High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

Abstract

Background: The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent reoperation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries. Methods: We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus. Results: There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the "successful healing" rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025). Conclusions: There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears. Level of study: Level IV, retrospective case series.

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

“…33,35 One noteworthy point from our study is that the incidence of LMORT was higher than that reported in previous studies, although the incidence of concomitant LM injuries was not high (29.9%) compared with previous studies (24%-52%). 7,17,18,20,24 This can be attributed to the higher proportion of sports injuries (82.2%) and the fact that only patients who underwent ACLR within 6 months of injury were included in our study. Previous studies have reported that most patients with ACLR with LMPRT sustained the injury during pivot-contact sports activity.…”

Meniscal repair: The current state and recent advances in augmentation

“…In both adult and juvenile patients, tears are predominantly located in the posterior region (67.0%–90.6%) but can also span multiple regions (20.3%–40.2%) (Figure 2B). Specifically, shown in adults, the medial meniscus is more likely to exhibit posterior tears (93.1%–97.7%) than the lateral meniscus (34.5%–80.7%) 38‐40 . Along the radial axis, more than half of tears span multiple zones (red‐red, red‐white, white‐white).…”

“…(A) Rates for affected meniscus (medial, lateral, or both) in adult (including adults with ACL reconstruction (+ACLR) and Athletes) and pediatric populations. Data from Jackson et al (2019), Robinson et al (2011), El Mansori et al (2018), Kim et al (2019), Ridley et al (2017), Christino et al (2019), Baker et al (1985), Terzidis et al (2006) 35‐42 . (B) Rates by region (anterior, body, posterior, multiple) in adult (including +ACLR and Athlete) and pediatric populations.…”

“…(B) Rates by region (anterior, body, posterior, multiple) in adult (including +ACLR and Athlete) and pediatric populations. Data from Jackson et al (2019), El Mansori et al (2018), Kim et al (2019), Terzidis et al (2006) 35,38‐40 . (C) Rates by vascular zone (outer = red‐red, intermediate = red‐white, inner = white‐white, multiple) in the medial and lateral menisci in adult populations.…”

Treatment Trends in Meniscal Pathology in the Setting of Concomitant ACL Injuries in Pediatric and Young Adult Patients: An Insurance Database Study

“…24 Although meniscal repair has demonstrated satisfactory long-term outcomes in the general 22 and pediatric 29 populations, performing meniscal repair at the time of ACL reconstruction may increase rates of arthrofibrosis 1 or require reoperation for recurrent tears or inadequate healing. 14 This disadvantage must be weighed against the potential long-term advantages of a healed meniscal repair. Although previous work has shown increasing rates of meniscal repair in pediatric and adolescent patients treated by surgeons during their board collection period, 4 the generalizability of this finding is unclear.…”