Total Knee Arthroplasty After Meniscectomy Is More Likely in Patients With Bicompartmental or Complex Tears

Purpose To determine the relationship between meniscus tear morphologies, stratified by location and pattern, and knee arthroplasty rates in a commercial insurance population. Methods The PearlDiver database was queried for patients ≥35 years old with a meniscus tear of specified laterality and ≥2 years follow‐up between 2015 and 2018. Two analyses were conducted with cohorts matched on age, sex, Charlson Comorbidity Index, obesity, osteoarthritis (OA), and treatment (meniscectomy vs conservative): one with equal‐sized subgroups by tear location (medial only, lateral only, or both medial and lateral) and another by tear pattern (bucket‐handle, complex, or peripheral). The rate of subsequent total knee arthroplasty (TKA) was compared between matched groups. Results In total, 129,987 patients (mean age: 57.8 ± 10.5 years) were matched by tear location; 1,734 patients with medial‐only tears (4.0%), 1,786 with lateral‐only tears (4.1%), and 2,611 with medial plus lateral tears (6.0%) underwent a TKA within 5 years ( P < .001). Patients with both medial and lateral tears were 1.55‐fold more likely to undergo TKA. In total, 24,213 patients (mean age: 56.0 ± 10.5 years) were matched by tear pattern; 296 patients with bucket‐handle tears (3.7%), 373 with complex tears (4.6%), and 336 with peripheral tears (4.2%) underwent TKA ( P = .01). Patients with complex tears were 1.29‐fold more likely to undergo TKA than patients with bucket‐handle tears ( P = .002). Conclusions In matched cohorts of patients with degenerative meniscus tears, having both medial plus lateral tears conferred a 1.5‐fold risk of TKA, whereas complex tears conferred a 1.3‐fold risk within 5 years. Specific meniscal tear patterns and locations harbor varying risk in progressing to end‐stage knee OA, and these data may help counsel patients about their likelihood of progressing to end‐stage OA warranting an arthroplasty procedure. Level of Evidence Level III, retrospective comparative study.