Abstract
Objectives:
Pediatric meniscus tear prevalence is increasing, and meniscus preservation methods are essential for long term knee function in this at risk group. In this patient population meniscus anatomy and vascularity may support higher rates of healing after repair, but safety of meniscus repair has not been studied in a large prospective cohort group. The purpose of this study is to establish the incidence of complications associated with pediatric meniscus repairs in a multi-center prospective quality improvement registry, and to identify the characteristics of meniscus repair that are associated with complications.
Methods:
A prospective multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of meniscus repairs was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA- compliant electronic platform. Each meniscus repair case with a complication form was secondarily reviewed to ensure consistency of identification and grading according to the modified Clavien Dindo classification. Demographics, tear type, repair technique, and implant type, when applicable, were included, and a common cause analysis was performed to evaluate risk factors for early repair failures.
Results:
2375 meniscus repair cases were identified, with a mean age of 15.1 years (2-19) and 44.1% females. These consisted of (25%) isolated repair, (5.4%) discoid meniscus repair, and (66.9%) concomitant ACL and meniscus repair. Overall complication rate was 12.64%, with 5.67% grade III complications. The most common complications were motion loss/stiffness (3.96%), failed repair (2.3%) and continued pain/mechanical symptoms (2.09%). Failed repair was identified in all repair groups but had the highest prevalence in isolated meniscus repair (6.38%), in which grade III complications were more common overall. Stiffness was more common when a meniscus repair was performed during an ACL reconstruction (2.1% Grade II and 1.27% Grade III). There was no statistical difference in complications associated with age, gender, or technique, medial or lateral meniscus, displacement, or zone of repair. However, posterior horn and posterior horn + body repairs of the medial meniscus sustained more complications (p=0.003) as did longitudinal/complex tears of the lateral meniscus (p=0.02).
Conclusions:
Pediatric meniscus repairs performed arthroscopically have a complication rate of 12.64%, with 1 and 20 meniscus repairs leading to a grade III complication. Although there is no difference in complications based on technique, posterior horn medial meniscus and longitudinal tears of lateral meniscus may be at higher risk of complications.