Systematic Review and Meta-analysis of Clinical Outcomes Following Meniscus Repair in Patients 40 Years and Older.

BACKGROUND

Meniscal repair has been associated with long-term benefit in patients compared with meniscectomy. As a generalization, meniscal repair in older patients is less likely to be successful, leading to reduced adoption of meniscal repair compared with younger patients.

PURPOSE

To establish the clinical performance of meniscal repair in "older" patients (age, ≥40 years) and compare it with performance in "younger" patients (age, <40 years).

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A systematic literature review was performed in September 2021 using Embase and PubMed to identify published English-language studies that reported on a meniscal repair in >5 patients aged ≥40 years. Outcomes of interest were success/failure rate (as defined by the study), revision meniscal procedure rate, and patient-reported outcomes. Meta-analyses were used to synthesize outcomes across all studies in older patients. Meta-analyses were also used to compare outcomes between older and younger patients across studies, providing data on both age groups.

RESULTS

Fourteen studies were identified. Meniscal repair in older patients was determined to have a failure rate of 12% (95% CI, 7.3% to 19.4%) and a revision meniscal procedure rate of 9.8% (95% CI, 6.2% to 15.0%). The postoperative Lysholm score was 86.7 (95% CI, 81.7 to 91.7). No statistically significant differences were observed between older and younger patients in failure rate (relative risk [RR], 0.73 [95% CI, 0.44 to 1.21]; = .2205), revision meniscal procedure rate (RR, 0.69 [95% CI, 0.41 to 1.16]; = .1613), or Lysholm scores (mean difference, 2.3 [95% CI, -4.7 to 9.2]; = .5278, 4 studies).

CONCLUSION

Meniscal repair in selected patients aged ≥40 years resulted in good success rates and patient-reported outcome measures, which appear similar to those reported for patients aged <40 years. Therefore, meniscal repairs can be performed in at least a specific portion of "older" patients, and age per se should not be the sole determining factor in whether to perform a meniscal repair.