Is there actually a study showing that something doesn’t get worse as we age? Yes!
Study: Age Doesn’t Influence Meniscus Repair Results
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Secondary#knee#meniscaltear#meniscusrepair
New work indicates that patients over the age of 40 don’t fare worse than those under 40 when it comes to meniscal repair.
The study, “Meniscal repair in patients age 40 years and older: A systematic review of 11 studies and 148 patients,” was published in the December 2018 edition of The Knee.
David Flanigan, M.D., an orthopedic surgeon at The Ohio State University Wexner Medical Center and co-author on the study, explained his work to OTW, “Meniscus tears are the most common injury treated by orthopedic surgeons.”
“From other injuries, we know that age can influence outcomes. Specifically for meniscus injuries, as we get older the meniscus undergoes degeneration. The main goal of this study was to explore how age influenced meniscus repair results.”
The research looked at outcomes for 148 patients enrolled in 11 studies and found that the the overall failure rate was 10%. Flanigan and his co-authors said, “…Most tears [mentioned in the studies] were peripheral tears with avascular extension (9% overall failure rate) or without avascular extension (9% failure rate).”
“Among studies that reported a tear pattern, overall failure rates for vertical-longitudinal or bucket handle tears were 9% and complex and/or horizontal tears were 23%. Repairs with concomitant ACL [anterior cruciate ligament] reconstruction had a 5% overall failure rate versus 15% in ACL intact patients.”
Dr. Flanigan explained his conclusions to OTW, “Age really does not matter. If an appropriate tear that can be repaired is found, especially if it extends to a vascular zone, the results of repairs are consistent across age groups (regardless of age over 40 years old).”
“Whenever possible, the meniscus is worth saving and will have good results regardless of age. We have many tools currently that can address multiple types of tears we great success. Age of the patient should not influence the decision making process.”
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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