A comparative analysis of outcomes of surgical treatment of meniscus injuries in the knee joint in children after meniscectomy and meniscus suture repair

Introduction. The most common modalities of surgical treatment of meniscus injuries in children are meniscectomy and meniscal suture repair. However, indications and contraindications for both approaches in the pediatric practice is one of the most discussed problems. To more precisely define indications and contraindications for resection and meniscus suture repair will optimize management of meniscus injuries in children, thus improving outcomes and preventing early osteoarthritis of the knee joint.

Purpose. To analyze outcomes after meniscectomy and meniscus suture repair in children after meniscus injuries.

Material and methods. From 2015 till 2020, 120 children were treated in the department of traumatology and orthopedics (Morozovskaya Children's Clinical Hospital) for meniscus injuries. 88 patients (73.3%) from Group 1 had arthroscopic meniscus suture repair. 32 children (26.7%) from the comparison group had meniscectomy. All removed menisci were subjected to histological examination. Outcomes were assessed in 6 and 12 months after the surgery: clinical examination, MRI, radiography, and questionnaires with KOOS-Child and Pedi-IKDC scales.

Results. In 6 months after the surgery, the following complaints were registered: after total meniscectomy pain was in 100% of patients; after partial resection of the meniscus pain was in 3.1% of patients. The basic complaint after meniscus suture repair was flexion restriction (10.2%). In 12 months after surgery, complaints were registered in 7 children after total meniscus resection (100% of all total meniscectomies), in 15 children after partial meniscus resection (60% of all partial meniscectomies), and in 14 children after meniscus suture repair (19.4% of all meniscus suture repairs). The assessment of clinical findings before and after meniscus suture repair in 6 and 12 months after the surgery has shown a statistically significant decrease in pain (p<0.001), in swelling of the knee joint (p<0.001) and relief of flexion restriction (p<0.021), if to compare with partial meniscectomy.

Conclusion. Unsatisfactory outcomes after total meniscectomy urge to exclude this type of intervention in the pediatric practice. Partial meniscectomy should be performed only if it is a case of multiple and multiplanar, multidirectional complex injury when meniscus repair is technically impossible. Marked cicatricial changes in the meniscus tissue which deform it and do not allow to make an anatomical reconstruction of the joint is also an indication for partial resection. If there are no marked degenerative changes and meniscus suture repair is technically possible, the damaged meniscus should be restored, regardless of the time of its injury and rupture location.