Summary

: Combined ACLR and LMPRR resulted in similar patient reported outcomes compared to isolated ACLR without lateral meniscus surgery at early follow-up.

Abstract

Introduction

Meniscal injuries are commonly encountered during anterior cruciate ligament reconstruction (ACLR). A lateral meniscal posterior root tear (LMPRT) is characterized by a tear within 1 cm of the insertion of the posterior root on the tibia, or an avulsion of the root itself. A meniscal root injury leads to loss of the hoop stress distribution capacity of the lateral meniscus, effectively rendering the meniscus non-functional. There has been an increased focus on identifying and repairing LMPRTs by bony reattachment of the root to its native footprint on the tibia. The purpose of this study is to evaluate the clinical outcomes after combined ACLR and lateral meniscus posterior root repair (LMPRR) using modern techniques at a high-volume center and compare them to a matched cohort of patients undergoing ACLR with no lateral meniscal surgery at 2-year follow-up.

Methods

All patients who underwent combined ACLR and LMPRR between January 2018 and February 2020 were identified in a single institution registry and matched to a control group of patients who underwent isolated ACLR on the basis of age and sex. All ACLR patients received autograft consisting of either bone-patellar tendon-bone, quadriceps tendon, or hamstring tendon. Patients with a history of revision ACLR, lateral extra-articular augmentation procedure, concomitant ligament reconstruction, knee osteotomy, and knee cartilage surgery were excluded. Patients were contacted at a minimum of 24-months post-operatively to evaluate patient reported outcomes, including IKDC score, Marx Activity Rating Scale, SANE score, rate of return to sport, level of sports participation, rate of reinjury, and psychological readiness for return to sport. Psychological readiness was determined using a six-item questionnaire adapted from the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale.

Results

Ten patients who underwent combined ACLR and LMPRR (6 male, 4 female) with a mean age of 21.9 years (range 15 to 36) were compared to 60 isolated ACLR patients with a mean age of 23.3 years (range 14 to 42) at a minimum 2-year follow-up. There were no statistically significant differences in post-operative IKDC (P=0.99), Marx (P=0.23), or SANE (P=0.18) scores between groups. Compared to pre-operatively, post-operative IKDC, Marx, and SANE scores improved significantly for both combined ACLR and LMPRR and isolated ACLR patients (P<0.01). There were 80% of combined ACLR and LMPRR patients versus 73% of isolated ACLR patients who returned to sports participation (P=0.99) and no significant differences in the number of patients reporting participation at the same level of competition or higher between groups (P=0.39). There were no significant differences in mean ACL-RSI scale scores between combined ALCR and LMPRR (76.5 ± 22.5) and isolated ACLR (67.6 ± 25.8) patients (P=0.37) or confidence in ability to play sports between combined ACLR and LMPRR (89.4 ± 10.6) and isolated ACLR (81.7 ± 22.8) (P=0.45). No LMPRR patients underwent subsequent meniscus surgery.

Discussion And Conclusion

Combined ACLR and LMPRR resulted in similar patient reported outcomes compared to isolated ACLR without lateral meniscus surgery at early follow-up. Return to sport rates were high and patients returned to similar levels of competition compared to before injury in both groups. Psychological readiness for play was similar between groups and no differences were identified in confidence in ability to play sports. These results suggest comparable functional outcomes between combined ACLR and LMPRR and isolated ACLR patients without lateral meniscal root repair at early-term follow-up.