Sage Journals: Discover world-class research

Abstract

Background:

Recently, the posterior horn lateral meniscal oblique radial tear (LMORT) was identified in 12% of acute anterior cruciate ligament (ACL) injuries. However, patient-reported outcomes for repair of this relatively common tear have not been reported.

Purpose:

To determine the minimum 2-year functional outcomes after LMORT repair at the time of ACL reconstruction (ACLR) compared to a matched cohort of patients who underwent isolated ACLR (iACLR).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Included were 100 patients (mean age at surgery, 21 years; range, 13-45 years) who underwent primary ACLR between 2010 and 2018. The mean follow-up period was 4.1 ± 2.0 years (range, 2.0-9.2 years). A total of 50 patients with surgically repaired LMORT type 3 or type 4 lesions, defined as partial or complete tears >10 mm from the root (LMORT group) were matched 1:1 based on age, date of surgery, and graft choice with 50 patients who underwent iACLR (iACLR group). The postoperative outcomes were compared between groups using the International Knee Documentation Committee subjective score (sIKDC) and the Tegner activity scale. An updated medical history was obtained via the electronic medical record to determine any subsequent complications and reoperations.

Results:

There was 1 ACL graft failure in each group as well as 5 (10%) reoperations per group. None of the patients in the LMORT group necessitated a lateral meniscal revision repair or partial meniscectomy. The LMORT and iACLR groups reported comparable sIKDC scores (92.5 ± 6.8 vs 91.9 ± 8.2, respectively; P = .712) as well as Tegner scores (6.7 ± 1.8 vs 6.6 ± 1.8, respectively; P = .910) at final follow-up. No failures of the LMORT repairs were reported.

Conclusion:

The study findings demonstrated that reoperations, graft failure rates, patient-reported outcomes, and patient activity levels at ≥2 years after type 3 and 4 LMORT repairs at the time of ACLR compared favorably with those of a matched cohort of patients who underwent iACLR with intact meniscus.

Keywords

Lateral meniscal oblique radial tear LMORT meniscal repair ACLR Tegner

Lateral meniscal tears commonly occur with anterior cruciate ligament (ACL) injuries.^1,10,15 Posterior root tears of the lateral meniscus have been identified in 7% to 14% of patients with ACL pathology.^10,15,30 A recent study has identified the lateral meniscal oblique radial tear (LMORT) of the posterior horn as one of the more common tear types, occurring in as many as 12% of patients with ACL injuries.¹⁵ The proposed classification system identified 78% of LMORTs as partial (type 3) or complete (type 4) oblique tears extending >10 mm from the root.¹⁵ These are distinct from both LMORT types 1 and 2, which are classified as occurring ≤10 mm from the root, as well as pure root tears.^8,16

Appropriate treatment of LMORTs is to correct the altered knee kinematics that occur in the setting of these meniscal lesions.^{2,13,17,24,39} The biomechanical consequences of LMORTs and root tears are similar, both resulting in increased contact pressures, meniscal extrusion, and increased instability.^{12,18,29,34,36} A biomechanical study of LMORT types 3 and 4 by Smith et al³⁶ demonstrated worsening anterior translation, rotatory instability, and meniscal extrusion in ACL-deficient knees when compared with knees with an intact lateral meniscus. Additionally, the knee instability and meniscal extrusion persisted following ACL reconstruction (ACLR) if the LMORT was not repaired at the same time.³⁶ However, little evidence is available on the clinical outcomes for repair of these tear patterns.⁸

The purpose of this study was to determine the minimum 2-year functional outcomes after LMORT repair at the time of ACLR compared to a matched cohort of patients who underwent isolated ACLR (iACLR). We hypothesized that patients who underwent LMORT repairs would have comparable failure and reoperation rates, as well as patient-reported outcomes (PROs), when compared with patients who underwent iACLR.

Methods

Patient Selection

Following institutional review board approval, a retrospective multicenter case-control study was performed at 2 academic sports medicine centers between 2010 and 2018. Patients who underwent primary ACLR with concomitant LMORT repair between 2010 and 2018 by 4 high-volume sports medicine and arthroscopic specialists (P.A.S., M.J.S., B.A.L., and A.J.K.) were identified. Arthroscopic photographs were carefully examined to classify the meniscal tear according to previous investigations.¹⁵

An a priori power analysis for noninferiority²⁵ was performed with α = .05, β = 0.80, 10.4 for the noninferiority limit based on prior reports of the minimal clinically important difference of the International Knee Documentation Committee (IKDC) for patients undergoing ACLR⁴³ and a population SD of 11.5 based on prior reports in similar populations.^1,3,41,45 A minimum sample size of 32 participants per group was determined.

