Summary

ACLR concomitant to MR has statistically significantly poorer PROMs compared to isolated ACLR at 2 years postoperatively, these differences are not clinically significant as measured by MCID, suggesting similar clinical outcomes for both groups.

Abstract

Introduction

Anterior cruciate ligament injuries commonly present with concomitant menisci tears potentially requiring a meniscus repair.

Methods

The study included 205 cases of isolated ACL reconstruction (i-ACLR) and 85 cases of ACLR with concomitant meniscal repair (ACLR+MR). Patient-reported outcome measures (PROMs) were assessed pre-operatively and at 2 years using the Lysholm and Knee Injury and Osteoarthritis Outcomes score (KOOS). Minimally clinical important difference (MCID) was used as a measure of clinical significance by comparing the percentage of patients from ACLR+MR and i-ACLR populations who achieve MCID.

Results

Baseline characteristics for age, gender and BMI (p>0.05) was similar in both groups. Pre-operatively, both groups had comparable PROMs (p>0.05). Post-operatively, both groups showed significant improvement (p<0.001) but the patients in the ACLR+MR group demonstrated inferior outcomes in the Lysholm score (74.9 vs 72.5,p<0.01) and all domains of the KOOS score: Symptoms (94.3 vs 91.5,p=0.007), ADL (98.2 vs 97.4,p=0.001), Pain (97.0 vs 96.3,p=0.038), Sport and Recreation function (89.6 vs 85.2, p=0.001) except the KOOS QoL (85.0 vs 81.9,p=0.055) at the two-year mark. The MCID values derived for Lysholm score (8.6 & 9.73) and KOOS score : Symptoms (9.44 & 10.9), Pain (8.58 & 9.98), ADL (7.62 & 9.21), KOOS Sports (15.0 & 17.5) and QoL (14.3 & 15.6) for ACLR & ACLR+MR respectively. However, clinically, both groups had similar percentage of the population passing MCID for the Lysholm score (90% vs 87.1%,p=0.424) and all domains of the KOOS score: Symptoms (79.0% vs 71.8%,p=0.182), Pain (80.5% vs 82.4%,p=0.712), ADL (86.3% vs 83.5%,p=0.536), Sports (95.1% vs 89.4%, p=0.074) and QoL (91.2% vs 89.4%, p=0.630) suggesting similar outcomes clinically.

Conclusion

Patients undergoing ACLR+MR had comparable pre-operative outcomes to the i-ACLR group. At 2 years, despite significant post-operative improvement, patients undergoing MR had poorer PROMs. However, these differences lacked clinical significance, suggesting similar clinical outcomes for both groups.