Abstract
Introduction
Meniscal surgery is one of the most common procedures in orthopedic surgery. Although several studies suggest an increased risk of osteoarthritis following meniscectomy compared to meniscus repair, surgical decision should consider individual patient's factor, such as tear pattern, age and activity level. Recent national trends in arthroscopic meniscal surgery in Japan remain unclear. This study aimed to analyze the number of meniscal surgeries, and the proportion of meniscal repairs performed between 2014 and 2023.
Materials and methods
The Excel files ‘Number of calculations by division, sex, and age group'under the ‘operation (code K)’ from 2014 to 2023 were downloaded from the National Databaseof Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data. Thearthroscopic data meniscectomy (code K068-2) and arthroscopic meniscus repair (code K069-3) were analyzed according to demographic characteristics (sex, age). The trend in the number of meniscal surgeries from 2014 to 2023 was examined. The number of surgical procedures performed per year and the incidence of both surgical procedures, calculated as the number performed per 100,000 population per year, were evaluated.
Results
The total number of arthroscopic meniscus surgeries increased from 35,100 cases in 2014 to 49,165 cases in 2023. The total number of arthroscopic meniscus repairs increased from 6652 cases in 2014 to 26,274 cases in 2023. The incidence per 100,000 person-years of arthroscopic meniscus repair also increased from 5.2 in 2014 to 21.1 in 2023. In contrast, the total number of arthroscopic meniscectomy decreased from 28,448 cases in 2014 to 22,891 cases in 2023. The incidence per 100,000 person-years of arthroscopic meniscectomy also decreased from 22.4 in 2014 to 18.4 in 2023. Ratio of arthroscopic meniscus repair significantly increased from 19.0 % in 2014 to 53.4 % in 2023 (p < 0.001). This trend was consistent in both sexes and across age groups. The rate of meniscus repair increased across all age groups (p < 0.001).
Conclusions
From 2014 to 2023 in Japan, the total number of arthroscopic meniscus surgeries increased with a marked rise in the proportion of arthroscopic meniscus repair. This trend was observed across age groups, including in patient over 40.
Level of evidence
Level Ⅳ
Keywords: Annual trend, Arthroscopic meniscus repair, Arthroscopic meniscectomy
1. Introduction
Meniscal surgery is one of the most common procedures in orthopedic surgery. Although several studies suggest an increased risk of osteoarthritis (OA) following meniscectomy compared to meniscus repair in patients with meniscus tear, surgical decision should consider individual patient's factor such as tear pattern, age and activity level.1, 2, 3 Thus, “save the meniscus” has become an important message for the management of meniscal lesions.4 Katano et al. reported that the rate of meniscus repair in Japan significantly increased from 9 % in 2011 to 25 % in 2016, based on the data from the Medical Care Activities in Public Health Insurance (MCA).5 However, more recent trends in arthroscopic meniscal surgery in Japan are unclear. The purpose of this study was to analyze the number of meniscal surgeries, and the proportion of meniscus repairs performed from 2014 to 2023 in Japan. And the hypothesis of this study was that the rate of arthroscopic meniscus repair significantly increased from 2014 to 2023.
2. Materials and Methods
This study was considered exempt from institutional review board approval because only data available to the public were used. There was no direct involvement of human participants or interventions. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) is operated by the Ministry of Health, Labor, and Welfare (MHLW) in Japan. The NDB is partially open as the NDB Open Data Japan and the NDB Open Data Japan site (https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000177182.html) is free to use for the public. The present study analyzed 10-year trend from 2014 to 2023 using the NDB Open Data. The Gregorian calendar of 2014 was defined as the starting point because it was the first calendar year for which procedure-specific surgical data became available in the NDB Open Data. The Excel files ‘Number of calculations by division, sex, and age group’ under ‘operation (code K)’ from 2014 to 2023 were downloaded. From the downloaded data, the data on arthroscopic meniscectomy (code K068-2) and arthroscopic meniscus repair (code K069-3) was extracted. The number of arthroscopic meniscus surgeries was analyzed by fiscal year, sex, and age (5-year interval). The trends in the number of meniscal surgeries from 2014 to 2023 were investigated. The analysis was performed overall, by sex, and by age (10-year interval). The number of surgical procedures performed per year and the incidence of both surgical procedures, calculated as the number performed per 100,000 population per year, were evaluated. The population data were obtained from the official website of the Statistics Bureau of Japan (www.stat.go.jp).
2.1. Statistical analysis
To evaluate the annual trends in the arthroscopic meniscus repair ratio, the Cochran–Armitage
Trend tests were performed using “EZR” (Easy R).6 A p value of 0.05 was set as a significant.
3. Results
The total number of arthroscopic meniscectomy decreased from 28,448 cases in 2014 to 22,891 cases in 2023 (Table 1, Fig. 1). The incidence per 100.000 person-years of arthroscopic meniscectomy also decreased from 22.4 in 2014 to 18.4 in 2023 (Fig. 2).
Table 1.
Number of patients who underwent meniscal surgeries from 2014 to 2023.
| Year | Meniscectomy (%) | Meniscus repair (%) | Total |
|---|---|---|---|
| 2014 | 28,448 (81.0) | 6652 (19.0) | 35,100 |
| 2015 | 27,106 (76.5) | 8340 (23.5) | 35,446 |
| 2016 | 25,475 (71.6) | 10,085 (28.4) | 35,560 |
| 2017 | 25,641 (70.2) | 10,862 (29.8) | 36,503 |
| 2018 | 26,725 (60.6) | 17,397 (39.4) | 44,122 |
| 2019 | 26,313 (56.8) | 20,017 (43.2) | 46,330 |
| 2020 | 23,884 (56.2) | 18,637 (43.8) | 42,521 |
| 2021 | 23,194 (51.7) | 21,688 (48.3) | 44,882 |
| 2022 | 21,759 (48.2) | 23,359 (51.8) | 45,118 |
| 2023 | 22,891 (46.6) | 26,274 (53.4) | 49,165 |
Fig. 1.
Number of patients who underwent meniscal surgeries from 2014 to 2023
The total number of arthroscopic meniscal surgeries increased from 35,100 patients in 2014 to 49,165 patients in 2023. The total number of arthroscopic meniscus repairs increased from 6652 patients in 2014 to 26,274 patients in 2023. The ratio of arthroscopic meniscus repair during this period was significantly increased from 19.0 % in 2014 to 53.4 % in 2023 (p < 0.001,
Cochran-Armitage trends test).
Fig. 2.
Incidence per 100,00 person-years of arthroscopic meniscectomy and meniscus repair from 2014 to 2023 The incidence per 100.000 person-years of arthroscopic meniscus repair increased from 5.2 in 2014 to 21.1 in 2023. The incidence per 100.000 person-years of arthroscopic meniscectomy decreased from 22.4 in 2014 to 18.4 in 2023.
The total number of arthroscopic meniscus repairs increased from 6652 cases in 2014 to 26,274 cases in 2023 (Table 1, Fig. 1). The incidence per 100.000 person-years of arthroscopic meniscus repair also increased from 5.2 in 2014 to 21.1 in 2023 (Fig. 2).
The ratio of arthroscopic meniscus repair during this period significantly increased from 19.0 % in 2014 to 53.4 % in 2023 (p < 0.001) (Fig. 1). This trend was observed in both sexes. In male patients, the ratio of arthroscopic meniscus repair significantly increased from 20.5 % in 2014 to 53.2 % in 2023 (p < 0.001) (Table 2, Fig. 3A). In female patients, the proportion of patients who underwent arthroscopic meniscus repair increased from 17.2 % in 2014 to 53.6 % in 2023 (p < 0.001) (Table 2, Fig. 3B).
Table 2.
Number of patients who underwent meniscal surgeries from 2014 to 2023 in each sex.
| Year | Male | Meniscectomy (%) | Meniscus repair (%) | Total | Female | Meniscectomy (%) | Meniscus repair (%) | Total |
|---|---|---|---|---|---|---|---|---|
| 2014 | 14,259 (79.5) | 3685 (20.5) | 17,944 | 14,180 (82.8) | 2952 (17.2) | 17,132 | ||
| 2015 | 13,480 (74.9) | 4528 (25.1) | 18,008 | 13,576 (78.3) | 3758 (21.7) | 17,334 | ||
| 2016 | 12,608 (70.4) | 5300 (29.6) | 17,908 | 12,789 (73.0) | 4727 (27.0) | 17,516 | ||
| 2017 | 12,791 (69.6) | 5597 (30.4) | 18,388 | 12,786 (71.1) | 5206 (28.9) | 17,992 | ||
| 2018 | 13,253 (60.2) | 8774 (39.8) | 22,027 | 13,418 (61.0) | 8561 (39.0) | 21,979 | ||
| 2019 | 13,354 (57.3) | 9957 (42.7) | 23,311 | 12,914 (56.4) | 9993 (43.6) | 22,907 | ||
| 2020 | 12,203 (56.4) | 9441 (43.6) | 21,644 | 11,628 (56.1) | 9100 (43.9) | 20,728 | ||
| 2021 | 11,846 (52.1) | 10,887 (47.9) | 22,733 | 11,283 (51.2) | 10,735 (48.8) | 22,018 | ||
| 2022 | 11,290 (48.8) | 11,845 (51.2) | 23,135 | 10,400 (47.5) | 11,478 (52.5) | 21,878 | ||
| 2023 | 11,791 (46.7) | 13,452 (53.3) | 25,243 | 11,031 (46.4) | 12,746 (53.6) | 23,777 |
Fig. 3.