Patient exclusion criteria consisted of (1) revision ACLR, (2) type 1 or 2 LMORT, (3) LMORT treated with transtibial root repair, inside-outside repair, or partial meniscectomy, and (4) patients who were found to have grade 3 or 4 cartilage lesions at time of arthroscopy. Of 58 eligible LMORT patients, 8 patients were unable to be contacted, resulting in an 86% follow-up rate. The final LMORT group consisted of 50 patients who (1) underwent ACLR with concomitant type 3 or 4 LMORT repaired with an all-inside technique (Figure 1), (2) had minimum 2-year follow-up data, and (3) were available for contact follow-up regarding confirmation of any complications, reoperations, and PROs. These patients were matched 1:1 with patients who received iACLR based on age, date of surgery, and graft choice. Matching was conducted with blinding of clinical outcomes. All participants provided informed consent.

Figure 1.

Arthroscopic view from the anterolateral portal demonstrating a type 3 LMORT. (A) LMORT 3 prior to repair. (B) LMORT 3 reduced by a probe from the anteromedial portal. (C) Repaired LMORT 3. LMORT, lateral meniscal oblique radial tear.

Surgical Technique

An all-inside technique with 1 to 5 horizontal sutures was utilized as described by Smith et al.³⁶ In brief, a suture passer was used to pass a 0.9-mm suture tape on each side of the tear nearest the capsule for a spanning suture. A locking, sliding Tuckahoe-type knot was then tied followed by 2 alternating half-hitches. A second spanning suture was then placed closer to the free edge of the meniscus.

Postoperative Rehabilitation

The iACLR group underwent a standard ACL rehabilitation protocol consisting of 2 weeks of weightbearing as tolerated with crutches, 4 weeks of bodyweight-limited open chain exercises, and 6 weeks of weight-resisted open chain exercises with increasing range of motion. The LMORT group underwent the same rehabilitation program with limited weightbearing until 4 weeks and limited loads on weightbearing with the knee at ≥90° of flexion for 16 weeks.

Data Collection

An electronic chart review was performed to obtain baseline characteristics including age at surgery, sex, body mass index, laterality, and concomitant injuries. Perioperative data included classification of LMORT using arthroscopic images, ACL graft type, fixation type for all-inside meniscal repair, and cartilage quality. Postoperative end points collected were reoperation/failure, IKDC subjective (sIKDC) scores and Tegner activity scores.⁵ The threshold Patient Acceptable Symptom State (PASS) for the sIKDC was set at 75.9 based on published data.^21,23

Statistical Analysis

Data were reported as means with standard deviations for quantitative variables and frequencies with percentages for qualitative variables. The Student t test was used to compare parametric quantitative variables. The Pearson chi-square test was used to compare parametric qualitative variables. Data analysis was performed using JMP (Version 17; SAS Institute Inc), and P < .05 was considered statistically significant.

Results

Patients and Injury Characteristics

Included were 100 patients (mean age at surgery, 21 years; range, 13-45 years). The mean follow-up period for the overall cohort was 4.1 ± 2.0 years (range, 2.0-9.2 years). The characteristics of the patients by group are summarized in Table 1. Patient age, sex, body mass index, laterality, and mean final follow-up times were comparable between the LMORT and iACLR groups. In the LMORT group, 35 (70%) tears were type 3 and 15 (30%) tears were type 4.

Table 1

Patient Characteristics by Group^a

Characteristic	LMORT (n = 50)	iACLR (n = 50)	P
Age, y	21.4 ± 7.3	20.7 ± 7.2	.677
Sex			.688
Female	26 (52)	28 (56)
Male	24 (48)	22 (44)
Body mass index	25.4 ± 4.3	23.9 ± 3.76	.078
Side			.546
Right	24 (48.0)	21 (42.0)
Left	26 (52.0)	29 (58.0)
Follow-up, y	4.1 ± 1.9	4.1 ± 2.1	.902
LMORT classification
Type 3	35 (70)	—
Type 4	15 (30)	—

Data are reported as mean ± SD or n (%). Dashes indicate areas not applicable. iACLR, isolated anterior cruciate ligament reconstruction; LMORT, lateral meniscal oblique radial tear.

