Failed Meniscal Repairs After Anterior Cruciate Ligament Reconstruction Increases Risk of Revision Surgery

Abstract

Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to reduced quality of life because of recurrent episodes of instability, restrictions in level of activity, and development of osteoarthritis. A profound knowledge of the causes of a failed surgery can ultimately help improve graft survival rates. Purpose: To investigate the patient-related risks of inferior outcomes leading to revision surgery after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: From a prospective cohort of primary ACLRs performed at a single center, patients who required later revision surgery were matched with a control group of uneventful primary ACLRs. Patient characteristics, data from the preoperative examinations, KT-1000 arthrometer laxity testing, Tegner activity scale, International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score, and perioperative data from the initial surgery were included. Results: A total of 100 revision cases and 100 matched controls, with a median follow-up time of 11 years, were included in the study. Those who had undergone revision surgery were younger at the time of reconstruction and had a shorter time from injury to surgery than their matched controls ( P = .006). The control group—of uneventful ACLRs—had a higher incidence of meniscal repair at reconstruction ( P = .024). Also, the revision group more frequently experienced later failure of the previous meniscal repair ( P = .004). Surgeon experience was not found to affect the risk of revision ACL surgery. Those who had undergone ACL revision surgery had more frequently received a hamstring tendon graft size of <8 mm ( P = .018) compared with the controls. Conclusion: The current study demonstrated that failed meniscal repair and a hamstring tendon graft size of <8 mm were associated with primary ACLR failure. Also, younger age at the time of surgery and shorter time from injury to surgery were found to affect the risk of undergoing revision ACL surgery.

Patient-Reported Outcome, Return to Sport, and Revision Rates 7-9 Years After Anterior Cruciate Ligament Reconstruction: Results From a Cohort of 2042 Patients

“…In a recent large study from Kaiser Permanente with 12 years of follow-up, meniscectomy did not influence revision rates. 32 Vindfeld et al 31 conducted a matched case-control study of 100 patients undergoing revision ACL surgery and 100 matched controls who were not revised at 11-year follow-up. Like us, those investigators found that patients who did not undergo revision were more likely to have had a meniscal tear identified during the primary surgery.…”

Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study

“…These results are consistent with our work at 2-year follow-up 20 and are in concordance with published results from primary as well as revision ACL reconstruction cohorts. 13,16 Sullivan et al 13 reported on the predictors of subsequent surgery after primary ACL reconstruction. This cohort consisted of 3276 patients (56.3% male) with a median age of 23 years and a 6-year follow-up rate of 91.5%.…”

“…They found that having a medial meniscal repair at the time of index primary ACL surgery was an independent significant risk factor for incurring subsequent meniscus-related surgery within 6 years. Similarly, Vindfeld et al 16 investigated patient-related risks of inferior outcomes leading to revision surgery after ACL reconstruction. The study included 100 revision cases and 100 matched controls, with a median follow-up of 11 years.…”

Meniscus tears in professional soccer athletes: resect or repair?

“…Menisci have been shown to provide secondary knee joint stability, especially in the setting of ACLR, while it has been suggested that meniscal integrity may be predictive of laxity and ACL graft survivorship following ACLR. [37][38][39][40] Inconclusive results from previous studies regarding the effect of ACLR in meniscal repair success rate, suggest that strong recommendations may be taken into consideration cautiously. However, the highly successful rates of meniscal repairs both in isolated and combined repairs with ACLR, as well as the important role of menisci as a secondary stabilizer, our personal belief is that in professional soccer players meniscal repair combined with ACLR should be performed.…”