Summary

While ACLR graft choice does not appear to influence the rate of meniscal repair failures, this study demonstrated that hamstring autografts may result in higher PROMs.

Abstract

Objective

Meniscal tears are one of the most common orthopedic injuries, often occurring simultaneously with an anterior cruciate ligament tear. Despite the clinical importance of preserving the meniscus, repair failure rates are significant, especially in the context of a concomitant anterior cruciate ligament reconstruction (ACLR). Few have investigated ACLR graft choice as a risk factor for meniscal repair failure rates. The purpose of this study is to evaluate the relationship between anterior cruciate ligament reconstruction (ACLR) graft choice and meniscal repair outcomes during concomitant ACLR and meniscal repairs.

Methods

A retrospective chart review identified patients who underwent concomitant ACLR and meniscal repair during the study period. Patients who received any allograft or hamstring autograft during the ACLR and with a minimum of 1 year follow up were included. Data collection included patient demographics, meniscus repair failure, time to failure, and patient-reported outcome measures (PROMs), which consisted of Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Marx Activity. Repair failure was defined as the need for a revision repair or meniscectomy. Patients were grouped by the type of ACL graft used, either allograft or hamstring autografts. T-test and chi-square test of independence were used to compare numerical and categorical data, respectively. Kaplan Meier survival analysis was used to compare time to failure between groups.

Results

Of the 677 meniscus repairs performed, 241 patients (142 males and 99 females) with average follow up of 4.9 years met the inclusion criteria. Overall, patients had an average age of 30.5 years and an average BMI of 28.7 kg/m2. Patients who received any allograft were older (35.2 vs 25.9 years, p < 0.001) and had a higher BMI (30.3 vs 27.0, p=0.006) compared to those who received a hamstring autograft. Meniscus repair failure occurred in 61 patients (25.3%). There were no significant differences in meniscus repair failure rates (16.7% vs. 27.1%, p=0.22) or time to failure (1.6 years vs. 2.5 years, p=0.19) between those who received an allograft and a hamstring autograft, respectively. Other than Marx Activity scores (4.7 vs 7.8, p=0.007), there were no significant differences among PROMs between allografts and autografts. However, except for KOOS Pain (85.8 vs. 88.8), allograft patients reported worse outcomes compared to hamstring autograft patients (KOOS Symptoms: 83.4 vs. 82.6; KOOS ADL: 88.0 vs. 19.0; KOOS Sport: 68.8 vs. 76.8; KOOS QOL: 61.0 vs. 67.2; IKDC: 73.3 vs. 79.6). It should be noted that 22 allograft patients and 87 hamstring autograft patients did not report PROMs.

Conclusions

ACLR graft choice does not appear to influence the rate of meniscal repair failures. However, this study demonstrated that hamstring autografts may result in higher PROMs. The relationship between ACLR graft choice and meniscus repair failure is complex and requires further research.