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Systematic review
Most elite athletes return to competition following operative management of meniscal tears: a systematic review
  1. Seper Ekhtiari1,
  2. Moin Khan1,2,
  3. Jacob M Kirsch2,
  4. Patrick Thornley3,
  5. Christopher M Larson4,
  6. Asheesh Bedi2
  1. 1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  4. 4Twin Cities Orthopedics, Minnesota Orthopedic Sports Medicine Institute, Edina, Minnesota, USA
  1. Correspondence to Dr Asheesh Bedi, University of Michigan, Sports Medicine and Shoulder Service, Ann Arbor, MI 48106, USA; abedi{at}med.umich.edu

Abstract

Importance Meniscal injuries are common among athletes. When operative management is indicated, the decision between meniscal repair and meniscectomy is not always clear, particularly in elite athletes.

Objective The aim of this systematic review was to (1) compare outcomes for partial meniscectomy and repair for the management of meniscus tears in elite athletes and (2) describe return-to-play (RTP) rates and complications for each operation.

Evidence review MEDLINE, Embase and PubMed were searched from inception through to 5 March 2017. All studies were screened in duplicate for eligibility. Data extracted included demographics, surgical technique and RTP rate and timeline.

Findings Ten studies (725 athletes) were included involving 355 elite athletes undergoing meniscal repair (111 patients) or partial/total meniscectomy (244). The majority of athletes were men (82.8%) and had a mean age of 25.0 years (14–38). Athletes were followed for a mean of 5.3 years (range=3 months to 18.4 years). American football was the most common sport (153 athletes), followed by soccer (69) and basketball (67). Athletes undergoing meniscal repair demonstrated a pooled mean RTP time of 7.6 months in comparison to 4.3 months for those undergoing partial meniscectomy (P<0.0001). Of athletes undergoing meniscal repair, 86.5% RTP at their preoperative level, compared with 80.4% of athletes undergoing partial meniscectomy (P=0.24). Following meniscectomy, athletes who were taller, drafted in higher rounds and had played or started more games preoperatively were less likely to suffer negative career impacts postoperatively. Satisfaction rates (92% vs 76%) and clinical scores (8.8 vs 6.9, P=0.05) were higher among recreational than elite athletes.

Conclusion Athletes undergoing partial meniscectomy RTP sooner than those undergoing meniscal repair. Both operations are safe and the majority of athletes RTP at their preoperative level of competition following either operation. Further research is required to identify when each option is preferable in this population.

Relevance Based on the currently available evidence, meniscectomy and meniscal repair are both viable options for elite athletes with meniscal injuries. Each method has small advantages and disadvantages compared with the other, and thus a shared decision should be made with the athlete.

Level of evidence Level IV, systematic review of level III and IV studies.

  • meniscus
  • elite athlete
  • debridement
  • repair

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Footnotes

  • Contributors SE and JMK carried out the search, screening process and assessment of study quality. SE and PT extracted the data. SE drafted the manuscript. PT and JMK edited the manuscript. MK and AB conceived the study, and provided key expert input and editing throughout the process. CML edited the manuscript and provided key expert input. All authors read and approved the final manuscript.

  • Competing interests CML reports consultancy fees from Smith & Nephew and A3 Surgical, and stock options in Smith & Nephew. AB reports consultancy fees from Arthrex.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement No unpublished data. All extracted data reported.

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