Variable outcomes of medial meniscectomy in middle aged and older patients after 2 to 8 years

OBJECTIVES: To review midterm results of arthroscopic medial meniscectomy in patients over the age of 40. METHODS: RETROSPECTIVE OBSERVATIONAL SERIES. All 354 patients over 40 years of age (after exclusion criteria) who underwent medial meniscectomy by a single surgeon for clinical and MRI correlated medial meniscal tears, having failed conservative treatment, between 2009 and 2014 were sent a questionnaire. Completed questionnaires from 179 patients at an average follow up of 52 ± 15 months (range, 20-79) were analysed. RESULTS: The average time to maximum recovery was longer than expected at 5.6 ± 6 months (range 0.5-36). 74% (133) felt they were largely or completely relieved of symptoms, but, as predicted from past experience, 5% (8) were worse post-operatively. Symptoms became worse in the follow-up period in another 26% (47). 11% (20) had further surgery (15 to TKR). 9% (17) preferred to have left the knee alone in retrospect. Final WOMET and Tegner-Lysholm scores showed overall fair results (36% excellent, 17% good, 22% fair, 25% poor.) CONCLUSION: Medial meniscectomy in the middle aged and elderly remains controversial, with some claiming that it is no better than placebo, and possibly harmful. This data should provide guidance in counselling patients regarding the risks, and likelihood of benefit, from such surgery, and has led to the authors using more rigorous selection criteria. Prospective studies are needed.