I have no disclosures. This was supported by a Kaiser Permanente Community Benefits Grant. So we're all here about the meniscus. We all know the meniscus is a shock absorber. It augments joint congurity. It provides joint lubrication. It contributes to proprioceptive feedback and mechanisms. And all that combined now decreases the tibial femoral stress. Meniscus tears come in different shapes and sizes. You've already heard about meniscal roots. They're hard to generalize. You can't just do a research study on all meniscus tears. The purpose of our study was to use bucket-handle tears as a proxy for large vertical tears. They comprise about 10% of all meniscal tears and are often more of a surgical urgency due to their mechanical symptoms, most often locking of the knee. There's a talk later on about we shouldn't be doing as many meniscus repairs, but as sports physicians, I think we're all in the state of the meniscus society, and as such we should know our outcomes of how these repairs do. There have been small studies focused on bucket-handle tears. Small number of patients, 24, 75, around the 20% failure or re-tear rate. There's been a recent systematic review that looked at 15 studies with 700 plus patients, and they had an almost 30% failure rate specifically focusing on all-in-side repairs. So we decided to use our Kaiser Permanente Northern California electronic patient database. This is a captured patient population. We used natural language processing to look for the term bucket and handle in CPD-coded meniscus repair surgeries. And then to ensure selection accuracy, we did perform a random sample analysis on 3%. This is our flowchart. We had about 7,000 patients who had a CPT code of a meniscus repair. If they had any prior history of a meniscus repair or a meniscectomy, we excluded them. The natural language had to catch bucket and handle in the op notes, so if they did, they were included. They needed to have an MRI within 60 days prior to the procedure. We excluded people who were too young or too old. They had to have an active Kaiser membership one year prior to the procedure and after the procedure. And then we excluded any surgeries that had a concomitant meniscectomy coded along with the meniscus repair. So that ended up with our patient population of 1,359 patients, had a mean age of 24 years. 44% of them underwent a concomitant ACL reconstruction at the time of the meniscus repair. And we had a little over a four-year average follow-up time. Subsequent knee surgeries were performed in 20% of the patients. And this is our survival curve. Of those 20%, 4% had a repeat meniscus repair and 12% had a repeat meniscectomy or a subsequent meniscectomy after the initial repair. We did a multivariate analysis and the green areas were risk factors that were protected against subsequent surgeries. So if you're Asian, congrats, thank you all. If you had a concomitant ACL reconstruction, you were also protected against subsequent surgeries. If you were younger, 12 to 18 or 19 to 30 years old, or if you were at a lower BMI, those are risk factors for actually having subsequent surgeries. Obviously, there's limitations to this study. This is a large database study. We weren't able to get patient-reported outcomes for such a large population or any other data that's not accessible by electronic data review. We're not able to comment on certain factors that may affect the success of the bucket handle repair, whether it's a medial or lateral-sided bucket tear, how old the tear was. We did have MRIs, but as you guys all know, there could be chronic tears that get MRIs that you end up fixing. Tear size, we're obviously not able to ascertain, but the fact that they were bucket-handle tears means they were large tears. And then the technique, whether it's all inside, inside-out, and the repair device used. So in conclusion, younger age and lower BMI increase the risk of subsequent surgical procedures after bucket-handle tears. The need for a concomitant ACL reconstruction decreases the risk of subsequent procedures. And re-operation following the initial bucket-handle repair is about 20% of the patient population and is three times more likely to have a meniscectomy than a revision meniscus repair. Thank you.

meniscus

functions

types of tears

bucket-handle tears

outcomes of repairs