Summary

This single-operator retrospective study on 234 patients operated for isolated ACL reconstruction with a mean follow-up of 9.5 years found that the presence of meniscal lesions during the initial surgery is the main determining factor in the occurrence of secondary meniscal lesions and should involve prolonged follow-up beyond 24 months, particularly after patellar tendon autograft reconstruction.

Abstract

Introduction

ACL reconstruction surgery is a frequent intervention and its functional result is largely linked to the meniscal status, which is the only guarantee of the preservation of the cartilage capital. Most of the studies focusing on the predictive risk factors of failure of the various meniscal treatments during this surgery are multicenter studies with short-term follow-up. The objective of this study is to describe the factors influencing the occurrence of secondary meniscal lesions after isolated ACL reconstruction using three different techniques with a minimum 5 years follow-up.

Material And Methods

This is a single-operator retrospective study of all consecutive patients who underwent isolated ACL reconstruction surgery between 2000 and 2012 according to their clinical and sports preoperative status, intraoperative data and follow-up at 24 months. Three different plasties were performed with patellar tendon autograft (n=67), hamstring double bundle graft (n=115) and hamstring double bundle graft (n=52).

Results

Of the 811 patients included who could be followed up to 24 months, 234 were able to achieve a complete follow-up at least 5 years after the surgery on their meniscal status. All three groups of different ACL reconstructions were comparable to each other (p>0,05). At surgery, 49% of patients had no meniscal lesions and there was 35% of medial meniscus lesions, 9% lateral meniscus lesions and 7% bimeniscal lesions. A suture of the meniscal lesion was performed in 66% of the case, for a lower rate of abstention (21%) and partial menisectomy (13%). At the mean follow-up of 9.5 +/- 3.5 years, 75% of the patients had not presented secondary lesions for 20% lesions of the medial meniscus, 4% of the lateral meniscus and 1% of bimeniscal lesions. The occurrence of secondary meniscal lesion was correlated with the type of meniscal lesion at ACL surgery (p=0.0002) and its treatment (p=0.0003). A decrease in sports activities at 24 months was also correlated with their occurrence (p= 0.0002). These lesions were later after patellar tendon autograft reconstruction (p=0.01).

Conclusion

The presence of meniscal lesions during the initial management of isolated ACL tears is the main determining factor in the occurrence of secondary meniscal lesions and should involve prolonged follow-up of these patients beyond 24 months, particularly after patellar tendon autograft reconstruction. A decrease in sporting activities during follow-up should encourage the search for secondary meniscal lesions and a prolonged follow-up.