Number of patients of each sex who underwent meniscal surgeries from 2014 to 2023.
(A) Male, (B) Female. The total number of arthroscopic meniscal surgeries was similar and increased from 2014 to 2023 in both sexes. The ratio of arthroscopic meniscus repair during this period was significantly increased in each sex (p < 0.001, Cochran-Armitage trends test).
In 2014, arthroscopic meniscectomy was performed on 28,448 cases, and the incidence per 100.000 person-years was 18.4. And arthroscopic meniscus repair was performed in 6652 cases, and the incidence per 100.000 person-years was 5.2. Although the total number of arthroscopic meniscal surgeries in 2020 was lower than that in 2019, the total number of arthroscopic meniscal surgeries increased from 35,100 cases in 2014 to 49,165 cases in 2023 (Table 1, Fig. 1). The total number of arthroscopic meniscus repairs increased from 6652 cases in 2014 to 26,274 cases in 2023 (Table 1, Fig. 1). The incidence per 100.000 person-years of arthroscopic meniscus repair also increased from 5.2 in 2014 to 21.1 in 2023 (Fig. 2). On contrast, the total number of arthroscopic meniscectomy decreased from 28,448 cases in 2014 to 22,891 cases in 2023 (Table 1, Fig. 1). The incidence per 100.000 person-years of arthroscopic meniscectomy also decreased from 22.4 in 2014 to 18.4 in 2023 (Fig. 2). The ratio of arthroscopic meniscus repair during this period significantly increased from 19.0 % in 2014 to 53.4 % in 2023 (p < 0.001) (Fig. 1). This trend was observed in both sexes. Total number of arthroscopic meniscal surgeries was similar and increased from 2014 to 2023 in both sexes (Table 2). In male patients, the ratio of arthroscopic meniscus repair significantly increased from 20.5 % in 2014 to 53.2 % in 2023 (p < 0.001) (Fig. 3A). In female patients, the proportion of patients who underwent arthroscopic meniscus repair increased from 17.2 % in 2014 to 53.6 % in 2023 (p < 0.001) (Fig. 3B). Moreover, this trend was observed in all age groups (Fig. 4). The proportion of arthroscopic meniscus repair significantly increased during this period in all age group (p < 0.001).
Fig. 4.
The proportion of meniscus repair from 2014 to 2023 in each age group (10-year interval)The proportion of arthroscopic meniscus repair significantly increased during this period in each, age group (p < 0.001, Cochran-Armitage trends test).
4. Discussion
This study revealed four major findings. First, the total number of arthroscopic meniscal surgeries increased from approximately 35,000 in 2014 to approximately 49,000 in 2023. Second, the proportion of patients undergoing arthroscopic meniscus repair significantly rose from 19.0 % in 2014 to 53.4 % in 2023. Third, the number of arthroscopic meniscus surgeries was comparable between sexes with significant increase in the proportion of arthroscopic meniscus repairs from 2014 to 2023. Lastly, the proportion of patients undergoing arthroscopic meniscus repair increased significantly both younger than 40 years of age and older age groups.
This study revealed that both the number and the proportion of meniscus repairs increased from 2014 to 2023 in Japan. A temporary decline in the number of arthroscopic meniscal surgeries was observed in 2020, this was likely due to the COVID-19 pandemic.7,8 Although this trend has been reported previously, several differences should be noted. Kawata et al. analyzed the Japanese Diagnosis Procedure Combination database and reported that the proportion of meniscal repair significantly increased from 7 % in 2005 to 25.9 % in 2014.9 Katano et al. used the data from the MCA and reported that the proportion of meniscus repair significantly increased from 9 % in 2011 to 25 % in 2016.5 In contrast, this study analyzed data from the NDB Open Data from 2014 to 2023, a more recent and comprehensive national dataset. Compared to prior reports, this study captures a longer and more recent timeframe and includes broader demographic coverage, likely explaining the higher repair proportions seen in recent years. Additionally, recent studies have reported similar upward trends in other countries such as France, Korea and the United States.10,11
Although this study revealed that the proportion of meniscectomy decreased from 81.0 % in 2014 to 46.6 % in 2023, the number of meniscectomy decreased by approximately 20 % during this period. In Italy, the number of meniscectomy performed in the adult population has almost halved from 2001 to 2016.12 Similar trend was observed in the United States from 2010 to 2020.13 Compared to these countries, meniscectomy is still a popular procedure in Japan.
