Partial Meniscectomy Yields Comparable Outcomes and Failure Rates to Meniscal Repair for Horizontal Cleavage Tears, With Fewer Complication Rates but Greater Progression of Degenerative Changes

Purpose: To compare the clinical outcomes, failure rates, surgical complications, and postoperative radiographic changes following partial meniscectomy versus meniscal repair for horizontal cleavage tears (HCTs). Methods: A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the Scopus, PubMed, and Embase computerized databases. Clinical studies evaluating partial meniscectomy or meniscal repair for HCTs were included. Demographic characteristics, surgical techniques, clinical outcomes, failure rates, complications, and radiographic assessments were recorded. Results: A total of 18 studies comprising 833 patients with HCTs were included, of which 562 patients (67.5%) were treated with partial meniscectomy and 271 (32.5%) with meniscal repair. Both types of treatments reported improved clinical outcomes, including International Knee Documentation Committee, Lysholm, Knee injury and Osteoarthritis Outcome Score, and Tegner scores. Failure rates were reported to range between 0% and 15% following partial meniscectomy and from 0% to 17.6% following repair; complications were 7.5% after partial meniscectomy and between 3.8% and 21.4% following meniscal repair. Patients undergoing meniscectomy demonstrated progression of degenerative changes on radiographic assessments. Conclusions: Repair of HCTs in the appropriately indicated patient can result in similar patient outcomes and failure rates compared to partial meniscectomy. However, especially in patients aged 42 years and younger, a greater complication rate can be expected with repair, while a greater degree of ipsilateral compartment degeneration is seen after partial meniscectomy. Level of Evidence: Level IV, systematic review of Level I to IV studies.