Download PDF
J Knee Surg 2019; 32(02): 196-204
DOI: 10.1055/s-0038-1636838
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Servicemembers from 2010 to 2015

Timothy B. Pekari
1   Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
,
Kevin C. Wang
2   Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Eric J. Cotter
2   Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
,
Nicholas Kusnezov
3   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
,
Brian R. Waterman
1   Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
› Author Affiliations
Further Information

Publication History

15 March 2017

28 January 2018

Publication Date:
07 March 2018 (online)

    Permissions and Reprints

Abstract

The purpose of this investigation is to report on trends over time in the treatment of meniscal pathology among military orthopaedic surgeons, as well as to evaluate the impact of patient demographics and concomitant procedure on the type of meniscal procedure performed. We performed a retrospective analysis of all active-duty United States military servicemembers who underwent a meniscal procedure from 2010 to 2015 within the Military Health System. Patient demographics and surgical variables were extracted from the electronic medical record. Treatments were categorized by location and by type of intervention (i.e., repair or debridement). Chi-square and linear regression analyses were performed to identify temporal trends in meniscal procedures and factors that were correlated with the type of meniscal procedure performed. Out of 29,571 meniscal procedures analyzed, partial meniscectomy was performed in 81.3% (n = 24,343) of cases, meniscal repair in 20.3% (n = 6,073), and meniscus allograft transplantation (MAT) in 0.7% (n = 206). The rates of debridement, repair, and concomitant surgeries did not demonstrate any significant temporal trends, whereas MAT demonstrated a significant decrease in overall utilization. Nearly two-thirds of all meniscal procedures were performed in the medial compartment. MAT occurred equally between the medial and lateral compartments. Lateral meniscal lesions demonstrated significantly higher rates of debridement. With each year of advancing age, there was a 3.7% increasing likelihood of meniscectomy and 6.5% decreasing likelihood of repair. Females were more likely to undergo meniscal repair than males. Patients in the military population were more likely to undergo meniscal repair compared with previously reported rates in the civilian population. In this physically active cohort of nearly 30,000 military patients, 1 in 5 meniscal tears were treated with meniscal repair. Meniscal repairs were performed at a higher rate for all age groups compared with previously reported rates in the civilian population. Further research is required to elucidate the causative factors behind these differences and the effect on postoperative outcomes.

Level of Evidence: IV, cross-sectional study.

