Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: 6-Year Follow-up Results From the MARS Cohort

MARS Group;¹; Jake A Fox^{2

1}, Laura J Huston^{2

1}, Amanda K Haas^{3

1}, Jacquelyn S Pennings^{2

1}, Christina R Allen^{4

1}, Daniel E Cooper^{5

1}, Thomas M DeBerardino^{6

1}, Warren R Dunn^{7

1}, Brett Brick A Lantz^{8

1}, Kurt P Spindler^{9

1}, Michael J Stuart^{10

1}, Annunziato Ned Amendola^{11

1}, Christopher C Annunziata^{12

1}, Robert A Arciero^{13

1}, Bernard R Bach Jr^{14

1}, Champ L Baker 3rd^{15

1}, Arthur R Bartolozzi^{16

1}, Keith M Baumgarten^{17

1}, Jeffrey H Berg^{18

1}, Geoffrey A Bernas^{19

1}, Stephen F Brockmeier^{20

1}, Robert H Brophy^{3

1}, Charles A Bush-Joseph^{14

1}, J Brad Butler V^{21

1}, James L Carey^{22

1}, James E Carpenter^{23

1}, Brian J Cole^{14

1}, Jonathan M Cooper^{24

1}, Charles L Cox^{2

1}, R Alexander Creighton^{25

1}, Tal S David^{26

1}, David C Flanigan^{27

1}, Robert W Frederick^{28

1}, Theodore J Ganley^{29

1}, Charles J Gatt Jr^{30

1}, Steven R Gecha^{31

1}, James Robert Giffin^{32

1}, Sharon L Hame^{33

1}, Jo A Hannafin^{34

1}, Christopher D Harner^{35

1}, Norman Lindsay Harris Jr^{36

1}, Keith S Hechtman^{37

1}, Elliott B Hershman^{38

1}, Rudolf G Hoellrich^{8

1}, David C Johnson^{39

1}, Timothy S Johnson^{39

1}, Morgan H Jones^{40

1}, Christopher C Kaeding^{27

1}, Ganesh V Kamath^{25

1}, Thomas E Klootwyk^{41

1}, Bruce A Levy^{42

1}, C Benjamin Ma^{43

1}, G Peter Maiers 2nd^{41

1}, Robert G Marx^{34

1}, Matthew J Matava^{3

1}, Gregory M Mathien^{44

1}, David R McAllister^{33

1}, Eric C McCarty^{45

1}, Robert G McCormack^{46

1}, Bruce S Miller^{23

1}, Carl W Nissen^{47

1}, Daniel F O'Neill^{48

1}, Brett D Owens^{49

1}, Richard D Parker^{9

1}, Mark L Purnell^{50

1}, Arun J Ramappa^{51

1}, Michael A Rauh^{19

1}, Arthur C Rettig^{41

1}, Jon K Sekiya^{23

1}, Kevin G Shea^{52

1}, Orrin H Sherman^{53

1}, James R Slauterbeck^{54

1}, Matthew V Smith^{3

1}, Jeffrey T Spang^{25

1}, Col Ret Steven J Svoboda^{55

1}, Timothy N Taft^{25

1}, Joachim J Tenuta^{56

1}, Edwin M Tingstad^{57

1}, Armando F Vidal^{58

1}, Darius G Viskontas^{59

1}, Richard A White^{60

1}, James S Williams Jr^{61

1}, Michelle L Wolcott^{62

1}, Brian R Wolf^{63

1}, James J York^{64

1}, Rick W Wright^{2

1}

Affiliations

¹ Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Vanderbilt University, Nashville, Tennessee, USA.
³ Washington University in St. Louis, St. Louis, Missouri, USA.
⁴ Yale University, New Haven, Connecticut, USA.
⁵ W.B. Carrell Memorial Clinic, Dallas, Texas, USA.
⁶ UT Health, San Antonio, Texas, USA.
⁷ Fondren Orthopedic Group, Houston, Texas, USA.
⁸ Slocum Research and Education Foundation, Eugene, Oregon, USA.
⁹ Cleveland Clinic, Cleveland, Ohio, USA.
¹⁰ Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Duke University, Durham, North Carolina, USA.
¹² Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.
¹³ University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁴ Rush University Medical Center, Chicago, Illinois, USA.
¹⁵ The Hughston Clinic, Columbus, Georgia, USA.
¹⁶ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
