Not all meniscal repair failures are equal: A comparison between early and late failure risk factors

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Abstract Purpose Meniscal repair failure is a significant clinical concern, but existing literature treats it as a single outcome without differentiating timing. Early and late failures may represent mechanistically distinct phenomena; identifying their differential predictors could improve risk stratification and postoperative monitoring. Methods A retrospective cohort study used a national database to identify patients undergoing arthroscopic meniscal repair, including both isolated repairs and repairs performed with concomitant anterior cruciate ligament reconstruction, classified into early failure (reoperation <365 days, approximating the conventional period of meniscal healing), late failure (≥365 days) or no failure. Cause‐specific Cox proportional hazards regression identified independent predictors of each failure type separately. Results Of 38,003 patients, 3399 (8.9%) experienced failure (1996 early; 1403 late). A bimodal hazard pattern supported phenotypic distinction between groups. Early failure was independently predicted by female sex (hazard ratio [HR] 1.15), bucket‐handle tear (HR 1.30), traumatic mechanism (HR 1.14), concomitant microfracture (HR 1.54), hamstring autograft (HR 1.21) and single‐anchor repair (HR 1.28); three or more anchors were protective (HR 0.83). Late failure was uniquely predicted by knee osteoarthritis (HR 1.33), whereas increasing age was independently protective (HR 0.98/year) as well as three or more anchors (HR 0.86). Among isolated meniscal repairs, partial meniscectomy was the most common reoperation in both groups, but more frequent in late failures (60.1% vs. 53.7%). Re‐repair was more common after early failure (22.5% vs. 16.1%), while TKA was more prevalent after late failure (9.8% vs. 5.4%). All reported associations and between‐group differences were statistically significant ( p < 0.05). Conclusion Early and late meniscal repair failures are distinct clinical phenotypes with differing risk factors and reoperation patterns. Early failure appears driven by mechanical and technical factors; late failure is more strongly associated with degenerative joint disease and host biology. These findings may inform individualised monitoring and risk stratification strategies. Level of Evidence Level III, retrospective cohort study.

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