The Fate of Meniscus Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction

Abstract

Background The management of meniscus tears identified at the time of primary ACL reconstruction is highly variable and includes repair, meniscectomy, and non-treatment. Hypothesis/Purpose The purpose of this study is to determine the reoperation rate for meniscus tears left untreated at the time of ACL reconstruction with minimum follow-up of 6 years. We hypothesize that small, peripheral tears identified at the time of ACL reconstruction managed with “no treatment” will have successful clinical outcomes. Study Design Retrospective study of a prospective cohort; Level of Evidence, 3 Methods Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group with minimum 6-year follow-up. Patient, tear, and reoperation data were obtained for analysis. Need for reoperation was used as the primary endpoint, with analysis performed to determine patient and tear characteristics associated with reoperation. Results There were 194 patients with 208 meniscus tears (71 medial; 137 lateral) left in situ without treatment with complete follow-up for analysis. Of these, 97.8% of lateral and 94.4% of medial untreated tears required no reoperation. Sixteen tears (7.7%) left in situ without treatment underwent subsequent reoperation: 9 tears (4.3%) underwent reoperation in the setting of revision ACL reconstruction and 7 tears (3.4%) underwent reoperation for isolated meniscus pathology. Patient age was significantly lower in patients requiring reoperation, while tears measuring ≥ 10 mm more frequently required reoperation. Conclusions Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at minimum 6-year follow-up for 97.8% and 94.4% of tears, respectively. These findings reemphasize the low reoperation rate following non-treatment of small, peripheral lateral meniscus tears while noting less predictable results for medial meniscus tears left without treatment.

During ACL reconstruction, small asymptomatic meniscal lesions can be left untreated: a systematic review

“…Duchman et al 13 recently reported a trend towards more reoperations in medial compartment tears as compared with lateral compartment tears left untreated (12.7% vs 5.1%, respectively; p=0.052).…”

“…In general, lateral tears were more frequently left untreated as compared with tears left untreated in the medial compartment13 (table 1). …”

“…In the MOON cohort study, Duchman et al 13 reported that tears measuring more than 10 mm underwent reoperation more frequently than tears measuring 10 mm or less (11.5% vs 3.2%, respectively; p=0.035). This relationship was not seen when excluding tears treated in the setting of concomitant revision ACL reconstruction.…”

Clinical and radiographic outcomes of meniscus surgery and future targets for biologic intervention: A review of data from the MOON Group

“…The influence the meniscal injury and treatment has on patient-reported and radiographic outcomes in the MOON cohort have been published in the literature. 9, 10, 17, 38 …”

“…Patients who had undergone meniscus surgery at the time of the ACL reconstruction have been evaluated by several metrics 9, 10, 34, 38 .…”