¹⁷ Orthopedic Institute, Sioux Falls, South Dakota, USA.
¹⁸ Town Center Orthopaedic Associates, Reston, Virginia, USA.
¹⁹ State University of New York at Buffalo, Buffalo, New York, USA.
²⁰ University of Virginia, Charlottesville, Virginia, USA.
²¹ Orthopedic and Fracture Clinic, Portland, Oregon, USA.
²² University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²³ University of Michigan, Ann Arbor, Michigan, USA.
²⁴ HealthPartners Specialty Center, St. Paul, Minnesota, USA.
²⁵ University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
²⁶ Synergy Specialists Medical Group, San Diego, California, USA.
²⁷ The Ohio State University, Columbus, Ohio, USA.
²⁸ The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
²⁹ Children's Hospital of Philadelphia, Philadelphia, USA.
³⁰ University Orthopaedic Associates, Princeton, New Jersey, USA.
³¹ Princeton Orthopaedic Associates, Princeton, New Jersey, USA.
³² Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
³³ University of California, Los Angeles, California, USA.
³⁴ Hospital for Special Surgery, New York, New York, USA.
³⁵ University of Texas Health Center, Houston, Texas, USA.
³⁶ Grand River Health, Rifle, Colorado, USA.
³⁷ Miami Orthopedics and Sports Medicine Institute, Coral Gables, Florida, USA.
³⁸ Lenox Hill Hospital, New York, New York, USA.
³⁹ National Sports Medicine Institute, Leesburg, Virginia, USA.
⁴⁰ Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴¹ Forte Sports Medicine and Orthopedics, Indianapolis, Indiana, USA.
⁴² Orlando Health, Orlando, Florida, USA.
⁴³ University of California, San Francisco, California, USA.
⁴⁴ Knoxville Orthopedic Clinic, Knoxville, Tennessee, USA.
⁴⁵ University of Colorado Denver School of Medicine, Denver, Colorado, USA.
⁴⁶ University of British Columbia/Fraser Health Authority, New Westminster, British Columbia, Canada.
⁴⁷ Connecticut Children's Medical Center, Hartford, Connecticut, USA.
⁴⁸ The Alpine Clinic, Plymouth, New Hampshire, USA.
⁴⁹ Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
⁵⁰ Valley Ortho, Aspen, Colorado, USA.
⁵¹ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵² Stanford University, Palo Alto, California, USA.
⁵³ NYU Hospital for Joint Diseases, New York, New York, USA.
⁵⁴ UNC Health Southeastern, Lumberton, North Carolina, USA.
⁵⁵ MedStar Orthopaedic and Sports Center, Washington, DC, USA.
⁵⁶ Albany Medical Center, Albany, New York, USA.
⁵⁷ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.
⁵⁸ The Steadman Clinic, Vail, Colorado, USA.
⁵⁹ Fraser Orthopaedic Institute, New Westminster, British Columbia, Canada.
⁶⁰ Fitzgibbon's Hospital, Marshall, Missouri, USA.
⁶¹ Cleveland Clinic, Euclid, Ohio, USA.
⁶² University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶³ University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁶⁴ Luminis Health Orthopedics, Pasadena, Maryland, USA.

PMID: 41220248
PMCID: PMC12657664
DOI: 10.1177/03635465251387333

Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: 6-Year Follow-up Results From the MARS Cohort

MARS Group; et al. Am J Sports Med. 2025.

. 2025 Nov 11;53(14):3635465251387333.

doi: 10.1177/03635465251387333. Online ahead of print.

