedGoogle Scholar
  3. 3.
    Bae JH, Lim HC, Kim HJ, Kim TS, Yang JH, Yoon JR (2010) Arthroscopic treatment of acute septic arthritis after meniscal allograft transplantation. Orthopedics 33Google Scholar
  4. 4.
    Barber FA, Coons DA, Ruiz-Suarez M (2006) Meniscal repair with the RapidLoc meniscal repair device. Arthroscopy 22:962–966CrossRefPubMedGoogle Scholar
  5. 5.
    Blackwell R, Schmitt LC, Flanigan DC, Magnussen RA (2016) Smoking increases the risk of early meniscus repair failure. Knee Surg Sports Traumatol Arthrosc 24:1540–1543CrossRefPubMedGoogle Scholar
  6. 6.
    Blevins FT, Salgado J, Wascher DC, Koster F (1999) Septic arthritis following arthroscopic meniscus repair: a cluster of three cases. Arthroscopy 15:35–40CrossRefPubMedGoogle Scholar
  7. 7.
    Cannon WD Jr, Vittori JM (1992) The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med 20:176–181CrossRefPubMedGoogle Scholar
  8. 8.
    Eberbach H, Zwingmann J, Hohloch L, Bode G, Maier D, Niemeyer P et al. (2017) Sport-specific outcomes after isolated meniscal repair: a systematic review. Knee Surg Sports Traumatol Arthrosc. CrossRefPubMedGoogle Scholar
  9. 9.
    Englund M, Lohmander LS (2004) Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50:2811–2819CrossRefPubMedGoogle Scholar
  10. 10.
    Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Jt Surg Br 30b:664–670CrossRefGoogle Scholar
  11. 11.
    Fillingham YA, Riboh JC, Erickson BJ, Bach BR Jr, Yanke AB (2017) Inside-out versus all-inside repair of isolated meniscal tears: an updated systematic review. Am J Sports Med 45:234–242CrossRefPubMedGoogle Scholar
  12. 12.
    Haklar U, Donmez F, Basaran SH, Canbora MK (2013) Results of arthroscopic repair of partial- or full-thickness longitudinal medial meniscal tears by single or double vertical sutures using the inside-out technique. Am J Sports Med 41:596–602CrossRefPubMedGoogle Scholar
  13. 13.
    Hoser C, Fink C, Brown C, Reichkendler M, Hackl W, Bartlett J (2001) Long-term results of arthroscopic partial lateral meniscectomy in knees without associated damage. J Bone Jt Surg Br 83:513–516CrossRefGoogle Scholar
  14. 14.
    Johns BP, Loewenthal MR, Dewar DC (2017) Open compared with arthroscopic treatment of acute septic arthritis of the native knee. J Bone Joint Surg Am 99:499–505CrossRefPubMedGoogle Scholar
  15. 15.
    Kise NJ, Drogset JO, Ekeland A, Sivertsen EA, Heir S (2015) All-inside suture device is superior to meniscal arrows in meniscal repair: a prospective randomized multicenter clinical trial with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 23:211–218CrossRefPubMedGoogle Scholar
  16. 16.
    Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH (2006) Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy 22:3–9CrossRefPubMedGoogle Scholar
  17. 17.
    Krych AJ, Reardon P, Sousa P, Levy BA, Dahm DL, Stuart MJ (2016) Clinical outcomes after revision meniscus repair. Arthroscopy 32:1831–1837CrossRefPubMedGoogle Scholar
  18. 18.
    Laurendon L, Neri T, Farizon F, Philippot R (2017) Prognostic factors for all-inside meniscal repair. An 87-case series. Orthop Traumatol Surg Res. PubMedCrossRefGoogle Scholar
  19. 19.
    Majewski M, Stoll R, Widmer H, Muller W, Friederich NF (2006) Midterm and long-term results after arthroscopic suture repair of isolated, longitudinal, vertical meniscal tears in stable knees. Am J Sports Med 34:1072–1076CrossRefPubMedGoogle Scholar
  20. 20.
    Makhni EC, Steinhaus ME, Mehran N, Schulz BS, Ahmad CS (2015) Functional outcome and graft retention in patients with septic arthritis after anterior cruciate ligament reconstruction: a systematic review. Arthroscopy 31:1392–1401CrossRefPubMedGoogle Scholar
  21. 21.
    Makris EA, Hadidi P, Athanasiou KA (2011) The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials 32:7411–7431CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Jt Surg Br 88:1549–1556CrossRefGoogle Scholar
  23. 23.
