The effect of meniscal pathology and management with ACL reconstruction on patient-reported outcomes, strength, and jump performance ten months post-surgery

Byrne, Laura; King, Enda; Fadden, Ciaran Mc; Jackson, Mark; Moran, Ray; Daniels, Katherine

doi:10.1016/j.knee.2021.07.005

Cited by 9 publications

(6 citation statements)

References 52 publications

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“…Few previous studies demonstrated that concurrent ACLR may have beneicial efect on meniscal repair outcomes as well [42,48,49]. On the contrary, more recent studies have shown no signiicant diference between isolated and combined with ACLR repairs [10,12,44,50]. Similarly, no diferences were found in this study, between combined ACL reconstruction and meniscal repair, and isolated meniscal repair regarding failure rate.…”

Section: Discussioncontrasting

confidence: 77%

Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk

Kalifis

Raoulis

Panteliadou

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeOutcomes after repair of bucket‐handle meniscal tears tend to be satisfying in the short‐term follow‐up. However, the literature is scarce regarding long‐term data following repair of bucket‐handle meniscal tears. The aim of this study was to assess long‐term follow‐up outcomes, focusing on knee osteoarthritis (OA) development and failure rate, and determine risk factors associated with failure. MethodsThis is a retrospective cohort study, including all patients with bucket‐handle tears within 4 mm of the menisco‐synovial junction, who underwent meniscal repair, either isolated or combined with anterior cruciate ligament reconstruction (ACLR) between 2004 and 2015. A combination of all‐inside, outside‐in, and inside‐out repair technique was used in all patients. Patients over 40 years old, concomitant multi‐ligamentous injuries, and severe cartilage lesions documented intraoperatively were excluded. During the follow‐up, a meniscus was considered healed using Barrett’s criteria, while knee OA evaluation was performed according to Kellgren–Lawrence (KL) classification using standing knee radiographs. Patients were assessed preoperatively as well as postoperatively in terms of knee function using International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). ResultsIn total, the inclusion criteria were met by 66 patients. Median age at the time of operation was 21.9 years (13–39). Median follow‐up was 114 (62–176) months. Total failure rate was approximately 33% at median time of 19 (6–39) months. Osteoarthritis was statistically significantly more prevalent in patients with failed repairs (mean KL score: 2.09) in comparison to patients with successful repairs (mean KL score: 0.54) p = 0.001. In addition, successful repairs were associated with higher KOOS score as compared with failed repairs (mean ± SD, 89.6 ± 4.6 vs 77.8 ± 4.9 p < 0.001), higher IKDC score (mean ± SD, 88.2 ± 5.1 vs 79.2 ± 5.2 p < 0.001), and Lysholm score (mean ± SD, 90.3 ± 5.3 vs 78.4 ± 7.8 p < 0.001). Patients with medial meniscus repair had 4.8 higher relative likelihood of failure compared to lateral meniscus [p = 0. 014, OR = 4.8 (95% Cl 1.2, 18.6)]. Patients over 16 years old had 5.7 higher relative likelihood of failure [p = 0. 016, OR = 5.7 (95% Cl 0.04, 0.85)]. Concurrent ACLR did not have a significant effect on the postoperative outcomes. ConclusionA high rate of clinical failure was observed after meniscal repair of bucket‐handle tears. However, successful treatment led to lower rates of knee OA development and better knee function, approximately 10 years postoperatively. Meniscal repair of bucket‐handle tears is recommended to improve knee function and prevent knee OA in young patients. Level of evidenceIII.

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Section: Discussioncontrasting

confidence: 77%

Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk

Kalifis

Raoulis

Panteliadou

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…However, in the present cohort, typical concomitant injuries, if appreciated and if indicated repaired, did not seem to be associated with inferior PROMs. Similar, Byrne et al have shown that concomitant meniscal surgery had no significant effect on postoperative PROMs as well as strength or patients’ jump metrics following ACL reconstruction [4]. Contrary, Balasingam et al have shown from the Swedish national ACL register that following ACL reconstruction concomitant intraarticular lesions lead to a deterioration in long‐term PROMs [2].…”

Section: Discussionmentioning

confidence: 99%

Promising functional outcomes following anterior cruciate ligament repair with suture augmentation