Authors

Affiliations

¹ Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Vanderbilt University, Nashville, Tennessee, USA.
³ Washington University in St. Louis, St. Louis, Missouri, USA.
⁴ Yale University, New Haven, Connecticut, USA.
⁵ W.B. Carrell Memorial Clinic, Dallas, Texas, USA.
⁶ UT Health, San Antonio, Texas, USA.
⁷ Fondren Orthopedic Group, Houston, Texas, USA.
⁸ Slocum Research and Education Foundation, Eugene, Oregon, USA.
⁹ Cleveland Clinic, Cleveland, Ohio, USA.
¹⁰ Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Duke University, Durham, North Carolina, USA.
¹² Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.
¹³ University of Connecticut Health Center, Farmington, Connecticut, USA.
¹⁴ Rush University Medical Center, Chicago, Illinois, USA.
¹⁵ The Hughston Clinic, Columbus, Georgia, USA.
¹⁶ 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
¹⁷ Orthopedic Institute, Sioux Falls, South Dakota, USA.
¹⁸ Town Center Orthopaedic Associates, Reston, Virginia, USA.
¹⁹ State University of New York at Buffalo, Buffalo, New York, USA.
²⁰ University of Virginia, Charlottesville, Virginia, USA.
²¹ Orthopedic and Fracture Clinic, Portland, Oregon, USA.
²² University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²³ University of Michigan, Ann Arbor, Michigan, USA.
²⁴ HealthPartners Specialty Center, St. Paul, Minnesota, USA.
²⁵ University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
²⁶ Synergy Specialists Medical Group, San Diego, California, USA.
²⁷ The Ohio State University, Columbus, Ohio, USA.
²⁸ The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
²⁹ Children's Hospital of Philadelphia, Philadelphia, USA.
³⁰ University Orthopaedic Associates, Princeton, New Jersey, USA.
³¹ Princeton Orthopaedic Associates, Princeton, New Jersey, USA.
³² Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.
³³ University of California, Los Angeles, California, USA.
³⁴ Hospital for Special Surgery, New York, New York, USA.
³⁵ University of Texas Health Center, Houston, Texas, USA.
³⁶ Grand River Health, Rifle, Colorado, USA.
³⁷ Miami Orthopedics and Sports Medicine Institute, Coral Gables, Florida, USA.
³⁸ Lenox Hill Hospital, New York, New York, USA.
³⁹ National Sports Medicine Institute, Leesburg, Virginia, USA.
⁴⁰ Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴¹ Forte Sports Medicine and Orthopedics, Indianapolis, Indiana, USA.
⁴² Orlando Health, Orlando, Florida, USA.
⁴³ University of California, San Francisco, California, USA.
⁴⁴ Knoxville Orthopedic Clinic, Knoxville, Tennessee, USA.
⁴⁵ University of Colorado Denver School of Medicine, Denver, Colorado, USA.
⁴⁶ University of British Columbia/Fraser Health Authority, New Westminster, British Columbia, Canada.
⁴⁷ Connecticut Children's Medical Center, Hartford, Connecticut, USA.
⁴⁸ The Alpine Clinic, Plymouth, New Hampshire, USA.
⁴⁹ Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
⁵⁰ Valley Ortho, Aspen, Colorado, USA.
⁵¹ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵² Stanford University, Palo Alto, California, USA.
⁵³ NYU Hospital for Joint Diseases, New York, New York, USA.
⁵⁴ UNC Health Southeastern, Lumberton, North Carolina, USA.
⁵⁵ MedStar Orthopaedic and Sports Center, Washington, DC, USA.
⁵⁶ Albany Medical Center, Albany, New York, USA.
⁵⁷ Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.
⁵⁸ The Steadman Clinic, Vail, Colorado, USA.
⁵⁹ Fraser Orthopaedic Institute, New Westminster, British Columbia, Canada.
⁶⁰ Fitzgibbon's Hospital, Marshall, Missouri, USA.
⁶¹ Cleveland Clinic, Euclid, Ohio, USA.
⁶² University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶³ University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁶⁴ Luminis Health Orthopedics, Pasadena, Maryland, USA.

