Reoperation Rates for Medial,Lateral,and Bicompartmental Meniscal Tears Managed During Primary Anterior Cruciate Ligament Reconstruction

Abstract

Background:

Meniscal tears occur at the time of anterior cruciate ligament (ACL) injury in 55% to 65% of patients. These tears exhibit different healing patterns and behavior compared with meniscal tears in a stable knee. The optimal management of different medial, lateral and bicompartmental tears during primary ACL reconstruction (ACLR) has yet to be defined.

Purpose:

To evaluate the reoperation rates associated with different meniscal treatment strategies and analyze the effect of medial, lateral, and bicompartmental meniscal tears on ACLR outcomes.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This investigation included 1137 patients undergoing primary ACLR with a concomitant meniscal injury. Patients with chondral defects and multiligament knee injuries were excluded. Meniscal treatments were divided into 3 categories: left in situ (LIS), partial meniscectomy (PM), and repair. Reoperation was defined as the primary endpoint, and multivariable analysis was conducted to identify patient and tear characteristics associated with reoperation. The influence of different treatment strategies on return to play (RTP), ACL reinjury rate, and patient-reported outcome measures (PROMs) was reported at 2 years. The PROMs recorded were the International Knee Documentation Committee (IKDC) score, the Marx Activity Rating Scale, and the Anterior Cruciate Ligament–Return to Sport after Injury score.

Results:

The mean age was 24.0 ± 6.9 years, and 76% of patients were male. Most injuries were noncontact (64.9%), commonly resulting from pivoting/sidestepping (50.1%). No significant differences in injury mechanism, playing surface, or footwear type were found between medial, lateral, or bicompartmental tears. Reoperation rates for patients were low for lateral (1.3%), medial (2.6%), and bicompartmental tears (3.2%) LIS at the time of ACLR. The rate of reoperation/subsequent meniscectomy for medial meniscal repairs (14.8%) was significantly higher than for other medial treatments (hazard ratio 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 with other types of lateral meniscal 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:

Stable meniscal tears LIS during ACLR had low reoperation rates and good patient-reported outcomes, including patients with bicompartmental tears. Medial meniscal repairs 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 with other lateral meniscal treatment strategies.