Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up

Abstract

Background: Meniscal repair is commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. No large-scale, prospective multicenter studies have evaluated the long-term success and patient-oriented outcomes after combined ACLR and meniscal repair.

Purpose: To define the operative success and patient-oriented outcome scores 6 years after combined meniscal repair and ACLR.

Study design: Cohort study; Level of evidence, 3.

Methods: All ipsilateral primary ACLR and meniscal repair cases from a multicenter study group between 2002 and 2004 were selected. Validated patient-oriented outcome instruments were completed at 3 time points: preoperatively and then 2 and 6 years after the index procedure. Subsequent ipsilateral knee reoperations were confirmed by operative reports to evaluate for the failure of meniscal repairs.

Results: In total, 286 patients with 1440 primary ACLRs underwent concurrent meniscal repairs (298 meniscal repairs). Of these, 235 (82.2%) were available for follow-up at 6 years (154 medial, 72 lateral, and 9 both lateral and medial meniscal repairs). Repaired menisci most commonly involved the peripheral one third of the meniscus (84%); patterns were typically longitudinal (84%) or displaced bucket-handle (10%), with a mean length of 16.5 ± 5.8 mm. Overall, the meniscal repair failure rate was 14% (medial: 21/154; lateral: 10/72; both: 2/9) at 6 years. Medial repairs failed earlier than lateral repairs (2.1 vs 3.7 years, respectively; P = .01). Significant improvements in outcome scores were sustained at 6-year follow-up. No differences in the suture number or type were detected between repair failures and successes. The rate of meniscal reoperations was higher in patients who underwent repair compared with those who did not have an identified meniscal injury at the time of ACLR (P < .01.

Conclusion: Concurrent meniscal repair with ACLR is associated with failure rates approximating 14% at 6-year follow-up. Improvements in patient-oriented outcome scores were sustained at 6-year follow-up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscal repair.

Keywords: anterior cruciate ligament (ACL) reconstruction; clinical medicine; meniscal repair; outcome.

Figure 1

Surgical success of meniscus repairs evaluated by medial/lateral meniscus. Similar rates of failures were noted in medial and lateral repair groups. Patients who underwent bilateral meniscal repairs had an increased rate of repair failure.

Figure 2

Evaluation of eligible patients segregated by repair technique. Failure rates were lowest in the inside-out technique group at 6-year follow-up. Given low numbers in open technique groups, it is difficult to accurately compare open techniques to all-inside.

Figure 3

Kaplan-Meier survival analysis of meniscal repairs performed in combination with ACL reconstruction. The vertical axis denotes cumulative survival, and the horizontal axis denotes time in years of survival of meniscal repair. The survival plot of patients who underwent both lateral and medial meniscal repairs is in blue; the survival plot of patients who underwent lateral meniscal repairs is in green; the survival plot of patients who underwent medial meniscal repairs is in tan. Note, medial repairs appeared to fail early (2.1 years), while lateral repair failures more commonly occurred late (3.7 years). Overall, similar survivals were noted between medial and lateral repairs.