Associated Pathology and Operative Characteristics

Concomitant nonlateral meniscal surgeries were performed in 30 (60%) of LMORT patients and 3 (6%) of iACLR patients (Table 2). Medial meniscal procedures were performed in 19 (38%) of LMORT patients and zero of 50 iACLR patients (P < .001). There were no significant differences in any other concomitant procedures between groups.

Table 2

Operative Characteristics by Group^a

Characteristic	LMORT (n = 50)	iACLR (n = 50)	P
Concomitant procedures
MCL	2 (4)	2 (4)	>.99
Medial meniscus	19 (38)	0	<.001
Lateral meniscus	50 (100)	0	<.001
Chondroplasty	7 (14)	1 (2)	.059
MPFL repair	1 (2)	0 (0)	>.99
Loose body removal	1 (2)	0 (0)	>.99
Autograft type
Patellar BTB	28 (56)	25 (50)
Hamstring tendon	17 (34)	14 (28)
Quadriceps tendon	5 (10)	11 (22)
Reoperations^b	(n = 5)	(n = 5)	>.99
Revision ACLR	1 (2)	1 (2)	>.99
Lateral meniscal APM/repair	0 (0)	1 (2)	>.99
Medial meniscal APM/repair	3 (6)	0 (0)	.24
Debriding procedures^c	2 (4)	3 (6)	>.99

Data are reported as n (%). Dashes indicate not applicable. ACLR, anterior cruciate ligament reconstruction. APM, arthroscopic partial meniscectomy, BTB, bone-tendon-bone; iACLR, isolated ACLR; LMORT, lateral meniscal oblique radial tear; MCL, medial collateral ligament; MPFL, medial patellofemoral ligament.

One reoperation may consist of >1 procedure (eg, meniscal procedures often occur concurrently with revision ACLRs).

Debriding procedures include notchplasties, synovectomies, interference screw removals, and excision of fat pad fibroses.

There were 5 (10%) reoperations in each group. There was 1 ACL graft failure as well as 1 patient who underwent subsequent lysis of adhesions in each group. There were no significant differences in the types of procedures performed. There were no subsequent lateral meniscal procedures (revision repair or partial meniscectomy) noted in the LMORT group.

PRO Scores

The mean sIKDC and Tegner scores at the final follow-up were comparable between the groups (Table 3). Three patients in the iACLR group and 1 patient in the LMORT group did not meet the PASS threshold.

Table 3

Patient-Reported Outcome Scores at Final Follow-Up^a

Outcome Measure	LMORT (n = 50)	iACLR (n = 50)	P
sIKDC	92.5 ± 6.8	91.9 ± 8.2	.712
Tegner	6.7 ± 1.8	6.6 ± 1.8	.910

Data are reported as mean ± SD. iACLR, isolated anterior cruciate ligament reconstruction; LMORT, lateral meniscal oblique radial tear; sIKDC, International Knee Documentation Committee subjective score.

Discussion

In this study, the failure/reoperations, PROs, and activity level after repair were equivalent to the patient population undergoing iACLR. This is the first clinical study to our knowledge comparing the outcome of type 3 and type 4 LMORT repair at the time of ACLR with a control group of iACLR patients.

We identified a reoperation rate of 5 (10%) in each group, with no LMORT repair failures, which is consistent with prior reports of excellent healing rates of lateral meniscal repairs in the setting of ACLR.^3,7 De Leissegues et al⁹ reported a reoperation rate of 10% (10/99) in a series of patients who underwent concomitant ACLR and lateral meniscal repairs or transtibial root repairs with a mean follow-up 42 months (Table 4). Anderson et al³ reported reoperation in 5 of 24 patients undergoing combined ACLR and lateral meniscal repair with a mean follow-up of 58.6 months. These reports are similar to other studies regarding the reoperation rates of iACLR with the literature overall demonstrating a reoperation rate of 10% to 26% at mid- to long-term follow up.^31,40

