Meniscus Repair - Long-term gains with short-term challenges?

Meniscus tears are common after knee injuries. The current treatment in patients under the age of 40 is typically arthroscopic partial meniscectomy (APM) or arthroscopic meniscus repair. Meniscus tears and surgeries are associated with an accelerated progression to knee osteoarthritis (OA) and disability.
PAPER I is an observational cohort study, utilising the Skåne Healthcare Register (SHR) to identify 2,487 surgically treated patients with a diagnose of a traumatic meniscus tear between the ages of 16 and 45 years. Of these 9.2% had meniscus repair. The aim was to compare the consultation rate for knee OA observed for up to 18 years postoperatively. The absolute risk of having consulted for knee
OA during that time was 10.0% after meniscus repair, 17% after APM and 2.3% in the general population.
PAPER II is an observational cohort study in which we cross-linked data from SHR, LISA and the Swedish social security agency (SSIA) during 2004–2014. The aim was to compare occurrence and duration of sick leave in persons aged 19–49 years after APM and meniscus repair. We found that after meniscus repair, individuals have more frequent and 37% longer periods of sick leave than after APM, when measured up to 2 years after surgery.
PAPER III is an observational cohort study using patient surgical records for all APM and meniscus repair surgeries in southern Skåne 2010–2015. The aim was to examine and compare reoperation rates and complications during 5–10 years of follow-up in 2098 patients and in a subgroup aged 15–40 years. We found that meniscus repair had a 4-fold increase in reoperations compared to APM, and
2.1% had medical complications.
In conclusion,
meniscus repair is associated with a lower risk of consulting for knee OA than APM during 18 years postoperatively. Meniscus repair is associated with both more prevalent and longer sick leave postoperatively than APM. The rate of reoperation is higher after meniscus repair than after APM, and more than 1/3 of all repaired menisci have a reoperation on the same meniscus within 5 years. Finally, the rate of other complications was found to be low after arthroscopic knee surgery in Skåne.

Key words: meniscus repair, APM, osteoarthritis, sick leave, reoperation