Recent Trends in Concomitant Meniscal Procedures During Anterior Cruciate Ligament Reconstruction

Abstract

Background: The chondroprotective effect and secondary stabilizing role of the meniscus has been well-established. Meniscal preservation during anterior cruciate ligament reconstruction (ACLR) has been advocated in the literature and supported by advancements in surgical techniques. Purpose: To examine the recent trends in concomitant partial meniscectomy and meniscal repair procedures with ACLR. Study Design: Descriptive epidemiological study. Methods: Patients who underwent arthroscopic meniscectomy (Current Procedural Terminology [CPT] codes 29880, 29881), meniscal repair (CPT codes 29882, 29883), and ACLR (CPT code 29888) between 2010 and 2018 were identified using the National Surgical Quality Improvement Program database. We calculated the proportion of patients who underwent each surgery type, stratified by year and by patient age and body mass index (BMI) groups. The Cochran-Armitage test for trend was used to analyze yearly proportions of concomitant meniscal surgery types. Results: During the 9-year study period, 22,760 patients underwent either isolated ACLR (n = 10,562) or ACLR with concomitant meniscal surgery (either meniscectomy [n = 8931] or meniscal repair [n = 3267]). There was a gradual decrease in the proportion of meniscectomies (from 80.8% of concomitant procedures in 2010 to 63.8% in 2018), while the proportion of meniscal repairs almost doubled (from 19.2% in 2010 to 36.2% in 2018) (trend, P < .001). ACLR with meniscal repair increased in patients aged 35 to 44 years and 45 to 54 years (trend, P = .027) between 2010 and 2018; at the same time, the proportion of normal weight patients decreased by 17.7%, the proportion of overweight patients increased by 13.2%, and increases were seen in BMI groups corresponding to obesity classes 1 to 3 (trend, P < .001). In 2010, the average BMI of patients undergoing ACLR with meniscectomy versus meniscal repair differed by 2 ( P = .004), but by 2018 the difference was nonsignificant (28.83 ± 5.80 vs 28.53 ± 5.73; P = .113). Conclusion: Between 2010 and 2018, there was an upward trend in the proportion of meniscal repairs performed during ACLR, with notable increases in the proportion of repairs being performed on older, overweight, and obese patients.

The Relationship Between the Timing of Knee Osteoarthritis Diagnoses and Arthroscopic Partial Meniscectomy

“…Patients who had an OA diagnosis 12 months before APM, at the time of their APM, 3 months after APM, 6 months after APM, 12 months after APM, and more than 12 months after APM were identified using ICD diagnostic codes S83.2x, M23.x, and M25.50x. [17][18][19] Matched laterality for OA diagnosis and APM was confirmed.…”

Anterior cruciate ligament reconstruction and concomitant procedures in Finland between 2004 and 2018 based on national registers

“…Based on data from an insurance company, 50% of the ACLR patients in 2014 received a concomitant meniscal procedure, including both meniscectomies and repairs (12). Further, according to US registry data from 2010 to 2018, 54% of all patients having an ACLR had a concomitant meniscal procedure, of which 73% were meniscectomies and 27% repairs (18). In these studies, concomitant collateral ligament repair was performed in 0.7-1.1% of the ACLRs.…”

“…The incidence of meniscal tears on magnetic resonance imaging is between 43% and 70%, and bone marrow lesions are even more common (16,17). Based on population data from the USA, as many as 53% of patients undergoing ACLR had a concomitant meniscal procedure (9,12,18). Concomitant collateral ligament or posterior cruciate ligament (PCL) injuries and reconstructions are rare (12).…”

Germany has a high demand in meniscal allograft transplantation but is subject to health economic and legal challenges: a survey of the German Knee Society

“…Persistent tibiofemoral overload causes degeneration of the articular cartilage, joint pain, loss of function, and ultimately early onset knee OA [ 11 ]. To mitigate such socioeconomic consequences for health care systems, meniscus- and joint-preserving treatment strategies have become increasingly important [ 14 , 15 ]. For partial meniscus deficiency, artificial, scaffold-based meniscal substitutes have been proposed [ 25 ].…”