Saving the Meniscus: A Retrospective Observational Study of the Incidence, Treatment, and Failure Rate of the Main Meniscal Tear Types at 24-Month Follow-Up

Background: Despite advances in repair techniques, the failure rates of meniscal surgery are still high. The seven most common tear types—horizontal cleavage tears (HCTs), radial tears (RTs), meniscal ramp lesions (MRLs), meniscal root tears (MRTs), longitudinal tears (LTs), bucket-handle tears (BHMTs), and complex meniscal tears (CMTs)—were reviewed. The present retrospective observational study aimed to analyze their characteristics, incidence, treatment approach and failure rates of a consecutive cohort of patients undergoing meniscal arthroscopic repair. Methods: The database of a high-volume meniscal suture center was examined for lesions managed by all-inside, inside-out, outside-in, or transtibial pull-out techniques from January 2018 to September 2022. Demographic (gender, age at surgery, laterality of the affected knee) and intraoperative data (tear type/site, repair technique, and suture number/combination) were collected in order to calculate the failure rates of the cohort and of each tear type and suture technique. Results: Altogether, 636 procedures met our criteria of having at least a 2-year follow-up. The overall failure rate was 1.98%. The most frequent lesions were HCTs (41.98%), with most injuries being in the body/posterior horn (88.52%) of the right knee (56.92%). Treatment predominantly (92.50%) included all-inside sutures. All-inside repair had the highest failure rate (2.98%), followed by inside-out (1.56%) repair (p = 1.0), whereas outside-in and pull-out techniques never failed. Failure rates by lesion included BHMTs (7.27%), HCTs (2.25%), CMTs (1.49%), and LTs (1.25%); RMT, RML, and MRT repair were always successful. Conclusions: Findings at two years suggest that 1–3 all-inside sutures minimize MRL failure, whereas three or more all-inside sutures or combined techniques seem to be effective for HCTs, LTs, and RTs but not BHMTs. Pull-out repair worked best for complete tears/avulsion types of MRTs, whereas all-inside sutures effectively managed partial lesions. Results for CMTs were inconclusive.