One-third of meniscal repairs undergo reoperation within five years: Incidence and predictors in a retrospective study of 2390 cases

Purpose: Meniscal repair is preferred over meniscectomy to preserve joint function, but failure leading to reoperation remains a concern, affecting both patient outcomes and healthcare resources. The purpose of this study was to determine the 5-year incidence of reoperation after meniscal repair in a large population-based cohort and to identify risk factors associated with failure. Methods: A total of 2390 meniscal repairs performed between 2010 and 2022 in the Central Denmark Region (six public hospitals) were analysed. Reoperation was defined as revision repair or meniscectomy on the same meniscus. Kaplan–Meier survival analysis was used to estimate cumulative reoperation risk. Independent risk factors were assessed using multivariable Cox regression including age, sex, body mass index (BMI), smoking status, meniscus laterality, time from injury to surgery, number of sutures, and concomitant anterior cruciate ligament (ACL) reconstruction. Results: The 5-year cumulative reoperation risk was 32.7% (95% confidence interval [CI], 30.6–34.7). Risk of reoperation was not associated with age, sex, BMI, or injury chronicity. Smoking showed a trend towards increased risk (hazard ratio [HR] 1.19, 95% CI 0.99–1.43). Medial meniscus repairs had higher risk than lateral repairs (35.8% vs. 21.2%, p < 0.001). Concurrent ACL reconstruction was protective (HR 0.52, 95% CI 0.45–0.60). Conclusion: In this large, population-based cohort, including 2390 repairs, the 5-year reoperation risk after meniscal repair was 32.7%. Age, BMI, and injury chronicity were not predictive of failure. Smoking and medial meniscus repair increased risk, while concomitant ACL reconstruction was protective. These findings support broader indications for meniscal preservation and underscore the importance of realistic preoperative counselling of patients. Level of Evidence: Level III.