What Are the Outcomes of Meniscus Repair vs Excision in Stable Knees in High School and College Athletes: A Prospective Cohort Study

OBJECTIVES: In high school and college athletes, the results of isolated meniscectomy compared to meniscal repair in ligamentously stable knees is unknown. Our objective was to compare patient-reported outcomes and reoperation rates at a minimum 1 year of follow-up for high school and college athletes undergoing isolated meniscal repair compared to meniscectomy. We hypothesized that both groups would see significant improvement in outcomes with meniscectomy having higher reported outcomes and a lower reoperation rate compared to meniscal repair. METHODS: Patients aged 13-22 years old undergoing meniscal surgery at a single institution between 2015-2017 were prospectively enrolled and followed in our outcomes management evaluation system (OME). Pre-operatively, patients’ baseline demographics and patient-reported outcomes (PROMs) specific to meniscal pathology were collected, including Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and quality of life (QoL) subsets. Post-operatively, intra-operative findings and treatments were recorded from OME. Patients were contacted and completed a minimum 1- or 2-year patient-reported outcome measures survey. Embedded in the post-operative survey was a question designed to evaluate the Patient Acceptable Symptom State (PASS). Patients were also specifically asked if they had undergone any subsequent surgeries to either knee since their primary procedure as a preliminary assessment of early failure. RESULTS: A total of 145 patients were enrolled (70% male; median age, 18 years). One-year minimum PROMs were obtained on 73% (n=106) of the cohort. The results are displayed in the table and figure. KOOS QoL (see figure) and pain scores at minimum 1-year follow-up were not significantly different between meniscal repair compared to meniscectomy. Reoperation rate was 7.5% overall with no significant difference noted between the groups. No individual variables, including body mass index (BMI), smoking, level of education, mental health status, or grade 3 or 4 cartilage lesions were found not to be significant risk factors for outcome in either group. A PASS was achieved in 82% of the meniscectomy group and 71% of the meniscal repair group. CONCLUSION: High school and college athletes undergoing isolated meniscal surgery had equally significant improvements in minimum 1-year PROMs regardless of whether they underwent meniscectomy or meniscal repair. Preliminary reoperation rates were similar amongst the two treatment groups and the majority of both groups achieved a patient acceptable symptom state. No individual variable was identified as a modifiable risk factor to poor outcome after isolated meniscal surgery in this age group.