Table 2 Evidence for meniscal repair

Randomised control trials

Jarvela and colleagues, 2010 [21]

Degenerative meniscal tear or knee OA excluded; 2-year follow-up

Screws, n = 21; mean age 30 years (±9 years)

Arrows, n = 21; mean age 32 years (±9 years)

N/A

N/A

Surgical failure. Structure

No between-group differences for surgical failure rate (P = 0.242). More chondral damage with arrows (P = 0.018)

Similar surgical outcomes. Arrows caused more chondral damage

Bryant and colleagues, 2007 [22]

Vertical meniscal tears only; 28-month follow-up

Sutures, n = 49; mean age 25.7 years (±9 years)

Arrows, n = 51; mean age 25.1 years (±8 years)

N/A

N/A

Re-tear rate. Symptoms and quality of life

No significant between-group differences for re-tear rate. No significant between-group differences for QOL or WOMET scores

No difference between the two different repair methods

Hantes and colleagues, 2006 [23]

Those with knee OA at arthroscopy excluded; 23-month follow-up

Group A: Outside-in, n = 17 (14 medial meniscus); mean age 28.5 years

Group B: Inside-out, n = 20 (17 medial meniscus); mean age 28 years

Group C: All-inside, n = 20 (17 medial meniscus); mean age 25 years

N/A

Operative time and healing rate

Healing rate in group C inferior to groups A and B. Group B was quickest procedure

Inside-out technique superior to other two as high rate of healing without prolonged operation time

Beidert, 2000 [10]

Painful intrasubstance medial meniscal tear; mean age 30.4 years (range 16 to 50 years); 26.5-month follow-up

Suture repair, n = 10

PT and NSAIDs, n = 12

Minimal resection, fibrin clot, suture repair, n = 7

APM, n = 11

Symptoms

Normal/near normal IKDC. Group 1, 75%; Group 2, 90%; Group 3, 43%; Group 4, 100%

Intra-substance (degenerative) meniscal tears were shown to be best treated by APM. Meniscal repair might give better medium-term to long-term results

Albrecht-Olsen and colleagues, 1999 [24]

Those with OA at arthroscopy excluded; 3-month to 4-month follow-up

Inside-out sutures, n = 32 (21 medial); median age 25.5 years (range 18 to 40 years)

All-inside meniscal arrows, n = 33 (21 medial); median age 26.5 years (range 18 to 37 years)

N/A

N/A

Healing rates

No between-group differences for healing (P = 0.11). No between-group differences in subgroup analyses, dependent on ACL reconstructed or ACL insufficient knees

Similar outcome with two meniscal repair procedures

Cohort studies

Melton and colleagues, 2011 [27]

ACL lesions without degenerative changes; median 10-year follow-up; mean age 28 years (range 20 to 53 years)

Inside-out repair, n = 35 (32 medial); mean age 28 years

APM, n = 40; mean age 27 years

Intact menisci, n = 40; mean age 27

N/A

Symptoms

Mean IKDC significantly higher in meniscal repair group compared with menisectomy group

Improved functional scores achieved in people with ACL reconstruction and meniscal repair compared with ACL reconstruction and menisectomy

Stein and colleagues, 2010 [26]

Traumatic meniscal tear; mid-term follow-up at 3.4 years (n = 35); long-term follow-up at 8.8 years (n = 46)

Meniscal repair, n = 42; mean age 31.2

APM, n = 39; mean age 30.4

N/A

N/A

Structure and function

Significantly less progression of OA0 (P = 0.005); greater preinjury activity level (P = 0.001) and greater sporting activity among athletes (P = 0.001) in people treated with meniscal repair

Meniscal repair associated with better outcomes than APM

Sommerlath, 1991 [25]

Baseline symptoms not reported; knee OA excluded; 7-year follow-up

Open suture meniscal repair, n = 34; mean age 27 years

APM, n = 26; mean age 27 years

N/A

N/A

Symptoms. Structure

In meniscal repair group, significantly: higher LKS scores; less OA; longer return to professional activities

Reduced OA in meniscal repair group despite longer return to work than people receiving APM