Does meniscal repair impact muscle strength following ACL reconstruction?

Abstract

Purpose: Meniscal lesions are commonly associated with anterior cruciate ligament (ACL) rupture. Meniscal repair, when possible, is widely accepted as the standard of care. Despite advancements in surgical and rehabilitation techniques, meniscal repair may impact muscle recovery when performed in conjunction with ACL reconstruction. The objective of this study was to explore if meniscal repairs in the context of ACL reconstruction affected muscle recovery compared to isolated ACL reconstruction. Methods: Fifty-nine patients with isolated ACL reconstruction were compared to 35 patients with ACL reconstruction with an associated meniscal repair. All ACL reconstructions were performed using hamstring grafts with screw-interference graft fixation. Isokinetic muscle testing was performed between six and eight months of follow-up. Muscle recovery between both groups was compared. A further subgroup analysis was performed to compare muscle recovery function of gender and meniscal tear location. Tegner scores were assessed at six months’ follow-up. Results: No significant differences were found between the two groups regarding muscle recovery. No difference in muscle recovery was found concerning gender. Lesion of both menisci significantly increased the deficit of hamstrings muscular strength at 60°/s compared to a lesion of one meniscus (26.7% ± 15.2 vs. 18.1% ± 13.5, p = 0.018) and in eccentric test (32.4% ± 26.2 vs. 18.1% ± 13.5, p = 0.040). No significant differences were found concerning the Tegner score. Conclusion: Meniscal repairs performed during an ACL reconstruction do not impact muscle recovery at 6–8 months post-operatively compared to an isolated ACL reconstruction. However, reparations of both menisci appear to impact hamstring muscle recovery negatively. Level of evidence: III, Retrospective cohort study

Return to Sports After ACL Augmentation With Anterolateral Reconstruction (ALR) Harvesting Gracilis Only Compared With ACL Reconstruction With ALR Harvesting Both Hamstring Tendons

“…Indeed, Yosmaoglu et al found a benefit of saving the gracilis (using a quadruple ST technique for ACL-Rc) at low angular velocity (60 deg/s), and the deficit was still of 9%. Also, the significant difference in terms of meniscal repair rate in both groups is not a problem, as it does not affect muscle strength after ACL-Rc, as described by Mesnard et al 42 To avoid this strength deficiency in flexion, we could opt for bone–patellar tendon–bone autograft. However, this would expose us to a greater deficit in quadriceps strength and to morbidity at the donor site, which has already been described.…”

Comparison of knee flexor strength recovery between semitendinosus alone versus semitendinosus with gracilis autograft for ACL reconstruction: a systematic review and meta-analysis

“…The varying sample size raise concerns about the risk of bias arising from smaller samples. Confounding factors, such as concomitant meniscal injuries [ 51 ] were not addressed in the statistical analysis which could have affected the investigation of the recovery of knee flexor strength. Lastly, there existed a notable risk of bias in both the non-randomized studies and the randomized controlled trials, contributing to a very low certainty of evidence based on the GRADE assessment.…”

Recommendations for Repair of Three Types of Anterior Cruciate Ligament Injuries with Combined Specific Meniscal Injuries

“…Meniscus repair usually results in further limitation of knee flexion angle and reduced weight-bearing capacity. In addition, meniscus repair surgery has certain trauma, which makes later ACL rehabilitation difficult [9]. From the perspective of joint range of motion, the peak flexion and extension torques were examined six months after ACLR surgery by Wenning et al They found that patients who underwent ACLR surgery and meniscus surgery have no significant differences from those who underwent isolated ACLR.…”

“…Therefore, surgeons should realize that repairing stable ramp lesions is not absolutely necessary and will not affect the speed of the recovery process in clinical practice. Meniscus repair should be used as a standard of care for meniscus lesions accompanying ACLR [9].…”