opportunity as well as my co-authors for their help with this project. Let's see and it works, good. All right, no pertinent disclosures for this talk. So this study focused on a very high-risk patient cohort of elite athletes undergoing meniscus repair. These elite athletes subject their knees and thus their meniscus repairs to incredibly high forces in an attempt to return to playing at the top levels. And as we've learned from our recent ACL literature, focusing on high-risk patient cohorts can really help us differentiate between two techniques that we may think are equivalent. I think everyone in this room appreciates the fact that over the past probably 25 years we've had a big shift away from meniscectomy to meniscal preservation when possible. And really over the past 12 to 15 years we've moved away from this historical gold standard of inside-out to the easier-to-use probably all-inside suture repairs. Now there have been systematic reviews which have shown that all-inside and inside-out meniscus repairs appear to be equivalent in the general patient population, but the purpose of this study was to determine if this was true in a special patient cohort of the top-level athletes. The secondary objective was to determine if there was any difference between medial and lateral meniscus repairs. So to achieve this, a retrospective review was performed of all meniscus repairs in elite athletes performed by the senior surgeon from January 2013 to September 2019. Now to really focus on the highest risk patients, we had a very strict definition of elite athletes to only include either A, athletes that were paid to perform their sport, or B, athletes that perform at a national or international level in non-revenue sports. This is not people who think they're elite, these are actually elite athletes. 170 athletes were identified that met this criteria, and not surprisingly a very young average age of 23 years old. The vast majority of these athletes were participating in soccer and rugby. Now very importantly, we defined failure as undergoing repeat surgery for a persistent meniscal tear. Out of these 170 athletes, 192 repairs were identified. There were more lateral meniscus repairs in this cohort than medial, with about an equal number of all-inside and inside-out meniscal repairs performed. So the results. Now these are the most up-to-date results as of about two months ago, which may be against rules, sorry if it is, but the findings were slightly different. I think it's important to give you the full picture. So there's a lot going on this slide, I'll help you with the gist of it. The first three rows, all they show is that the different patient cohorts were equal regarding age, gender, and sport. Now the big findings are at the bottom, which are obviously underlined in red, and these show the specific failure rates of both all-inside and inside-out meniscal repair for both medial and lateral suture, for both medial and lateral meniscus. Now there's going to be two takeaways today. The first takeaway is what's in the box on the right, is that the medial meniscus repairs overall failed at a significantly higher rate of 42% compared to lateral meniscus repairs at about 12%. Now this discrepancy is even more impressive when you consider that more than 90% of the medial meniscus repairs performed were done in conjunction with a cruciate ligament reconstruction, which has been shown to potentially increase meniscal healing. Delving into these medial meniscal repair failures, we can see that all-inside medial meniscus repairs failed at the highest rate of any patient cohort of 58% versus inside-out medial meniscus repairs, which failed approximately 23% of the time. Now it's very important to note that there were no differences found in all-inside versus inside-out for the lateral meniscus in this study. Finally, looking at the Kaplan-Meier curve to assess time to failure, we see that the vast majority of the failure occurred within the first two years, with approximately 50% in the first year, but the all-inside medial meniscus repair actually had continued failures even after this time. Now it's important to remember this was a study looking at elite athletes, professional and paid athletes, and while this patient cohort is very useful to study and help us understand and determine if there are differences between different techniques, this may not be applicable to our general patient population. In addition, our strict definition of re-tear requiring patients to undergo re-operation may have underestimated the re-tear rate, but I would actually argue that if we missed any re-tears, they were probably in the medial meniscus. As many of you know, athletes tolerate medial meniscal tears a lot better than lateral meniscus tears, and so we have actually, we may have underestimated the discrepancy between medial meniscal repair failure and lateral meniscal repair failure. Finally, this was a retrospective study, therefore it has inherent biases, but importantly this was not a database study. This was based on the senior author's personal practice. So, in conclusion, the takeaway points. Medial meniscus repair failed significantly higher rate than lateral meniscus repair. The all-inside medial meniscus repair failed at the highest rate of any cohort of 58%, but there was no difference, importantly, in all-inside and inside-out for the lateral meniscus repairs. Thanks so much.

elite athletes

meniscus repair

all-inside technique

failure rate

retrospective review