Table 4

Studies of Lateral Meniscal Repairs in Setting of ACLR^a

Study	Minimum Follow-up, mo	Reoperation (Failure)	Criteria for Failure of Meniscal Repair	Tegner^b	sIKDC^b	Details
Krych et al¹⁴	24 (mean, 41)	2/32 (2/32)	Clinical	6.5	89.5	Transtibial
LaPrade et al¹⁹	24	0/15 (NR)	Clinical	4	NR	Transtibial
Okazaki et al²⁶	6	0/17 (NR)	Clinical	NR	73.0 ± 17.7	All inside/transtibial
Pan et al²⁸	24 (mean, 38)	0/31 (NR)	Clinical	NR	86.9 ± 11.5	Transtibial
Tsujii et al⁴¹	24 (mean, 40)	0/41 (3/30)	Second-look arthroscopy	NR	NR	All inside
Zhuo et al⁴⁵	24 (mean, 26.7)	0/29 (3/22)	Second-look arthroscopy	5.4 ± 0.7	92.1 ± 2.6	All inside
De Leissegues et al⁸	24 (mean, 42)	10/99 (1/10)	Second-look arthroscopy	6	86.9 ± 7.6	All inside/transtibial
Jeon et al¹¹	24 (mean, 32)	0/79 (0/61)	Second-look arthroscopy	6.4	82.9	All inside

ACLR, anterior cruciate ligament reconstruction; NR, not reported; Reop, reoperation; sIKDC, International Knee Documentation Committee subjective score.

Mean or mean ± SD.

A 2022 study by Jeon et al¹¹ reported a complete healing rate of 80.3% in LMORTs with second-look arthroscopy. Similarly, a recent systematic review of lateral meniscal repairs in the setting of ACLR that included several of these studies found a complete or partial healing rate of 93.6%.⁴⁴ One possible explanation for the high rate of healing of repaired posterolateral meniscal tears associated with ACL rupture versus isolated radial tears could be the relatively increased vascularity near the meniscus roots versus the body.⁷

There were no significant differences in the sIKDC scores between the 2 groups in this study, and scores were consistently better than those of previously reported series of ACLR and ACLR with lateral meniscal repair.^7,9,24,33 Randsborg et al³¹ reported a mean sIKDC of 84.3 in 1024 patients undergoing ACLR with no meniscal lesion at a mean 7.2-year follow-up. A recent series of 79 patients with minimum 2-year follow-up who underwent ACLR with LMORT repair reported a mean sIKDC score of 82.9.¹¹

A high activity level was maintained by patients in both groups in the current study, and the Tegner scores in our cohort were comparable with those of previously published series. Sonnery-Cottet et al³⁸ reported a mean Tegner score of 6.4 in patients undergoing iACLR. In a series of 8 patients undergoing all-inside lateral meniscal repair with ACLR, Anderson et al³ noted a mean postoperative Tegner score of 5.8. Similarly, Song et al³⁷ reported a postoperative Tegner score of 6.7 at ≥12 months, at mean 24-month follow-up for posterolateral radial meniscal repairs in the setting of ACL tears. Other published studies of lateral meniscal repairs in the setting of ACLR with 2-year minimum follow-up include Jeon et al¹¹ who reported a mean Tegner score of 6.4 at a mean 32-month follow-up, Zhuo et al⁴⁵ who reported a mean Tegner score of 5.4 at a mean 26.7-month follow-up, and De Leissegues et al⁹ who reported a mean Tegner score of 6 at a mean 42-month follow-up.

The results reported here are comparable with those of reported series of repairs of radial tears of the lateral meniscus.^4,18 Choi et al⁶ reported results of 14 patients who underwent repair of isolated radial tears of the midbody of the lateral meniscus with an all-inside technique with a mean follow-up of 36 months and mean Lysholm score of 94.7, Tegner score of 5.7, and magnetic resonance imaging (MRI) showing full (5/14) or partial (8/14) healing in 13 of 14 patients. A recent systematic review by Milliron et al²² included 12 retrospective studies that reported results of radial meniscal tear repair with significant and clinically important improvement in Lysholm score (range, 47-68.9 preoperatively to 86.4-95.6 postoperatively) and Tegner score (range, 2.5-3.1 preoperatively to 4.7-6.7 postoperatively) at a mean 35-month follow-up (range, 12-76 months). Additionally, of those tears assessed by MRI or second-look arthroscopy, 62% showed full healing and an additional 30% partial healing.