PMID: 41220248
PMCID: PMC12657664
DOI: 10.1177/03635465251387333

Abstract

Background: Meniscal preservation has been demonstrated to contribute to long-term knee health and has been a successful intervention in isolation and in patients with anterior cruciate ligament reconstruction (ACLR). The long-term results of meniscal repair in the setting of revision ACLR have yet to be documented.

Purpose: To report the incidence of meniscal repair failures at the 6-year follow-up in a cohort of patients who underwent concurrent revision ACLR and primary meniscal repair.

Study design: Prospective cohort study; Level of evidence, 2.

Methods: All revision ACLRs with concomitant primary meniscal repair cases from a multicenter group between 2006 and 2011 were selected. Six-year follow-up was obtained to determine whether any subsequent surgery had occurred since their initial revision ACLR. If so, operative reports were obtained, whenever possible, to verify pathological condition and treatment.

Results: In total, 221 patients from 1234 revision ACLRs underwent concurrent primary meniscal repairs (18% of the cohort). There were 238 repairs performed: 173 medial and 65 lateral. The majority of these repairs (n = 181; 76%) were performed with an all-inside technique. Six-year surgical follow-up was obtained in 77% (171/221) of the cohort, or 189 of 238 (79%) of the repairs (136 medial, 53 lateral). The meniscal repair failure rate, defined as reoperation, was 16% (31/189) at 6 years. Of the 31 failures, 28 were medial (24 all-inside, 4 inside-out; 28/136 = 20.6% failure rate) and 3 were lateral (2 all-inside, 1 inside-out; 3/53 = 5.7% failure rate). Three medial failures were treated in conjunction with a subsequent repeat revision ACLR. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears (20.6% vs 5.7%; P = .01) and had a significantly shorter survival time compared with lateral tears (P = .02). No difference was found between the failure and nonfailure groups when it came to tear type, tear length, repair technique utilized, suture/implant type, or number of sutures used between the 2 groups.

Conclusion: Meniscal repair in the revision ACLR setting has a 16% failure rate at 6 years. Failure rates for medial tears (20.6%) were found to be higher than that for lateral tears (5.7%), which aligns with previous studies in both the revision and primary ACLR setting.

Keywords: anterior cruciate ligament reconstruction; meniscal repair; outcomes; revision.