This study revealed that the proportion of arthroscopic meniscus repair in patients older than 40 years significantly increased from 8.8 % in 2014 to 41.0 % in 2023. Recent studies support this result. Engler et al. reported that patient-reported outcomes at an average of 5 years postoperatively were satisfactory and similar in patients undergoing meniscus repair and meniscectomy, indicating that age alone should not be a contraindication to meniscal repair.14 Husen et al. reported that clinical outcome scores were greater in the meniscal repair group than in the matched meniscectomy group among selected patients aged 60 years and older.15 Similarly, Zhu et al. demonstrated favorable clinical outcomes following isolated arthroscopic repair of medial degenerative meniscus tears in patients over 45 years-old who failed conservative treatment.16
Technical innovations have also expanded the indications of meniscus repair in complex tear. Ohori et al. reported that complete radial tears of the lateral meniscus significantly increase peak contact pressure in lateral compartment of knee joint.17 And meniscectomy of lateral meniscus causes the progressive OA in rapidly. Thus, lateral meniscus repair is recommended even in elite athlete.18 Uchida R et al. reported good clinical outcomes after the repair of an isolated radial tear in the middle segment of the lateral meniscus.19 Additionally, meniscus extrusion is known as the risk factor for OA progression due to loss of hoop stress resulting in the significant disruption of load distribution.20,21 Medial meniscus posterior root tear (MMPRT) is also known as the cause of meniscus extrusion and OA, and poor clinical outcomes of nonoperative treatment have been reported.22 Techniques of pull-out repair for MMPRTs have demonstrated reduced the volume of the extruded meniscus and improved outcomes. In addition, the meniscus centralization technique was developed by Koga et al. for extruded meniscus.23,24 Recently, these techniques has becoming performed even when combined with high tibial osteotomy (HTO) in varus aligned knees.25, 26, 27, 28, 29 These techniques may increase the proportion of arthroscopic meniscus repair in older age in Japan. While meniscus allograft transplantation has shown good mid-to long-term outcomes and increasing adoption in Korea.30, 31, 32, 33 However, it remains unavailable in Japan. Thus, arthroscopic meniscus repair using these advanced techniques currently represents the best available strategy for preserving meniscal function, which likely contributed to the upward trend observed in this study.
4.1. Limitations
This study has several limitations. First, there was a possibility of coding errors in this study because the NDB Open Data does not cover all data in Japan. Second, as it was impossible to analyze the concomitant injuries such as ligament injuries from the NDB Open Data, the influence of concomitant surgeries, such as anterior cruciate ligament reconstruction or HTO, on meniscal treatment could not be evaluated. Third, the NDB Open Data only includes two procedures for meniscus surgery: meniscectomy (code K068-2) and meniscus repair (code K 069-3). Patients who underwent arthroscopic meniscectomy and meniscus repair may have been coded solely as code K069-3, potentially leading to misclassification. Fourth, lack of detailed data on surgical techniques used for meniscus repair (eg inside-out, outside-in, all-inside, pull-out, or centralization methods) limits the ability to analyze the adaptation and effectiveness of these surgical approaches. Fifth, the NDB Open Data did not provide detailed patient specific clinical characteristics, such as the activity level and body mass index of the patients, or preoperative symptoms, which could influence surgical decision making and outcomes. Sixth, the NDB Open Data did not provide institutional data (hospital volume, type). These data might influence surgical trends. Seventh, the NDB Open Data did not provide the data before 2014. Thus, it was impossible to evaluate the older trend of meniscus surgery before 2014. Finally, the NDB Open Data represents the number of cases, not patients.
5. Conclusion
From 2014 to 2023 in Japan, the total number of arthroscopic meniscus surgeries increased with a marked rise in the proportion of arthroscopic meniscus repair. This trend was observed across age groups, including in patient over 40.
Authors’ contribution
HN and SU had a major contribution in planning and formulating the study design, data interpretation and writing the manuscript. HN performed statistical analysis. YM, ST, HF and HN had an important contribution in data correction. AS had an important contribution in formulating the research plan. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Disclosure
One or more authors have declared potential conflict of interest. S.U. is a consultant for Smith & Nephew and has received research funding from Smith & Nephew.
Ethical approval
This study was considered exempt from institutional review board approval because only data available to the public were used. There was no direct involvement of human participants or interventions.
Fundings
None.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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