Schneider

Ahlbäumer²,

Gosheger

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose There has been a renewed interest in the repair of the torn anterior cruciate ligament (ACL). Purpose of this study was to evaluate the functional outcome of arthroscopic ACL repair with additional suture augmentation (SA), hypothesizing that isolated ACL ruptures would yield superior patient-reported outcome measures (PROMs) compared to those with concomitant meniscal and/or ligamentous injuries. Methods This is a retrospective analysis of 93 consecutive patients (67 female, median age 42 years) who underwent arthroscopic ACL repair with SA between January 2017 and March 2019 for an acute traumatic ACL tear conirmed by magnetic resonance imaging (MRI). Patients with pre-or intraoperative mid-substance or distal ACL tears and/or poor tissue quality of the ACL remnant were not considered for ACL repair but were scheduled for an ACL reconstruction with a tendon autograft. In patients who underwent ACL repair with SA, the SA construct was proximally stabilized with a lip-button and distally with a suture anchor. Surgery was preferably performed on the day of injury and all surgeries were performed by the same surgeon. Postoperative rehabilitation included partial weight-bearing (20 kg) for 6 weeks and immobilization in a brace limited at 90-degrees of knee lexion for 4 weeks. Patient-reported outcome measures (PROMs) were determined using International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm Score (LS), Tegner Activity Score (TS) and Forgotten Joint Score (FJS). Knee-laxity was assessed using the KT-1000 arthrometer (Med Metrics Corp. Inc., San Diego, USA). Results Nine patients underwent revision surgery for a traumatic re-tear (four patients) and chronic instability (ive patients) and were excluded from further functional analysis. Functional results of 77 patients (54 female) with a median age of 44 years (IQR 33-51) on the day of surgery were available for follow-up after a median time of 35 months (IQR 33-44). Concomitant injuries were observed in 66 Patients (86%), meniscal injuries in 43 patients (55%) and ligamentous injuries in 50 patients (65%). Median interval from injury to surgery was 1 day (IQR 0-1) with 81% (62/77) of patients being treated within 24 h of injury. The median IKDC was 92 (IQR 86-99), the median LS was 95 (IQR 86-100), the median pre-traumatic TS was 7 (IQR 6-7), the median post-traumatic TS was 6 (IQR 5-7) with a non-signiicant median diference (TS Dif ) of 0 (IQR 0-1). The median FJS was 95 . KT-1000 measurements were available in 34 of 77 patients with a median postoperative laxity compared to the uninjured side of 1 mm (IQR 0-2). Interval from injury to surgery, patients' age, body mass index (BMI), knee laxity and concomitant ligamentous or meniscal injuries had no statistically signiicant impact on postoperative PROMs (n.s.). Conclusion Following arthroscopic ACL repair with SA good-to-excellent functional results were observed. However, a failure rate of 10% cannot be neglected and warrants further attention. Concomitant injuries to the...

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“… 1 , 14 It has been reported that performing meniscal surgery together with ACLR does not have a significantly negative effect on postoperative clinical and functional outcomes. 5 It has also been reported that cartilage-related surgeries performed together with ACLR do not have a significant effect on postoperative clinical and functional outcomes, but a lesion size >2 cm 2 may lead to unsatisfactory results. 18 In our study, there was no significant difference among the soft tissue interposition groups or the cortical button migration groups in terms of meniscal and cartilage pathologies.…”

Section: Discussionmentioning

confidence: 99%

Effect of Soft Tissue Interposition and Postoperative Suspensory Cortical Button Migration on Functional Outcomes and Ligamentization After Single-Bundle ACL Reconstruction

Özbek

Kocaoğlu

Karaca

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity. Results: There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores ( P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M). Conclusion: Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR.

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The effect of meniscal pathology and management with ACL reconstruction on patient-reported outcomes, strength, and jump performance ten months post-surgery

Cited by 9 publications

References 52 publications

Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk

Long-term follow-up of bucket-handle meniscal repairs: chondroprotective effect outweighs high failure risk

Promising functional outcomes following anterior cruciate ligament repair with suture augmentation

Effect of Soft Tissue Interposition and Postoperative Suspensory Cortical Button Migration on Functional Outcomes and Ligamentization After Single-Bundle ACL Reconstruction

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