Operative Treatment of Isolated Meniscus Injuries in Adolescent Patients: A Meta-Analysis and Review.

CONTEXT: With the rise in sports participation and increased athleticism in the adolescent population, there is an ever-growing need to better understand adolescent meniscus pathology and treatment.

OBJECTIVE: To better understand the operative management of meniscus tears in the adolescent population.

DATA SOURCES: A systematic review of PubMed (MEDLINE) and Google Scholar was performed for all archived years.

STUDY SELECTION: Studies that reported on isolated meniscus tears in adolescent patients (age, 10-19 years) were included.

STUDY DESIGN: Systematic review and meta-analysis.

LEVEL OF EVIDENCE: Level 4.

DATA EXTRACTION: Two authors reviewed and extracted data from studies that fulfilled all inclusion criteria.

RESULTS: Nine studies on isolated meniscus tears in adolescent patients were found, with level of evidence ranging from 3 to 4. These studies evaluated a total of 373 patients (248 males, 125 females) and 390 knees. Seven studies were published between 1979 and 2000, all of which discuss meniscectomy as the primary treatment. Two studies were published after 2000 and report on meniscus repair surgery. The mean patient age was 14.4 years. A total of 308 meniscectomies and 64 meniscus repairs were performed. Follow-up ranged from 1.8 to 30 years (mean, 10.8 years). A 37% retear rate was reported for patients undergoing meniscus repair. Different outcome measures were used for meniscectomy versus meniscus repair. Three studies evaluating meniscectomy reported Tapper-Hoover scores, showing 54 patients with an excellent result, 58 with good, 57 with fair, and 23 with poor results.

CONCLUSION: A shift in the management of isolated adolescent meniscal tears is reflected in the literature, with a recent increase in operative repair. This is likely secondary to poor outcomes after meniscectomy reflected in long-term follow-up studies. The current literature highlights the need for improved description of tear patterns, standardized reporting of outcome measures, and improved study methodologies to help guide orthopaedic surgeons on operative treatment of meniscal tears in adolescent patients.