Root Repair has Superior Radiological and Clinical Outcomes than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review.

PURPOSE:The purpose of this study was to compile and analyze structural and clinical outcomes after Meniscus Root Tear (MRT) treatment as currently described in the literature. METHODS:A review was conducted to identify studies published since 2011 on efficacy of repair, meniscectomy, and nonoperative management in the treatment of meniscus root tears. Patient cohorts were grouped into treatment categories, with medial and lateral root tears analyzed separately; data was collected on patient demographics, structural outcomes including joint space width (JSW), degree of medial meniscal extrusion (MME), progression to total knee arthroplasty (TKA), and patient-reported outcome measures (PROMs). Risk of Bias (ROB) was assessed utilizing the MINORS criteria. Heterogeneity was measured using the I-statistic, and outcomes were summarized utilizing forest plots without pooled means. RESULTS:A total of 56 studies with 3,191 patients were included. Mean age among the included studies ranged from 24.6 to 65.6, whereas mean follow-up ranged from 12 months to 125.9 months. Heterogeneity analysis identified significant differences between studies. Change in JSW ranged from -2.4 - -0.6mm (i.e., decreased space) following meniscectomy (n=186) and -0.90 - -0.1mm following root repair (n=209); change in MME ranged from -0.6 - 6.5mm following root repair (n=521) and 0.2 - 4.2mm following meniscectomy (n=66); and event rate for TKA ranged from 0.00 - 0.22 after root repair (n=205), 0.35 - 0.60 after meniscectomy (n=53), and 0.27 - 0.35 after nonoperative treatment (n=93). Root repair produced the greatest numerical increase in IKDC and Lysholm scores of the three treatment arms. Additionally, root repair improvements in KOOS pain (range: 22 - 32), sports and recreational activities (range: 23 - 36), quality of life (range: 22 - 42), and symptoms subscales (range: 10 - 19), in studies with low ROB. CONCLUSIONS:The literature reporting on the treatment of MRTs is heterogenous and largely limited to level III and IV studies. Current evidence suggests root repair may be the most effective treatment strategy in lessening joint space narrowing of the knee and producing improvements in patient reported outcomes.