Keywords

meniscus - military - meniscectomy - repair - ACL
 

  • References

  • 1 Jones JC, Burks R, Owens BD, Sturdivant RX, Svoboda SJ, Cameron KL. Incidence and risk factors associated with meniscal injuries among active-duty US military service members. J Athl Train 2012; 47 (01) 67-73
    CrossrefPubMedGoogle Scholar
  • 2 Cameron KL, Owens BD. The burden and management of sports-related musculoskeletal injuries and conditions within the US military. Clin Sports Med 2014; 33 (04) 573-589
    CrossrefPubMedGoogle Scholar
  • 3 Parker BR, Hurwitz S, Spang J, Creighton R, Kamath G. Surgical trends in the treatment of meniscal tears: analysis of data from the American Board of Orthopaedic Surgery Certification Examination Database. Am J Sports Med 2016; 44 (07) 1717-1723
    CrossrefPubMedGoogle Scholar
  • 4 Moulton SG, Bhatia S, Civitarese DM, Frank RM, Dean CS, LaPrade RF. Surgical techniques and outcomes of repairing meniscal radial tears: a systematic review. Arthroscopy 2016; 32 (09) 1919-1925
    CrossrefPubMedGoogle Scholar
  • 5 Anz AW, Hackel JG, Nilssen ECAJ. Application of Biologics in the Treatment of the Rotator Cuff, Meniscus, Cartilage, and Osteoarthritis. J Am Acad Orthop Surg 2014; 22 (02) 68-79
    PubMedGoogle Scholar
  • 6 Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ. Trends in meniscus repair and meniscectomy in the United States, 2005-2011. Am J Sports Med 2013; 41 (10) 2333-2339
    CrossrefPubMedGoogle Scholar
  • 7 Fisher TF, Waterman BR, Orr JD, Holland CA, Bader J, Belmont Jr PJJ. Tibial tubercle osteotomy for patellar chondral pathology in an active United States military population. Arthroscopy 2016; 32 (11) 2342-2349
    CrossrefPubMedGoogle Scholar
  • 8 Waterman BR, Hoffmann JD, Laughlin MD. , et al. Success of high tibial osteotomy in the United States military. Orthop J Sports Med 2015; 3 (03) 2325967115574670
    CrossrefPubMedGoogle Scholar
  • 9 Waterman BR, Rensing N, Cameron KL, Owens BD, Pallis M. Survivorship of meniscal allograft transplantation in an athletic patient population. Am J Sports Med 2016; 44 (05) 1237-1242
    CrossrefPubMedGoogle Scholar
  • 10 Montgomery SR, Zhang A, Ngo SS, Wang JC, Hame SL. Cross-sectional analysis of trends in meniscectomy and meniscus repair. Orthopedics 2013; 36 (08) e1007-e1013
    CrossrefPubMedGoogle Scholar
  • 11 Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jäger A. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 2010; 38 (08) 1542-1548
    CrossrefPubMedGoogle Scholar
  • 12 Howell R, Kumar NS, Patel N, Tom J. Degenerative meniscus: pathogenesis, diagnosis, and treatment options. World J Orthop 2014; 5 (05) 597-602
    CrossrefPubMedGoogle Scholar
  • 13 Ahn JH, Lee YS, Yoo JC, Chang MJ, Koh KH, Kim MH. Clinical and second-look arthroscopic evaluation of repaired medial meniscus in anterior cruciate ligament-reconstructed knees. Am J Sports Med 2010; 38 (03) 472-477
    CrossrefPubMedGoogle Scholar
  • 14 Kang HJ, Chun CH, Kim KM, Cho HH, Espinosa JC. The results of all-inside meniscus repair using the Viper Repair System simultaneously with anterior cruciate ligament reconstruction. Clin Orthop Surg 2015; 7 (02) 177-184
    CrossrefPubMedGoogle Scholar
  • 15 Rue J-P, Pickett A. Meniscal repair and transplantation in the military active-duty population. Clin Sports Med 2014; 33 (04) 641-653
    CrossrefPubMedGoogle Scholar
  • 16 Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med 1982; 10 (02) 90-95
    CrossrefPubMedGoogle Scholar
  • 17 Lutz C, Dalmay F, Ehkirch FP. , et al; French Arthroscopy Society. Meniscectomy versus meniscal repair: 10 years radiological and clinical results in vertical lesions in stable knee. Orthop Traumatol Surg Res 2015; 101 (8, Suppl): S327-S331
    CrossrefPubMedGoogle Scholar
  • 18 Frank RM, Cole BJ. Meniscus transplantation. Curr Rev Musculoskelet Med 2015; 8 (04) 443-450
    CrossrefPubMedGoogle Scholar
  • 19 Lee SJ, Aadalen KJ, Malaviya P. , et al. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 2006; 34 (08) 1334-1344
    CrossrefPubMedGoogle Scholar
  • 20 Nawabi DH, Cro S, Hamid IP, Williams A. Return to play after lateral meniscectomy compared with medial meniscectomy in elite professional soccer players. Am J Sports Med 2014; 42 (09) 2193-2198
    CrossrefPubMedGoogle Scholar
  • 21 Galvin JW, Dukes CA, Grassbaugh JA, Marchant BG, Arrington ED. Return to duty rates following meniscal repair surgery in an active duty military population. Mil Med 2016; 181 (11) e1661-e1665
    CrossrefPubMedGoogle Scholar
  • 22 Kluczynski MA, Marzo JM, Rauh MA, Bernas GA, Bisson LJ. Sex-specific predictors of intra-articular injuries observed during anterior cruciate ligament reconstruction. Orthop J Sports Med 2015; 3 (02) 2325967115571300
    CrossrefPubMedGoogle Scholar
  • 23 Harris JD, Hussey K, Saltzman BM. , et al. Cartilage repair with or without meniscal transplantation and osteotomy for lateral compartment chondral defects of the knee: case series with minimum 2-year follow-up. Orthop J Sports Med 2014; 2 (10) 2325967114551528
    CrossrefPubMedGoogle Scholar
  • 24 Deledda D, Rosso F, Cottino U, Bonasia DE, Rossi R. Results of meniscectomy and meniscal repair in anterior cruciate ligament reconstruction. Joints 2016; 3 (03) 151-157
    PubMedGoogle Scholar
  • 25 Feucht MJ, Bigdon S, Bode G. , et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg 2015; 10: 34
    CrossrefPubMedGoogle Scholar
  • 26 Yan F, Xie F, Gong X, Wang F, Yang L. Effect of anterior cruciate ligament rupture on secondary damage to menisci and articular cartilage. Knee 2016; 23 (01) 102-105
    CrossrefPubMedGoogle Scholar
  • 27 Hagino T, Ochiai S, Senga S. , et al. Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg 2015; 135 (12) 1701-1706
    CrossrefPubMedGoogle Scholar
  • 28 Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries. Clin Sports Med 2017; 36 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 29 Gornitzky AL, Lott A, Yellin JL, Fabricant PD, Lawrence JT, Ganley TJ. Sport-specific yearly risk and incidence of anterior cruciate ligament tears in high school athletes: a systematic review and meta-analysis. Am J Sports Med 2016; 44 (10) 2716-2723
    CrossrefPubMedGoogle Scholar
  • 30 Chalmers PN, Karas V, Sherman SL, Cole BJ. Return to high-level sport after meniscal allograft transplantation. Arthroscopy 2013; 29 (03) 539-544
    CrossrefPubMedGoogle Scholar
  • 31 Marcacci M, Marcheggiani Muccioli GM, Grassi A. , et al. Arthroscopic meniscus allograft transplantation in male professional soccer players: a 36-month follow-up study. Am J Sports Med 2014; 42 (02) 382-388
    CrossrefPubMedGoogle Scholar