Although some studies indicate that small peripheral lateral meniscal tears may be left in situ and fair acceptably without repair,^20,33 biomechanical studies indicate that LMORT tears have a significant negative impact on meniscal function and stability and can result in increased joint laxity and meniscal extrusion.^2,35,36 These findings suggest that ACL graft integrity could be compromised from a failure to repair the meniscus.⁸ Regarding healing of these tears, second-look arthroscopy in LMORT tears as described by Jeon et al¹¹ showed 80.3% complete healing status and 19.7% partial healing status in 61 repaired LMORTs. As a substantial portion of the tear crosses obliquely through the red-red and red-white zones of the meniscus and repair is occurring during the time of ACLR, there is ample vascularity and stimulus to encourage healing of these tears when combined with anatomic repair.^4,7,27,32,42 Additionally, these studies show that repair rather than management via meniscectomy is superior.^35,36 Importantly, here we validate these studies indicating that not only is repair efficacious, but, clinically, the outcomes of repair are equivalent to having no meniscal tear at all. Similarly, lateral meniscus root repair at the time of ACLR has been shown to improve functional outcomes and prevent the accelerated progression of osteoarthritis.^1,33,41

Limitations

Significant limitations of this study include that it is a retrospective study and thus subject to the bias of the surgeon selection of patients with LMORTs that were deemed appropriate candidates for repair. This bias is partially mitigated, as, at the centers where the study was performed, all type 3 and 4 LMORTs routinely undergo repair. The selection of a cohort of ACLR patients without LMORTs was matched on key demographic variables, but there is a possibility that ACL tears with LMORTs reflect a specific injury mechanism or pattern that is significantly different from that associated with isolated ACL tears. However, a cohort of iACLR patients was chosen for comparison given prior biomechanics studies that demonstrated iACLR was similar to ACLR+LMORT repair. Regarding the PASS threshold for this study, it is important to note it was set by a different cohort. Finally, we did not perform second-look arthroscopy or follow-up imaging to assess the status of the LMORT repair. However, given the previous reports of high rates of healing for posterior lateral meniscal tears¹¹ and the lack of patient symptoms requiring reoperation, we are confident these data would not change the clinical relevance of the reported results.

Conclusion

The study findings demonstrated that reoperations, graft failure rates, PROs, and patient activity levels at ≥2 years after type 3 and 4 LMORT repairs at the time of ACLR compared favorably with those of a matched cohort with iACLR with intact meniscus. No failures of the LMORT repairs were reported; however, long-term follow-up on this type of repair is needed.

Footnotes

Final revision submitted June 17, 2023; accepted June 29, 2023.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the US National Institutes of Health. One or more of the authors has declared the following potential conflict of interest or source of funding: Research support was received from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950) and from the Foderaro-Quattrone Musculoskeletal/Orthopaedic Surgery Research Innovation Fund. E.T. has received a grant from Arthrex, education payments from Arthrex, and hospitality payments from Stryker. M.J.S. has received research support from Stryker, education payments from Arthrex, consulting fees from Arthrex, nonconsulting fees from Arthrex, and royalties from Arthrex. B.A.L. has received consulting fees from Arthrex and Smith & Nephew; nonconsulting fees from Arthrex, Smith & Nephew, and Linvatec; royalties from Arthrex; and stock from COVR Medical. P.A.S. has received research support from Arthrex; education payments from United Orthopedics and Elite Orthopedics; consulting fees from Arthrex; nonconsulting fees from Arthrex, Kairos Surgical, United Orthopedics, Medical Device Business Services, Elite Orthopedics, and Alpha Orthopedic systems; royalties from Arthrex; and stock options from Spinal Simplicity. A.J.K. has received research support from Aesculap, B. Braun, Ceterix, Arthritis Foundation, Histogenics, and Arthrex; a grant from DJO; consulting fees from Arthrex, Vericel, JRF Ortho, and Responsive Arthroscopy; nonconsulting fees from Arthrex; royalties from Arthrex and Responsive Arthroscopy; honoraria from JRF Ortho, MTF Biologics, and Responsive Arthroscopy; and hospitality payments from Gemini Mountain Medical and 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.

Ethical approval for this study was obtained from Mayo Clinic (reference No. PR15-000601-09).

References

Ahn

Lee

Yoo

, et al. Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy. 2010;26(1):67-75.

Allaire

Muriuki

Gilbertson

Harner

CD.

Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Joint Surg Am. 2008;90(9):1922-1931.

Anderson

Watts

Shapter

, et al. Repair of radial tears and posterior horn detachments of the lateral meniscus: minimum 2-year follow-up. Arthroscopy. 2010;26(12):1625-1632.

Arnoczky

Warren

RF.

Microvasculature of the human meniscus. Am J Sports Med. 1982;10(2):90-95.

