Influence of Meniscal Repair vs. Meniscectomy on Anterior Cruciate Ligament Reconstruction in Terms of Knee Stability and Radiological Imaging

Abstract

The menisci are essential components in the pathophysiology of knee osteoarthritis. Patients with meniscal lesions and an intact anterior cruciate ligament (ACL) undergoing meniscectomy exhibit a significantly increased prevalence of radiographic osteoarthritis. ACL reconstruction surgery enhances knee stability and mitigates the advancement of minor meniscal tears. The purpose of this study was to show the influence of meniscal repair as compared to meniscectomy on anterior cruciate ligament reconstruction in terms of knee stability and radiological imaging. This was a retrospective study performed in Dr. D.Y. Patil Hospital, Pimpri, Pune, on a sample size of 30 patients between December 2021 and January 2023. Patients were followed up clinically and radiologically post-operatively at six months and one year. ACL reconstruction with meniscectomy was performed on 16 patients (group 2), while ACL reconstruction with meniscus repair was performed on 14 patients (group 1). At the end of six months in group 1, one patient out of 14 had a grade 2 Lachman test positive, while seven patients out of 16 had a grade 2 Lachman test positive in group 2. It was a statistically insignificant value (p>0.05). Further, at the end of 12 months, X-ray evaluation of the femoral tunnel shows an average increment of 0.5 mm in Group 1, while an average femoral tunnel widening of 3 mm was observed in Group 2. It was statistically insignificant (p>0.05). The study concluded that meniscus repair significantly increases anteromedial knee stability. It has been shown that meniscectomy, when done along with ACL reconstruction, increases the chances of femoral tunnel widening, resulting in less graft bone integration.

Medial meniscal lesions increase antero‐posterior laxity in knees with anterior cruciate ligament injury

“…Meniscal lesions should therefore be carefully considered when performing ACL reconstruction surgery to restore knee stability [29][30][31][32]. In fact, while meniscectomy can increase the femoro-tibial contact stress and anterior tibial translation in ACL-deficient knees, meniscal repair showed to increase anteromedial knee laxity [8,33]. In this scenario, it is paramount to understand the role that menisci play in knee biomechanics and how meniscal lesions can affect knee laxity, as their contribution to knee stability could influence the results of ACL surgery.…”

“…There is a significant variability in their execution and interpretation, and they do not permit to quantify objectively a torn-ACL knee laxity [6,7]. Moreover, they do not allow a precise evaluation of the contribution that concomitant intra-articular lesions can have on knee laxity [8].…”