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• W3039598914 abstract "We read the recent editorial commentary “Meniscal Repair—Why Bother?”1Hohmann E. Editorial commentary: Meniscal repair–why bother?.Arthroscopy. 2020; 36: 1154-1155Abstract Full Text Full Text PDF Scopus (1) Google Scholar commenting on our study “Meniscus Repair Does Not Result in an Inferior Short-Term Outcome Compared With Meniscus Resection: An Analysis of 5,378 Patients With Primary Anterior Cruciate Ligament Reconstruction.”2Cristiani R. Parling A. Forssblad M. Edman G. Engström B. Stålman A. Meniscus repair does not result in an inferior short-term outcome compared with meniscus resection: An analysis of 5,378 patients with primary anterior cruciate ligament reconstruction.Arthroscopy. 2020; 36: 1145-1153Abstract Full Text Full Text PDF Scopus (10) Google Scholar We have some concerns regarding the interpretation of the results of our study. The commentary states: “The logical conclusion for us, as readers of this article, seems that we should not bother wasting time in repairing the meniscus: let’s resect the torn part and get on with the ACLR.” This was not the message that we wanted to deliver to the readers, and it’s obvious in the publication. Recent large cohort registry studies3Svantesson E. Cristiani R. Hamrin Senorski E. Forssblad M. Samuelsson K. Stålman A. Meniscal repair results in inferior short-term outcomes compared with meniscal resection: A cohort study of 6398 patients with primary anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2251-2258Crossref PubMed Scopus (18) Google Scholar,4LaPrade C.M. Dornan G.J. Granan L.P. LaPrade R.F. Engebretsen L. Outcomes after anterior cruciate ligament reconstruction using the Norwegian knee ligament registry of 4691 patients: How does meniscal repair or resection affect short-term outcome?.Am J Sports Med. 2015; 43: 1591-1597Crossref PubMed Scopus (42) Google Scholar suggested poorer outcomes, measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS),5Roos E.M. Roos H.P. Lohmander L.S. Ekdahl C. Beynnon B.D. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administrated outcome measure.J Orthop Sports Phys Ther. 1998; 28: 88-96Crossref PubMed Scopus (2184) Google Scholar for meniscus repair compared with meniscus resection in the setting of primary anterior cruciate ligament reconstruction (ACLR) at 1- and 2-year follow-up. However, in these studies, patients who underwent subsequent meniscus resection at follow-up because of failure of the meniscus repair performed at the index ACLR were not identified and studied. We identified and separately analyzed patients with unsuccessful meniscus repair in conjunction with ACLR, and we showed that they reported significantly inferior KOOS scores in comparison with patients with successful meniscus repair at both the 1- and 2-year follow-ups. Bearing this in mind, we suggested that the nonidentification of patients with unsuccessful meniscus repair and their subsequent inclusion in the KOOS analysis in the previously mentioned registry studies3Svantesson E. Cristiani R. Hamrin Senorski E. Forssblad M. Samuelsson K. Stålman A. Meniscal repair results in inferior short-term outcomes compared with meniscal resection: A cohort study of 6398 patients with primary anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2251-2258Crossref PubMed Scopus (18) Google Scholar,4LaPrade C.M. Dornan G.J. Granan L.P. LaPrade R.F. Engebretsen L. Outcomes after anterior cruciate ligament reconstruction using the Norwegian knee ligament registry of 4691 patients: How does meniscal repair or resection affect short-term outcome?.Am J Sports Med. 2015; 43: 1591-1597Crossref PubMed Scopus (42) Google Scholar may have led the authors to an incorrect interpretation of the data, suggesting that meniscus repair results in inferior short-term outcomes compared with meniscus resection in the setting of primary ACLR. In contrast, our study shows that patients with a successful (no resection at follow-up) medial meniscus and/or lateral meniscus repair with ACLR do not have inferior short-term outcomes compared with patients with isolated ACLR or patients with ACLR with concomitant medial meniscus or lateral meniscus resection. Thus, the conclusion was that every effort should be made to repair the meniscus whenever possible, even in light of the well-known long-term negative effects of meniscus resection over meniscus repair at a long-term follow-up.6Shelbourne K.D. Gray T. Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery: Five- to fifteen-year evaluations.Am J Sports Med. 2000; 28: 446-452Crossref PubMed Scopus (295) Google Scholar,7Stein T. Mehling A.P. Welsch F. von Eisenhart-Rothe R. Jäger A. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears.Am J Sports Med. 2010; 38: 1542-1548Crossref PubMed Scopus (292) Google Scholar As highlighted in the commentary, the low follow-up rate at 2 years might be a limitation. Attrition is a known phenomenon of studies performed using large registries.8Kvist J. Kartus J. Karlsson J. Forssblad M. Results from the Swedish national anterior cruciate ligament register.Arthroscopy. 2014; 30: 803-810Abstract Full Text Full Text PDF PubMed Scopus (147) Google Scholar,9Ahldén M. Samuelsson K. Sernert N. Forssblad M. Karlsson J. Kartus J. The Swedish national anterior cruciate ligament register: A report on baseline variables and outcomes of surgery for almost 18,000 patients.Am J Sports Med. 2012; 40: 2230-2235Crossref PubMed Scopus (245) Google Scholar However, rather than setting a level of what constitutes an “acceptable” follow-up, the potential statistical implications of loss to follow-up should be considered case by case for each individual study. Attrition is important for 3 main reasons—potential bias, generalizability of the results, and loss of statistical power.10Fewtrell M.S. Kennedy K. Singhal A. et al.How much loss to follow-up is acceptable in long-term randomized trials and prospective studies?.Arch Dis Child. 2008; 93: 458-461Crossref PubMed Scopus (362) Google Scholar Due to our large sample size, even with a not-optimal follow-up rate, KOOS scores at 2 years were still available for 2,450 patients. This sample size has a very satisfactory power and allows the results to be highly generalizable. With regard to the potential bias, we performed a drop-out analysis, which showed only small differences in age and sex between the included cohort and the loss to 2-year follow-up cohort. Moreover, these baseline characteristics (age and sex) were included as covariates in the analysis of covariance model comparing the different meniscus treatment groups. Therefore, the potential effect of differences in these baseline characteristics would be considered very limited.11Kristman V. Manno M. Cote P. Loss to follow-up in cohort studies: How much is too much?.Eur J Epidemiol. 2004; 19: 751-760Crossref PubMed Scopus (395) Google Scholar The findings of our study are important for surgeons in clinical practice when it comes to clinical decision making. Contrary to what is reported by previous large cohort registry studies,3Svantesson E. Cristiani R. Hamrin Senorski E. Forssblad M. Samuelsson K. Stålman A. Meniscal repair results in inferior short-term outcomes compared with meniscal resection: A cohort study of 6398 patients with primary anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2251-2258Crossref PubMed Scopus (18) Google Scholar,4LaPrade C.M. Dornan G.J. Granan L.P. LaPrade R.F. Engebretsen L. Outcomes after anterior cruciate ligament reconstruction using the Norwegian knee ligament registry of 4691 patients: How does meniscal repair or resection affect short-term outcome?.Am J Sports Med. 2015; 43: 1591-1597Crossref PubMed Scopus (42) Google Scholar a successful meniscus repair does not result in an inferior short-term outcome compared with meniscus resection in the setting of primary ACLR. Therefore, we should not resect a meniscus tear that is reparable for fear of having a worse subjective knee outcome at a short-term follow-up. The meniscus is an essential structure for preserved knee health, and we should make efforts to preserve it. However, patients should be informed that there is a risk of failure and reoperation after meniscus repair. Download .pdf (1.72 MB) Help with pdf files ICMJE author disclosure forms" @default.
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• W3039598914 title "Regarding “Editorial Commentary: Meniscal Repair—Why Bother?”" @default.
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• W3039598914 doi "https://doi.org/10.1016/j.arthro.2020.04.052" @default.
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