Briggs

Lysholm

Tegner

, et al. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. 2009;37(5):890-897.

Choi

Kim

Son

Victoroff

BN.

Meniscal repair for radial tears of the midbody of the lateral meniscus. AM J Sports Med. 2010;38(12):2472-2476.

Crawford

Hellwinkel

Aman

, et al. Microvascular anatomy and intrinsic gene expression of menisci from young adults. Am J Sports Med. 2020;48(13):3147-3153.

Daniel

Krych

Smith

PA.

The lateral meniscus oblique radial tear (LMORT). Curr Rev Musculoskelet Med. 2023;16(7):306-315.

De Leissegues

Vieira

Fayard

Thaunat

Low reoperation rate following lateral meniscus root repair: clinical outcomes at 2 years follow-up. Knee Surg Sports Traumatol Arthrosc. 2023;31(2):495-502.

10.

Feucht

Bigdon

Bode

, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res. 2015;10:34.

11.

Jeon

Alsomali

Yang

, et al. Posterior horn lateral meniscal oblique radial tear in acute anterior cruciate ligament reconstruction incidence and outcomes after all-inside repair: clinical and second-look arthroscopic evaluation. Am J Sports Med. 2022;50(14):3796-3804.

12.

Kaiser

Damodar

Udine

, et al. Meniscal extrusion: a critical analysis review. JBJS Rev. 2022;10(8):e22.00019.

13.

Katakura

Horie

Watanabe

, et al. Effect of meniscus repair on pivot-shift during anterior cruciate ligament reconstruction: objective evaluation using triaxial accelerometer. Knee. 2019;26(1):124-131.

14.

Krych

Bernard

Kennedy

, et al. Medial versus lateral meniscus root tears: is there a difference in injury presentation, treatment decisions, and surgical repair outcomes? Arthroscopy. 2020;36(4):1135-1141.

15.

Krych

LaPrade

Cook

, et al. Lateral meniscal oblique radial tears are common with ACL injury: a classification system based on arthroscopic tear patterns in 600 consecutive patients. Orthop J Sports Med. 2020;8(5):2325967120921737.

16.

LaPrade

James

Cram

, et al. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 2015;43(2):363-369.

17.

LaPrade

James

LaPrade

RF.

A modified transtibial pull-out repair for posterior root avulsions of the lateral meniscus with concomitant anterior cruciate ligament reconstruction: a report of two cases. JBJS Case Connect. 2014;4(4):e96.

18.

LaPrade

Jansson

Dornan

, et al. Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am. 2014;96(6):471-479.

19.

LaPrade

Matheny

Moulton

James

Dean

CS.

Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Am J Sports Med. 2017;45(4):884-891.

20.

Lee

Jang

Lee

, et al. Clinical, radiological, and morphological evaluations of posterior horn tears of the lateral meniscus left in situ during anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42(2):327-335.

21.

Maheshwer

Wong

Polce

, et al. Establishing the minimal clinically important difference and patient-acceptable symptomatic state after arthroscopic meniscal repair and associated variables for achievement. Arthroscopy. 2021;37(12):3479-3486.

22.

Milliron

Magnussen

Cavendish

Quinn

DiBartola

Flanigan

DC.

Repair of radial meniscus tears results in improved patient-reported outcome scores: a systematic review. Arthrosc Sports Med Rehabil. 2021;3(3):e967-e980.

23.

Muller

Yabroudi

Lynch

, et al. Defining thresholds for the patient acceptable symptom state for the IKDC Subjective Knee Form and KOOS for patients who underwent ACL reconstruction. Am J Sports Med. 2016;44(11):2820-2826.

24.

Musahl

Citak

O’Loughlin

, et al. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med. 2010;38(8):1591-1597.

25.

Negida

Sample size calculation guide—part 6: how to calculate the sample size for a non-inferiority or an equivalence clinical trial. Adv J Emerg Med. 2020;4(1):e15.

26.

Okazaki

Furumatsu

Kamatsuki

, et al. Transtibial pullout repair of the lateral meniscus posterior root tear combined with anterior cruciate ligament reconstruction reduces lateral meniscus extrusion: a retrospective study. Orthop Traumatol Surg Res. 2020;106(3):469-473.

27.

Ozeki

Kohno

Kushida

, et al. Synovial mesenchymal stem cells promote the meniscus repair in a novel pig meniscus injury model. J Orthop Res. 2021;39(1):177-183.

