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Original research
Higher odds of meniscectomy compared with meniscus repair in a young patient population with increased neighbourhood disadvantage
  1. Sahil Dadoo1,
  2. Laura E Keeling1,
  3. Ian D Engler1,2,
  4. Audrey Y Chang1,
  5. Armin Runer1,3,
  6. Janina Kaarre1,4,
  7. James J Irrgang5,
  8. Jonathan D Hughes1,6,
  9. Volker Musahl1,4,6
  1. 1UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  2. 2Central Maine Medical Center, Lewiston, Maine, USA
  3. 3Department of Sports Orthopaedics, Technical University of Munich, Munchen, Germany
  4. 4Department of Orthopaedics, Sahlgrenska Academy, Goteborg, Sweden
  5. 5Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
  6. 6University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  1. Correspondence to Sahil Dadoo, UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; sahildadoo{at}gmail.com

Abstract

Objectives To investigate the impact of demographic and socioeconomic factors on the management of isolated meniscus tears in young patients and to identify trends in surgical management of meniscus tears based on surgeon volume.

Methods Data from a large healthcare system on patients aged 14–44 years who underwent isolated meniscus surgery between 2016 and 2022 were analysed. Patient demographics, socioeconomic factors and surgeon volume were recorded. Patient age was categorised as 14–29 years and 30–44 years old. Area Deprivation Index (ADI), a measure of neighbourhood disadvantage with increased ADI corresponding to more disadvantage, was grouped as <25th, 25–75th and >75th percentile. Multivariate comparisons were made between procedure groups while univariate comparisons were made between surgeon groups.

Results The study included 1552 patients treated by 84 orthopaedic surgeons. Older age and higher ADI were associated with higher odds of undergoing meniscectomy. Patients of older age and with non-private insurance were more likely to undergo treatment by a lower-volume knee surgeon. Apart from the year 2022, higher-volume knee surgeons performed significantly higher rates of meniscus repair compared with lower-volume knee surgeons. When controlling for surgeon volume, higher ADI remained a significant predictor of undergoing meniscectomy over meniscus repair.

Conclusion Significant associations exist between patient factors and surgical choices for isolated meniscus tears in younger patients. Patients of older age and with increased neighbourhood disadvantage were more likely to undergo meniscectomy versus meniscus repair. While higher-volume knee surgeons favoured meniscus repair, a growing trend of meniscus repair rates was observed among lower-volume knee surgeons.

Level of evidence Retrospective cohort study, level III.

  • Meniscus

Data availability statement

No data are available.

https://doi.org/10.1136/bjsports-2023-107409

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    Data availability statement

    No data are available.

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    Footnotes

    • Contributors All listed authors have contributed substantially to this work. Literature search, study design and primary manuscript preparation were performed by SD, LEK, IDE and AYC. Data collection, analysis and interpretation of results were performed by SD, AYC, AR and JK. Final manuscript drafting and editing were performed by JJI, JDH and VM. VM is guarantor of this study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests VM reports educational grants, consulting fees and speaking fees from Smith & Nephew plc, educational grants from Arthrex and DePuy/Synthes, is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and deputy editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). JDH is on the editorial board of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). JJI is President of the Board of Directors for the Journal of Orthopaedic and Sports Physical Therapy (JOSPT).

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.