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. 2024 Dec 20;12(12):23259671241303178.
doi: 10.1177/23259671241303178. eCollection 2024 Dec.

Comparing Postoperative Outcomes of Isolated Anterior Cruciate Ligament Reconstruction and the "Terrible Triad" Anterior Cruciate Ligament Reconstruction With Medial Meniscus Ramp and Lateral Meniscus Root Repairs

Evan P Shoemaker  1 , Luke V Tollefson  1 , Nicholas I Kennedy  1 , Rebecca Stone McGaver  1 , Morgan Homan  1 , Kayla J Sieffert  1 , Ayush D Shah  2 , Corey A Wulf  1 , Christopher M Larson  1 , Brian P Bjerke  1 , Robert F LaPrade  1
Affiliations

Comparing Postoperative Outcomes of Isolated Anterior Cruciate Ligament Reconstruction and the "Terrible Triad" Anterior Cruciate Ligament Reconstruction With Medial Meniscus Ramp and Lateral Meniscus Root Repairs

Evan P Shoemaker et al. Orthop J Sports Med. .

Abstract

Background: A new "terrible triad" has been reported to be an anterior cruciate ligament (ACL) tear with a concomitant medial meniscus ramp tear and lateral meniscus root tear. Patient-reported outcomes (PROs) for isolated ACL reconstruction (ACLR) versus an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs are not well known.

Purpose: To compare postoperative outcomes between isolated ACLR and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs.

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

Methods: An initial cohort of 1228 patients with ACLRs were retrospectively identified between April 2016 and November 2021. A total of 41 patients with isolated ACLR (isolated cohort) were age and sex matched to 41 patients who had an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Patients in the triad cohort were identified consecutively by date of surgery. Preoperative and ≥2-year postoperative PROs were evaluated to compare the isolated cohort with the triad cohort. Statistical analysis was performed with unpaired t tests and chi-square tests.

Results: Both the isolated cohort and triad cohort demonstrated significant differences between preoperative and postoperative PROs in all questionnaire categories assessed. Postoperative scores for the International Knee Documentation Committee (isolated, 88.8; triad, 86.2; P = .392), Cincinnati (isolated, 91.1; triad, 88.1; P = .295), and Lysholm (isolated, 92.1; triad, 90.1; P = .472) PROs demonstrated no significant differences between the cohorts. No significant difference was found between the isolated and triad cohorts for all preoperative questionnaire categories. Additionally, no significant difference was found in revision or reoperation rates between isolated and triad patients (P = .733).

Conclusion: No significant differences in PROs were found at minimum follow-up of 2 years postoperatively between the patients who underwent isolated ACLR (isolated cohort) and those who underwent ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Inferior outcomes were not observed in the triad cohort when revision rates, reoperation rates, and postoperative PROs were compared. Given the optimistic short-term outcomes for isolated versus triad ACLR patients and the known biomechanical consequences of these untreated meniscal injuries, medial meniscus ramp and lateral meniscus root repairs should be performed when encountered concurrently with an ACL tear when possible.

Keywords: ACL; general; knee; knee, meniscus; lateral meniscus root tear; medial meniscus ramp tear; patient-reported outcomes; terrible triad.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: N.I.K. has received hospitality payments from Encore Medical and Zimmer Biomet Holdings and education payments from Foundation Medical and Smith+Nephew. C.A.W. has received nonconsulting fees from Smith+Nephew. C.M.L. has received nonconsulting fees from Smith+Nephew and Synthes GmbH and consulting fees from Responsive Arthroscopy and Smith+Nephew. R.L.F. has received royalties from Arthrex and Smith+Nephew, education payments from Foundation Medical, and nonconsulting fees from Smith+Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Comparison of preoperative PROs between isolated ACLR (isolated) and ACLR with medial meniscus ramp and lateral meniscus root repairs (triad). ACLR, anterior cruciate ligament reconstruction; IKDC, International Knee Documentation Committee; KOOS, Knee injury and Osteoarthritis Outcome Score; Preop, preoperative; PROs, patient-reported outcomes; QOL, Quality of Life; Sports & Rec, Sports and Recreation.
Figure 2.
Figure 2.
Comparison of PROs between preoperative and postoperative measures in the isolated ACLR cohort. ACLR, anterior cruciate ligament reconstruction; IKDC, International Knee Documentation Committee; KOOS, Knee injury and Osteoarthritis Outcome Score; Postop, postoperative; Preop, preoperative; PROs, patient-reported outcomes; QOL, Quality of Life; Sports & Rec, Sports and Recreation.
Figure 3.
Figure 3.
Comparison of PROs between preoperative and postoperative measures in ACLR with medial meniscus ramp and lateral meniscus root repairs (triad). ACLR, anterior cruciate ligament reconstruction; IKDC, International Knee Documentation Committee; KOOS, Knee injury and Osteoarthritis Outcome Score; Postop, postoperative; Preop, preoperative; PROs, patient-reported outcomes; QOL, Quality of Life; Sports & Rec, Sports and Recreation.
Figure 4.
Figure 4.
Comparison of PROs between isolated ACLR (isolated) and ACLR with medial meniscus ramp and lateral meniscus root repairs (triad). ACLR, anterior cruciate ligament reconstruction; IKDC, International Knee Documentation Committee; KOOS, Knee injury and Osteoarthritis Outcome Score; Postop, postoperative; PROs, patient-reported outcomes; QOL, Quality of Life; Sports & Rec, Sports and Recreation.
Figure 5.
Figure 5.
Revision and reoperation rates between isolated anterior cruciate ligament reconstruction (ACLR) (isolated) and ACLR with medial meniscus ramp and lateral meniscus root tears (triad) demonstrated no significant differences (chi-square goodness-of-fit test).
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