Background:

Little is known about the benefits and outcomes of meniscal repair in patients older than 60 years.

Purpose:

To (1) report the clinical and radiographic outcomes of meniscal repair in patients aged ≥60 years and compare them with matched patients who underwent meniscectomy and (2) identify procedural failures.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

We included 32 knees in 32 patients aged ≥60 years (20 female, 12 male; mean age, 64.5 ± 4.6 years) who underwent meniscal repair surgery at a single medical institution between 2010 and 2020. Patients were matched according to age, sex, body mass index, and meniscal tear type with a comparison cohort who underwent meniscectomy (n = 49 patients [49 knees]; 32 female, 17 male). For all patients, demographic information, clinical history, physical examination findings, treatment details, and radiographic images were reviewed and analyzed. At final follow-up (mean, 42.2 months; range, 13-128 months), patients completed the 2000 International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Clinical failure was defined as revision surgery and/or progression to total knee arthroplasty (TKA). A matched-pairs t test was used to analyze differences between the 2 treatment groups, and Kaplan-Meier analysis was used to determine the rates of knee osteoarthritis and progression to TKA.

Results:

The majority of patients had a medial meniscal tear (72.8%), whereas the lateral meniscus was torn in 27.2% of cases. Most tears were located in the meniscal root (56.8%), followed by the posterior horn (34.6%) and midbody (8.6%). At final follow-up, all outcome scores were higher in the repair group compared with the meniscectomy group (IKDC, 78.9 ± 13.4 vs 56.0 ± 15.4; KOOS, 86.6 ± 11.9 vs 61.7 ± 16.2; Lysholm, 88.3 ± 13.3 vs 68.7 ± 15.2, respectively; P < .001 for all). Clinical failure was observed in 22% of patients in the repair group.

Conclusion:

All clinical outcome scores were higher in the meniscal repair group compared with the matched meniscectomy group at final follow-up. The clinical failure rate of the repair group was 22%. These findings support meniscal repair in selected patients aged ≥60 years.

中文翻译：

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半月板修复对 60 岁及以上患者的益处

背景：

对 60 岁以上患者进行半月板修复的益处和结果知之甚少。

目的：

(1) 报告年龄≥60 岁患者半月板​​修复的临床和影像学结果，并将其与接受半月板切除术的匹配患者进行比较，以及 (2) 确定手术失败。

学习规划：

队列研究；证据等级，2。

方法：

我们纳入了 2010 年至 2020 年间在一家医疗机构接受半月板修复手术的 32 名年龄≥60 岁（20 名女性，12 名男性；平均年龄 64.5 ± 4.6 岁）的 32 个膝关节。体重指数和半月板撕裂类型与接受半月板切除术的比较队列（n = 49 名患者 [49 个膝盖]；32 名女性，17 名男性）。对所有患者的人口统计信息、临床病史、体格检查结果、治疗细节和放射影像进行了审查和分析。在最后一次随访（平均 42.2 个月；范围 13-128 个月）时，患者完成了 2000 年国际膝关节文献委员会 (IKDC) 主观膝关节评估表、膝关节损伤和骨关节炎结果评分 (KOOS) 以及 Lysholm 评分。临床失败定义为翻修手术和/或进展至全膝关节置换术 (TKA)。配对t检验用于分析 2 个治疗组之间的差异，Kaplan-Meier 分析用于确定膝骨关节炎和进展为 TKA 的发生率。

结果：

大多数患者有内侧半月板撕裂 (72.8%)，而外侧半月板撕裂占 27.2%。大多数撕裂位于半月板根部 (56.8%)，其次是后角 (34.6%) 和中体 (8.6%)。在最后一次随访时，修复组的所有结果评分均高于半月板切除术组（IKDC，78.9 ± 13.4 vs 56.0 ± 15.4；KOOS，86.6 ± 11.9 vs 61.7 ± 16.2；Lysholm，88.3 ± 13.3 vs 68.7 ± 15.2 ，分别；所有P < .001）。修复组 22% 的患者出现临床失败。

结论：

在最后一次随访时，半月板修复组的所有临床结果评分均高于匹配的半月板切除术组。修复组的临床失败率为22%。这些发现支持对年龄≥60 岁的选定患者进行半月板修复。