Abstract
Objectives:
The indications and criteria for meniscal repair are expanding in parallel with new understanding in pathophysiology, biomechanics and novel surgical techniques. In learning from the previous management of meniscal tears with total meniscectomy, there is growing concern for preservation of meniscus and its implication in the development of osteoarthritic changes, specifically in the young population. The American Board of Orthopaedic Surgery (ABOS) has developed a comparative effectiveness program that intends to assist in the geographic variation in various orthopaedic practices, trends in practice patterns for the treatment of various conditions, and the differential effectiveness of certain procedures in the treatment of various conditions. The objective of this study is to analyze the surgical management trends of meniscal pathology from 2004-2012 among recent orthopaedic graduates.
Methods:
A query of the American Board of Orthopaedic Surgery (ABOS) database was used to identify patients from 2004-2012 who underwent meniscal repair and partial meniscectomy with and without anterior cruciate reconstruction. The specialty training of the surgeon, the age of the patient, the region where the surgery was performed, and the complications were collected from the case database.
Results:
Among meniscal procedures the frequency of repair has increased from 5% to 7.3% from 2004-2012. However, within this context, partial meniscectomies have decreased disproportionately to the increase in meniscal repair. In contrast, when performed in combination with ACL reconstruction, the frequency of meniscal repairs has increased from 14.9% to 22.3%, while the incidence of partial meniscectomy has increased from 34.8% to 39.3%. When comparing sports fellowship and non-sports trained physicians, there is no significance difference in these procedure trends. There is no variability in region with regards to the type of meniscal procedure being performed. The total complication rate of all ABOS queried meniscal procedures was 5.9% and the implant failure rate was 0.4%. The complication rate was 6.5% in sports trained physicians vs. 5.0% in the non-sports trained physicians.
Conclusion:
Partial meniscectomies are being performed at a significantly decreasing rate in proportion to the increasing rate of meniscal repairs amongst candidate ABOS member surgeons. In combination with ACL reconstruction, both repair and meniscectomy are being performed at an increasing incidence. There is no difference in the rate at which these procedures are being performed based on age, geography, and surgeon training from 2004-2012. These trends may be a reflection of the new understanding of meniscus healing potential, advances in techniques and technology, and new resident core competencies.