Patient-relevant outcomes fourteen years after meniscectomy: influence of type of meniscal tear and size of resection

Objectives. To study long-term patient-relevant outcomes after meniscectomy , a surgical procedure associated with a high risk of knee osteoarthritis ( OA). Principal objectives were to compare traumatic with degenerative menis cal tear and partial with subtotal meniscectomy. Methods. We studied a well-defined cohort of 205 patients who had undergone isolated unilateral meniscectomy between 1983 and 1985. There was no previ ous knee surgery and all knees were stable. The type of meniscal tear and s urgical resection was ascertained by review of medical records. Patients we re followed up after 14 yr (range 12-15 yr) by self-administered questionna ires, one generic [Short Form 36 (SF-36)] and one disease-specific [Knee In jury and Osteoarthritis Outcome Score (KOOS)]. Results. In a multivariate analysis, using the Sports and Recreation Functi on and knee-related Quality of Life subscales of the KOOS questionnaire as dependent variables, patients with a degenerative tear scored significantly worse than individuals with a traumatic tear (P less than or equal to 0.00 1). When we analysed unmatched subgroups and age- and sex-matched patients with degenerative or traumatic lesions, the same result was found for the k nee-specific outcome (P less than or equal to 0.02) and SF-36 except for So cial Functioning (P less than or equal to 0.04). There was no difference in outcome for the total cohort according to the type of resection. However, subgroup analyses showed that patients who underwent subtotal meniscectomy for a degenerative tear scored significantly worse on the knee-specific out come than individuals who had had a partial meniscectomy for the same type of tear (P less than or equal to 0.02). Conclusions. The long-term outcome of meniscal injury and surgery appears t o be determined largely by the type of meniscal tear. Furthermore, our find ings support the use of minimal. meniscal resection in the treatment of deg enerative tears. We suggest that the disease processes associated with the development of OA of the joint cartilage may also be active in the meniscus , and that a tear in a meniscus with degenerative changes might be regarded as the first sign of OA of the joint.