    Myerthall S, Ogilvie-Harris DJ (1996) Failure of arthroscopic meniscal repair following septic arthritis. Arthroscopy 12:746–748CrossRefPubMedGoogle Scholar
  24. 24.
    Nepple JJ, Dunn WR, Wright RW (2012) Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Jt Surg Am 94:2222–2227CrossRefGoogle Scholar
  25. 25.
    Parkinson B, Robb C, Thomas M, Thompson P, Spalding T (2017) Factors that predict failure in anatomic single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 45:1529–1536CrossRefPubMedGoogle Scholar
  26. 26.
    Peres LR, Marchitto RO, Pereira GS, Yoshino FS, de Castro Fernandes M, Matsumoto MH (2016) Arthrotomy versus arthroscopy in the treatment of septic arthritis of the knee in adults: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 24:3155–3162CrossRefPubMedGoogle Scholar
  27. 27.
    Petty CA, Lubowitz JH (2011) Does arthroscopic partial meniscectomy result in knee osteoarthritis? A systematic review with a minimum of 8 years’ follow-up. Arthroscopy 27:419–424CrossRefPubMedGoogle Scholar
  28. 28.
    Radin EL, de Lamotte F, Maquet P (1984) Role of the menisci in the distribution of stress in the knee. Clin Orthop Relat Res 185:290–294Google Scholar
  29. 29.
    Rochcongar G, Cucurulo T, Ameline T, Potel JF, Dalmay F, Pujol N et al (2015) Meniscal survival rate after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 101:S323–S326CrossRefPubMedGoogle Scholar
  30. 30.
    Roeddecker K, Nagelschmidt M, Koebke J, Guensche K (1993) Meniscal healing: a histological study in rabbits. Knee Surg Sports Traumatol Arthrosc 1:28–33CrossRefPubMedGoogle Scholar
  31. 31.
    Salzler MJ, Lin A, Miller CD, Herold S, Irrgang JJ, Harner CD (2014) Complications after arthroscopic knee surgery. Am J Sports Med 42:292–296CrossRefPubMedGoogle Scholar
  32. 32.
    Schuster P, Schulz M, Immendoerfer M, Mayer P, Schlumberger M, Richter J (2015) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: evaluation of an arthroscopic graft-retaining treatment protocol. Am J Sports Med 43:3005–3012CrossRefPubMedGoogle Scholar
  33. 33.
    Smith JP 3rd, Barrett GR (2001) Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears. Am J Sports Med 29:415–419CrossRefPubMedGoogle Scholar
  34. 34.
    Toman CV, Dunn WR, Spindler KP, Amendola A, Andrish JT, Bergfeld JA et al (2009) Success of meniscal repair at anterior cruciate ligament reconstruction. Am J Sports Med 37:1111–1115CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Torres-Claramunt R, Pelfort X, Erquicia J, Gil-Gonzalez S, Gelber PE, Puig L et al (2013) Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc 21:2844–2849CrossRefPubMedGoogle Scholar
  36. 36.
    Uzun E, Misir A, Kizkapan TB, Ozcamdalli M, Akkurt S, Guney A (2017) Factors affecting the outcomes of arthroscopically repaired traumatic vertical longitudinal medial meniscal tears. Orthop J Sports Med 5:2325967117712448CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Wang C, Lee YH, Siebold R (2013) Recommendations for the management of septic arthritis after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 22:2136–2144CrossRefPubMedGoogle Scholar
  38. 38.
    Westermann RW, Duchman KR, Amendola A, Glass N, Wolf BR (2017) All-inside versus inside-out meniscal repair with concurrent anterior cruciate ligament reconstruction: a meta-regression analysis. Am J Sports Med 45:719–724CrossRefPubMedGoogle Scholar
  39. 39.
    Westermann RW, Wright RW, Spindler KP, Huston LJ, Wolf BR (2014) Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 42:2184–2192CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Yeranosian MG, Petrigliano FA, Terrell RD, Wang JC, McAllister DR (2013) Incidence of postoperative infections requiring reoperation after arthroscopic knee surgery. Arthroscopy 29:1355–1361CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Philipp Schuster
    • 1
  • Markus Geßlein
    • 2
  • Michael Schlumberger
    • 1
  • Philipp Mayer
    • 1
  • Hermann Josef Bail
    • 2
  • Jörg Richter
    • 1
  1. 1.Centre for Arthroscopy and Sports MedicineOrthopedic Hospital MarkgroeningenMarkgroeningenGermany
  2. 2.Department of Orthopedics and Traumatology, Clinic NurembergParacelsus Medical Private UniversityNuernbergGermany

Personalised recommendations