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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: This project was funded by grant No. 5R01 AR060846 from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases. D.E.C. has received royalties or license from DJO and Stryker; and consulting fees from DJO. T.M.D. has received royalties, consulting fees, and speaking fees from Arthrex; and consulting fees from Kowa Pharmaceuticals American. K.P.S. has received support for education from Summit Surgical and consulting fees from NovoPedics. M.J.S. has received royalties, consulting fees, and speaking fees from Arthrex; and grant and support for education from Smith & Nephew. A.A. has received royalties and consulting fees from Arthrex; consulting fees from LimaCorporate and DJO; travel support from Lima USA; support for education from Southtech Orthopedics and Tricoast Surgical Solutions; and acquisitions and investment interest in Anika Therapeutics. C.C.A. has received support for education from Arthrex and Supreme Orthopedics Systems. R.A.A. has received acquisitions and consulting fees from Linvatec Coporation; and consulting fees from Biorez and Smith & Nephew. B.R.B. has received consulting fees from OsteoCentric Technologies. C.L.B. has received travel support from Arthrex and CGG Medical. K.M.B. has received consulting fees from Miach Orthopaedics, Stryker, and Wright Medical Technology. J.H.B. has received support for education from Supreme Orthopedic Systems. G.A.B. has received support for education from Prodigy Surgical Distribution. S.F.B. has received consulting fees and royalties from Arthrex and Exactech; and royalties from Zimmer Biomet Holdings. C.A.B.J. has received a grant from DJO. J.B.B. has received consulting fees from DePuy and Medical Device Business Services; and support for education from Steelhead Surgical. J.L.C. has received consulting fees and honoraria from Vericel; speaking fees from Arthrex; and consulting fees from Bioventus and Joint Restoration Foundation; he is an associate editor for AJSM. B.J.C. has received consulting fees from Acumed, Aesculap Biologics, Anika Therapeutics, Arthrex, Averitas Pharma, Bioventus, DJO, Endo Pharmaceuticals, Ossio, Pacira Pharmaceuticals, and Vericel; royalties from Arthrex and DJO; speaking fees from Terumo BCT and Vericel; and support for education from Endo Pharmaceuticals. R.A.C. has received consulting fees from Arthrex; hospitality payment from Shoulder Innovations; and support for education from Southtech Orthopedics. T.S.D. has received consulting fees and royalties from Arthrex; and support for education from ImpactOrtho. D.C.F. has received consulting fees from Anika Therapeutics, Bioventus, DePuy Synthes Products, Linvatec, Medical Device Business Services, MOXIMED, OSSIO, Smith & Nephew, and Vericel; hospitality payments from Arcuro Medical, ERMI, and International Life Sciences; and speaking fees from Karl Storz Endoscopy–America. R.W.F. has received support for education from Liberty Surgical and hospitality payments from Stryker. C.J.G. has received hospitality payments from Smith & Nephew; and support for education from SeaPearl. S.L.H. has received consulting fees from Smith & Nephew and speaking fees from Arthrex. N.L.H. has received hospitality payments from Arthrex. K.S.H. has received acquisitions from Anika Therapeutics; and support for education from Arthrex, Southern Edge Orthopaedics, and Zimmer Biomet Holdings. R.G.H. has received support for education from Steelhead Surgical. T.S.J. has received support for education from Supreme Orthopedic Systems and hospitality payments from Arthrex. C.C.K. has received speaking fees and consulting fees from Arthrex; consulting fees from Bioventus; and speaking fees from Smith & Nephew. G.V.K. has received hospitality payments from Smith & Nephew, Stryker, and TriCoast Surgical Solutions. B.A.L. has received consulting fees and royalties from Arthrex; hospitality payments from Reel Surgical; and speaking fees from Smith & Nephew. M.J.M. has received consulting fees, speaking fees, and travel support from Arthrex; and support for education from Elite Orthopedics. D.R.M. has received honoraria from Musculoskeletal Transplant Foundation; and consulting fees and royalties from Zimmer Biomet Holdings. E.C.M. has received consulting fees from Zimmer Biomet Holdings, Bioventus, DePuy Synthes Products, Pacira Therapeutics, Medical Device Business Services, and Vericel; royalties from Zimmer Biomet Holdings; and travel support from Synthes GmbH. B.S.M. has received consulting fees from Arthrex; travel support from Exactech; consulting fees and royalties from FH Orthopedics; and support for education from Pinnacle. B.D.O. has received royalties from Linvatec; consulting fees from Linvatec, Medical Device Business Services, Vericel, and DePuy Synthes Products; and is editor in chief of AJSM. M.L.P. has received support for education from Gemini Mountain Medical. A.J.R. has received support for education from Arthrex. M.A.R. has received travel support from Smith & Nephew; support for education from Prodigy Surgical Distribution; and royalties from Stryker. K.G.S. has received consulting fees from OrthoPediatrics and nView Medical; support for education from Evolution Surgical and Elite Orthopedics; and speaking fees from Arthrex. M.V.S. has received support for education from Arthrex and Elite Orthopedics; and travel support from Medical Device Business Services. S.J.S. has received travel support and support for education from Supreme Orthopedic Systems. J.J.T. has received travel support and support for education from Arthrex and Prodigy Surgical Distribution. E.J.T. has received travel support from DePuy Synthes Sales; and support for education from Summit Surgical. R.A.W. has ownership interest in Spinal Simplicity. J.S.W. has ownership interest in Lazurite. B.R.W. has received royalties and consulting fees from Linvatec. J.J.Y. has received support for education from Supreme Orthopedic Systems. 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.**
Survival analysis between medial and lateral meniscus repairs.

See this image and copyright information in PMC

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Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: 6-Year Follow-up Results From the MARS Cohort

Affiliations

Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: 6-Year Follow-up Results From the MARS Cohort

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous