Meniscal repair in patients age 40 years and older: A systematic review of 11 studies and 148 patients

Purpose: The purpose of this review is to evaluate published outcomes for reported failure rates following meniscus repair in patients age 40 years or older. Methods: A systematic search was performed, and 225 meniscus repair outcome studies on adults were identified in the English literature. Included studies reported either individual patient data with at least one patient age 40 years or summary data with all patients' age >= 40 years. Failure rates were determined based on previously reported risk factors (regardless of age) including concomitant anterior cruciate ligament (ACL) reconstruction (ACLR), tear location, and tear pattern. Results: Meniscus repair outcomes for 148 patients from 11 studies were included (125 inside out repairs and 23 all-inside repairs). The overall failure rate was 10% (15/148) and ranged from 0 to 23% in individual studies with more than one patient age years. One comparative study of patients over versus under age >= 40 years was identified, with no difference in failure rates between groups. Most tears were peripheral tears with avascular extension (nine-percent overall failure rate) or without avascular extension (nine-percent failure rate). Among studies that reported tear pattern, overall failure rates for vertical-longitudinal or bucket handle tears were nine percent and complex and/or horizontal tears were 23%. Repairs with concomitant ACL reconstruction had a five-percent overall failure rate versus 15% in ACL intact patients. Conclusion: Meniscus repair failure rates in patients age 40 years and older are comparable to rates quoted for younger patients. (C) 2018 Published by Elsevier B.V.