Abstract
Objectives:
While meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Augmented repair of meniscal tears is intended to provide an enhanced healing environment. Fibrin clot augmentation (FCA) affords structural and biochemical properties which are proposed to improve healing rates and patient outcomes.
We recently published a retrospective case series of 50 patients undergoing isolated fibrin clot augmented meniscal repair (1). We demonstrated excellent rates of healing in tears considered to be at high risk of failure. Patient-reported outcome measures demonstrated improvement on the Lysholm, IKDC, Tegner and Oxford Knee scores (mean 30 months post-surgery).
The purpose of this study is to prospectively follow a cohort of isolated FCA meniscal repairs to determine failure rates and the association with tear pattern characteristics. Secondary aims will measure patient reported outcome measures (PROMs) and complications of FCA meniscal repairs.
We hypothesize that few patients will require additional surgical procedures following fibrin clot augmentation (FCA) meniscal repairs. Furthermore, we hypothesize that patients will report a clinically significant improvement in validated patient-reported outcome measures (including Tegner, KOOS, IKDC, and Lysholm) at 12-month follow-up.
Methods:
A prospective multi-surgeon cohort series of all patients undergoing isolated FCA meniscal repair between January 2023 and October 2024 was undertaken. All cases were considered to be at increased risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears outside the red–red zone. Patients were excluded if they had a concomitant procedure including anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure at 12-months defined as further repair or debridement. Secondary outcomes were PROMs - Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner Activity Scale, and surgical complications.
Results:
(*Preliminary at time of abstract submission) ~70 isolated inside-out meniscal repairs using FCA were performed in 70 patients (62% male). The mean age was 34 years (range 14–60). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases involved repair of the white–white zone. 16% of cases were revision procedures. All patients were followed up for a minimum of 12 months (mean = X months, range) to assess survivorship and will continue to be followed up longitudinally. Statistically significant improvement in all PROMs were demonstrated at a median of 30 months post-operatively. Five patients (7%) underwent further surgery for failure after median 21 months. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 10% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p = 0.4).
Conclusion:
Fibrin Clot augmented (FCA) meniscal repair performed for tears considered to be at increased risk of failure demonstrate low rates of clinical failure. Longitudinal surveillance of this prospective cohort will serve to monitor medium and long-term survivorship. A multi-surgeon, multi-centre cohort will increase the power of this study group allowing more robust analysis.
(1) Fibrin clot augmentation of high-risk meniscal repairs may result in clinical healing in up to 90% of cases. Davies PSE, Goldberg M, Anderson JA, Dabis J, Stillwell A, McMeniman TJ, Myers PT. J ISAKOS. 2024 Dec;9(6):100316.