Summary

Meniscal repairs performed at the time of allograft ACL reconstruction are more likely to fail than those performed with bone-patellar tendon-bone autograft ACL reconstruction.

Abstract

Background

Meniscal repair is commonly performed at the time of anterior cruciate ligament (ACL) reconstruction. However, the effect of ACL graft type on meniscal repair outcomes is unknown. The purpose of this study was to determine if ACL graft type influences the outcome of meniscal repairs performed at the time of ACL reconstruction. We hypothesize that meniscal repairs fail at the lowest rate when concomitant ACL reconstruction is performed with bone-patellar tendon-bone (BTB) autograft.

Methods

Patients who underwent meniscal repair at the time of primary ACL reconstruction and had a minimum of 6-year follow-up data were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus repaired at index surgery, were identified. After identifying patients with a subsequent meniscal surgery, operative notes were reviewed to accurately classify pathology and treatment of meniscus re-injuries. A logistic regression model was built to assess the association of ACL graft type, patient-specific factors (age, sex, and body mass index [BMI]), baseline Marx activity rating score, and meniscal repair location (medial or lateral) with the occurrence of repair failure at 6-year follow-up. Statistically significant results were determined by 95% confidence intervals that did not include the null value (1).

Results

A total of 646 patients were included. (BTB and soft tissue (ST) autografts were used in 55.7% and 33.9% of cases, respectively. Various allografts were utilized in the remaining cases (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. The odds of meniscal repair failure within 6 years of index surgery for the BTB autograft group were 2.34 times that of the allograft group (95% CI: 1.1 – 4.9; P = 0.02). The odds of failure were 68% higher with medial versus lateral repairs (95% CI: 0.41 – 0.83; P < 0.001). There was a statistically significant, nonlinear relationship between baseline Marx activity level and the risk of meniscal repair failure—patients with low or high baseline activity were at the highest risk (odds ratio [OR]: 1.17; 95% CI: 1.05 – 1.31; p=0.004). No significant differences in meniscal repair failure rate were observed based on patient age (OR: 0.87; 95% CI: 0.6 – 1.3; P = 0.48), sex (OR: 0.91; 95% CI: 0.6 – 1.5; P = 0.69) or BMI (OR: 0.80; 95% CI: 0.6 – 1.1; P = 0.13).

Conclusion

Meniscal repairs performed at the time of ACL reconstruction with allograft are 2.3 times more likely to fail than those performed with BTB autograft. Medial repairs fail at a significantly higher rate than lateral repairs. Patients with low or high baseline activity levels are also at an increased risk.