Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort

Abstract

Background: Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. Purpose: To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. Study Design: Case-control study; Level of evidence, 3. Methods: All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. Results: In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. Conclusion: Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.

Differences in Postoperative Knee Function Based on Concomitant Treatment of Lateral Meniscal Injury in the Setting of Primary ACL Reconstruction

“…These differences may re ect the clinical importance of protecting the lateral meniscus in the setting of ACLR, as the value of meniscal preservation on long term knee health is widely agreed upon. [42][43][44][45] However, with an absolute difference of less than 2 points between the Symptoms subscale scores between the two groups, it again is uncertain that this difference is associated with any clinically signi cance. Previous studies suggest that irrespective of statistical signi cance, differences of less than 10 between some KOOS subscale scores may not correlate with clinical meaningfulness.…”

Controversies in ACL revision surgery: Italian expert group consensus and state of the art

“…Unfortunately, especially in the setting of chronic ACL lesions, meniscal injuries are often not repairable. Meniscectomy is the most frequently performed procedure according to the literature (45.1% partial meniscectomy; 30.8% meniscal repair; 5.5% meniscal allograft transplant) [ 27 ]. The failure rate for meniscus repair in the revision ACL reconstruction setting at the 2-year follow-up is quite low (< 10%), but significantly higher for medial than lateral tears [ 22 ].…”

Quadriceps tendon autograft is becoming increasingly popular in revision ACL reconstruction

“…Numerous studies have demonstrated the chondroprotective and stabilizing role of the menisci, underscoring their vital role in maintaining normal knee kinematics and function [ 3 , 20 , 40 ]. As a result, meniscal repairs are increasing and high success rates have been reported in the setting of revision ACL-R [ 26 , 43 ]. In one study, 18% of patients undergoing revision ACL-R underwent concurrent meniscal repair, with more than two-thirds of repairs accounting for the medial meniscus and an overall failure rate of meniscal repairs of 9% [ 26 ].…”

“…As a result, meniscal repairs are increasing and high success rates have been reported in the setting of revision ACL-R [ 26 , 43 ]. In one study, 18% of patients undergoing revision ACL-R underwent concurrent meniscal repair, with more than two-thirds of repairs accounting for the medial meniscus and an overall failure rate of meniscal repairs of 9% [ 26 ]. Similarly, in the current study, more medial than lateral meniscal repairs were performed (26% vs. 19%), with a total of 45% of patients undergoing concurrent meniscal repair.…”