Summary

The rate of meniscal repair can be significantly increased when carried out with acute ACL repair, in comparison to delayed ACL reconstruction

Abstract

Rupture of the anterior cruciate ligament (ACL) often occurs in conjunction with meniscal tears. In this study we investigate the rates and outcomes of meniscal repair surgery performed with ACL reconstruction compared with acute ACL repair surgery.

Data was collected for all patients undergoing surgery for ACL rupture between 2011 and 2018, including ACL reconstruction with hamstring autograft and primary ACL repair augmented with suture tape. Meniscal injury was evaluated intra-operatively and the treatment determined by type of tear, reducibility, and quality of meniscal tissue. If possible, tears were repaired using all-inside anchors and all others were resected. Information recorded were demographics, Tegner activity score, interval between injury and surgery, the nature of any meniscal surgery, and any related complications up to the time of the study.

A total of 410 patients were included, with 4 lost to follow-up leaving 272 (67%) ACL reconstructions and 134 (33%) ACL repairs. The mean age was 28 (±9) and 35 (±14) years respectively (p<0.01). There were more males in the reconstruction group (82% v 56%, p<0.01), while mean Tegner activity score was 6.6 in both groups. The mean interval from injury to surgery was longer in the reconstruction group (26.2 v 1.3 months, p<0.01) while mean follow up time was 5 years for both groups. In total, 208 (51%) patients required meniscal surgery at the time of their ACL procedure, 55% of reconstructions and 43% of ACL repairs. In the reconstruction group 123 (70%) were meniscectomies and 53 (30%) were meniscal repairs compared to 31 (50%) of each in the ACL repair group. Meniscal repair was more likely to be possible when carried out as part of acute ACL repair surgery, ?2(1, n=238)=7.94, p<0.01. There was an inverse correlation between repairability of meniscus and time interval from injury to surgery (rs=-0.27, p<0.01). The success rate of meniscal repair (97%) was not different between groups and not influenced by time interval.

The rate of meniscal repair is 67% higher when the surgery was performed early in conjunction with ACL repair. When ACL reconstruction is performed, meniscal resection was more likely. Rates of post-traumatic osteoarthritis are high after ACL reconstruction and meniscal resection is associated with a further increase. Therefore, retention of meniscal tissue by repair should be encouraged whenever possible. In fact, when carried out with ACL surgery, the success rate of meniscal repair is high, as evidenced with a success rate of 97%. The main difference between the ACL groups was the time from injury to surgery. Over time, torn meniscal tissue deteriorates and longer time with an unstable knee may account for higher rate of meniscal injury in the reconstruction group. Therefore, early intervention should be encouraged, but is often not possible due to waiting times, or attempting conservative rehabilitation. In conclusion, the rate of meniscal repair can be significantly increased when carried out with acute ACL repair, in comparison to delayed ACL reconstruction. Higher rates of meniscal retention as well as retained native ACL tissue may reduce the risk of osteoarthritis.