Isolated meniscal repair, medial meniscus repair and older age increase failure risk after all-inside meniscal repair: A cohort study of 2264 patients

Abstract

Purpose: To evaluate the overall failure rate and assess factors influencing the failure of modern all-inside meniscal repair. Methods: Patients who underwent all-inside meniscal repair at Capio Artro Clinic, Stockholm, Sweden, from January 2015 to June 2022, were identified. The primary outcome was the occurrence of failure of the repair, defined as reoperation and secondary partial or total meniscal resection within three years. Kaplan–Meier analysis was performed to assess meniscal repair survival, with multivariate Cox regression analysis to adjust for confounders. Results: A total of 2264 patients who underwent meniscal repairs were included (55.9% males, mean age of 27 years ±10). The meniscal repair failure rate for the entire cohort was 20.2% (457/2264). Older age (>40 years) (p = 0.03), medial meniscus repair (p < 0.001) and isolated meniscal repair (without concomitant anterior cruciate ligament reconstruction [ACLR]) (p < 0.001) were associated with statistically significant increased failure rates. Multivariate Cox regression analysis revealed that failure after meniscal repair was statistically significant related to age > 40 (hazard ratio [HR] 1.22; 95% confidence interval (CI) 1.03–1.56; p = 0.034), medial meniscus repair (HR 2.57; 95% CI 2.06–3.19; p < 0.001) and isolated repairs (HR 2.63; 95% CI 2.17–3.19; p < 0.001). Conclusions: In this large cohort study of more than 2000 patients, the overall failure rate of all-inside meniscal repair was 20.2%. Repair without concomitant ACLR, medial meniscal repair, and older age were associated with an increased hazard of failure. These findings underscore the clinical importance of recognising patient-specific risk factors for meniscal repair failure, as such knowledge can guide surgical decision-making and improve individualised treatment strategies to enhance long-term knee function. Level of Evidence: Level III.