28.

Pan

Hua

Surgical treatment of combined posterior root tears of the lateral meniscus and ACL tears. Med Sci Monit. 2015;21:1345-1349.

29.

Perez-Blanca

Espejo-Baena

Amat Trujillo

, et al. Comparative biomechanical study on contact alterations after lateral meniscus posterior root avulsion, transosseous reinsertion, and total meniscectomy. Arthroscopy. 2016;32(4):624-633.

30.

Praz

Vieira

Saithna

, et al. Risk factors for lateral meniscus posterior root tears in the anterior cruciate ligament–injured knee: an epidemiological analysis of 3956 patients from the SANTI Study Group. Am J Sports Med. 2019;47(3):598-605.

31.

Randsborg

Cepeda

Adamec

, et al. Patient-reported outcome, return to sport, and revision rates 7-9 years after anterior cruciate ligament reconstruction: results from a cohort of 2042 patients. Am J Sports Med. 2022;50(2):423-432.

32.

Scott

Jolly

Henning

CE.

Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing. J Bone Joint Surg Am. 1986;68(6):847-861.

33.

Shelbourne

Roberson

Gray

Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Am J Sports Med. 2011;39(7):1439-1443.

34.

Shybut

Vega

Haddad

, et al. Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med. 2015;43(4):905-911.

35.

Smith

Bezold

Cook

, et al. Kinematic analysis of lateral meniscal oblique radial tears in the anterior cruciate ligament–deficient knee. Am J Sports Med. 2021;49(14):3898-3905.

36.

Smith

Bezold

Cook

, et al. Kinematic analysis of lateral meniscal oblique radial tears in anterior cruciate ligament–reconstructed knees: untreated versus repair versus partial meniscectomy. Am J Sports Med. 2022;50(9):2381-2389.

37.

Song

Bae

Park

Shim

Repair of a radial tear in the posterior horn of the lateral meniscus. Knee. 2014;21(6):1185-1190.

38.

Sonnery-Cottet

Haidar

Rayes

, et al. Long-term graft rupture rates after combined ACL and anterolateral ligament reconstruction versus isolated ACL reconstruction: a matched-pair analysis from the SANTI Study Group. Am J Sports Med. 2021;49(11):2889-2897.

39.

Tang

Marshall

Wang

, et al. Lateral meniscal posterior root repair with anterior cruciate ligament reconstruction better restores knee stability. Am J Sports Med. 2019;47(1):59-65.

40.

Thaunat

Clowez

Saithna

, et al. Reoperation rates after combined anterior cruciate ligament and anterolateral ligament reconstruction: a series of 548 patients from the SANTI Study Group with a minimum follow-up of 2 years. Am J Sports Med. 2017;45(11):2569-2577.

41.

Tsujii

Yonetani

Kinugasa

, et al. Outcomes more than 2 years after meniscal repair for radial/flap tears of the posterior lateral meniscus combined with anterior cruciate ligament reconstruction. Am J Sports Med. 2019;47(12):2888-2894.

42.

Wei

Sun

Gui

, et al. The critical role of Hedgehog-responsive mesenchymal progenitors in meniscus development and injury repair. eLife 2021;10:e62917.

43.

Zhang

, et al. Predicting the objective and subjective clinical outcomes of anterior cruciate ligament reconstruction: a machine learning analysis of 432 patients. Am J Sports Med. 2022;50(14):3786-3795.

44.

Zheng

Song

, et al. Clinical, radiographic, and arthroscopic outcomes of surgical repair for radial and avulsed lesions on the lateral meniscus posterior root during ACL reconstruction: a systematic review. Orthop J Sports Med. 2021;9(3):2325967121989678.

45.

Zhuo

Chen

Zhu

Arthroscopic side-to-side repair for complete radial posterior lateral meniscus root tears. BMC Musculoskelet Disord. 2020;21(1):130.

Outcomes of Lateral Meniscal Oblique Radial Tear Repair Compared With Intact Meniscus After ACL Reconstruction: A Cohort Study

Abstract

Background:

Purpose:

Study Design:

Methods:

Results:

Conclusion:

Keywords

Methods

Patient Selection

Surgical Technique

Postoperative Rehabilitation

Data Collection

Statistical Analysis

Results

Patients and Injury Characteristics

Associated Pathology and Operative Characteristics

PRO Scores

Discussion

Limitations

Conclusion

Footnotes

References