Meniscal Tearing after ACL Reconstruction

Ichinohe, Sadato; Yoshida, Masahiro; Murakami, Hideki; Takayama, Hiroyuki; Izumiyama, S; Shimamura, Tadashi

doi:10.1177/230949900000800110

Cited by 9 publications

(10 citation statements)

References 9 publications

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“…The reasons for excluding articles from meta-analysis were clinical diagnosis of meniscal tear only (10 studies35 50–58 and 1 additional study arm24), other ACL surgery than ACL reconstruction (4 studies)59–62 or both (2 studies) 63 64. We excluded studies if there was an unknown number of patients with new meniscal injuries (four studies) 65–68. We made a post hoc decision to exclude one study of patients with partial ACL tears 69…”

Section: Resultsmentioning

confidence: 99%

Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury

et al. 2020

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ObjectiveTo investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction.DesignPrognosis systematic review (PROSPERO registration number CRD42016036788).MethodsWe searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology.ResultsOf 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%–21% when follow-up was <2 years, 0%–29% when follow-up was 2 to 5 years, 5%–52% when follow-up was 5 to 10 years and 4%–31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low.ConclusionNew meniscal tears occurred in 0%–52% of patients between 4 months and 20 years (mean 4.9±4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.

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Section: Resultsmentioning

confidence: 99%

Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury

et al. 2020

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“…Moreover, if the follow-up duration after surgery is limited, the follow-up times are different between the early and delayed groups, and some of the patients undergoing early ACLR might develop meniscal lesions after this follow-up, which was also shown in the literature. 7 , 25 , 30 , 41 …”

Section: Discussionmentioning

confidence: 99%

Does Anterior Cruciate Ligament Reconstruction Protect the Meniscus and Its Repair? A Systematic Review

Korpershoek

Windt

Vonk

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament (ACL) tear and meniscal injury often co-occur. The protective effect of early ACL reconstruction (ACLR) on meniscal injury and its repair is not clear. Critical literature review can support or change clinical strategies and identify gaps in the available evidence. Purpose: To assess the protective effect of ACLR on the meniscus and provide clinical guidelines for managing ACL tears and subsequent meniscal injury. We aimed to answer the following questions: (1) Does ACLR protect the meniscus from subsequent injury? (2) Does early ACLR reduce secondary meniscal injury compared with delayed ACLR? (3) Does ACLR protect the repaired meniscus? Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed through use of MEDLINE and Embase electronic databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included ACL, reconstruction, and meniscus. Studies describing primary ACLR and nonoperative treatment in adult patients were included, as well as studies indicating timing of ACLR. The included articles were assessed individually for risk of bias through use of the modified Cochrane Risk of Bias and MINORS (Methodological Index for Nonrandomized Studies) tools. Results: One level 2 randomized controlled trial and several level 3 and 4 studies indicated a protective effect of ACLR on meniscal injury compared with nonoperative treatment. There was weak (level 3) evidence of the protective effect of early ACLR on the meniscus. Meniscal repair failure was less frequent in patients with ACL reconstruction than in patients with ACL deficiency (level 4). Conclusion: The evidence collected in this review suggests a protective effect of ACLR for subsequent meniscal injury (level 2 evidence). ACLR should be performed within 3 months of injury (level 3 evidence). Meniscal injury requiring surgical repair in the ACL-deficient knee should be treated with repair accompanied by ACLR (level 3 evidence). The paucity of level 2 studies prevents the formation of guidelines based on level 1 evidence. There is a strong clinical need for randomized or prospective trials to provide guidelines on timing of ACLR and meniscal repair.

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“…A few studies have evaluated subsequent meniscal injuries and surgery after ACL reconstruction. 4-6,11,14 A small case series by Ichinohe et al 11 evaluated subsequent meniscal tears in the same knee after ACL reconstruction with second-look arthroscopic surgery in 72 patients. At the initial surgery, 40 medial menisci and 31 lateral menisci demonstrated no tears.…”

Section: Discussionmentioning

confidence: 99%

The Incidence of Subsequent Meniscal Surgery Is Higher in the Anterior Cruciate Ligament–Reconstructed Knee Than in the Contralateral Knee

Davis¹,

Chen

Inacio

et al. 2017

Am J Sports Med

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After ACL reconstruction, the overall risk of subsequent meniscal surgery was low. However, the relative risk of subsequent meniscal surgery in the ACL-reconstructed knee was higher compared with the contralateral knee. Only graft type was found to be a risk factor for subsequent meniscal surgery in the ACL-reconstructed knee, with a higher risk for allografts and hamstring autografts compared with BPTB autografts.

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Meniscal Tearing after ACL Reconstruction

Cited by 9 publications

References 9 publications

Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury

Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury

Does Anterior Cruciate Ligament Reconstruction Protect the Meniscus and Its Repair? A Systematic Review

The Incidence of Subsequent Meniscal Surgery Is Higher in the Anterior Cruciate Ligament–Reconstructed Knee Than in the Contralateral Knee

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