Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness
PMID: 29517925
Most medial meniscus root tears occur in patients in their fourth or fifth decades of life, causing moderate to severe joint-line pain. Historically, surgeons have elected to treat these tears nonoperatively or by meniscectomy. Unfortunately, clinical studies have shown that these options can accelerate degeneration of cartilage and subsequently require total knee replacement. Meniscus root repair is a surgical alternative to these options that has demonstrated improved clinical outcomes and slower progression of osteoarthritis. However, there is still some uncertainty and controversy regarding the best treatment option. Thus, this study evaluates the long-term clinical and cost-effectiveness of the following three treatment options in those with medial meniscus root tears and osteoarthritis: root repair, meniscectomy, and initial nonoperative management.
Over 10 years, meniscus repair, meniscectomy, and nonoperative treatment led to 53.0%, 99.3%, and 95.1% rates of osteoarthritis and 33.5%, 51.5%, and 45.5% rates of total knee replacement, respectively. Additionally, data over a 10 year span also showed that meniscectomy and nonoperative treatment incurred 40% and 11% higher costs, respectively, when compared to costs of meniscal repair. Together, findings suggest that meniscus root repair is associated with less osteoarthritis and is a cost-saving intervention, when compared to total meniscectomy and nonsurgical treatment.