Summary
Meniscal tears left in situ during ACLR had low reoperation rates and good patient-reported outcomes, including patients with bicompartmental tears.
Abstract
Background
Meniscal tears occur at the time of anterior cruciate ligament (ACL) injury in 55-65% of patients. These tears exhibit different healing patterns and behaviour compared to meniscal tears in a stable knee. The most appropriate management for medial, lateral and bicompartmental tears during primary ACL reconstruction (ACLR) has not been established.
Purpose
This study evaluates the reoperation rates associated with different meniscal treatment strategies and analyses the impact of medial, lateral, and bicompartmental meniscal tears on ACLR outcomes. We also aimed to identify patient and tear-related characteristics associated with reoperation.
Design: Cohort study; Level 3 evidence
Methods
This investigation included 1137 patients undergoing primary ACLR with a concomitant meniscal injury. Patients with chondral defects and multi-ligament knee injuries were excluded. Meniscal treatments were divided into: left in situ (LIS), partial meniscectomy (PM) and repair. Reoperation was defined as the primary endpoint and regression analysis was conducted to identify patient and tear characteristics associated with reoperation. The influence of different treatments for meniscal tears on Return to play (RTP), ACL reinjury rate and patient-reported outcome measures (PROMs) were reported at 2 years. The PROMs recorded were the International Knee Documentation Committee (IKDC), the Marx Activity Rating Scale and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) score.
Results
The mean age was 24.0 +/- 6.9 years and 76% of patients were male. Most injuries were non-contact (64.9%), commonly resulting from pivoting/sidestepping (50.1%). There was no significant difference in injury mechanism, playing surface, or footwear type between medial, lateral, or bicompartmental tears. Reoperation rates for patients were low for lateral (1.3%), medial (2.6%) and bicompartmental tears (3.2%) left in situ at the time of ACLR. The reoperation rate for medial meniscal repairs (14.8%) was significantly higher than for other medial treatments (HR 12.8, p <.001). Patients who underwent meniscal repair with a concomitant tear in the opposite compartment (Repair + PM/LIS) had the highest reoperation rates (16.7%) and lowest RTP rates (60%). IKDC scores were significantly lower for patients who underwent lateral meniscal repair (81.1 +/- 15.3) compared to other types of lateral meniscus management (p < .027). ACL reinjury rate was not influenced by meniscal treatment. A higher preoperative Marx score increased the risk of reoperation in all groups.
Conclusion
Meniscal tears left in situ during ACLR had low reoperation rates and good patient-reported outcomes, including patients with bicompartmental tears. Medial meniscal tears had the highest risk of reoperation, particularly when another tear was present in the lateral compartment. Lateral meniscal repairs were associated with lower IKDC scores compared to other lateral meniscus treatment strategies.