Summary
Patients with a medial meniscus injury at the time of anterior cruciate ligament reconstruction have lower return to sport rates, with better results if a repair is performed, whereas no difference is found for a lateral meniscus injury
Abstract
Background
While meniscal tears, particularly when treated by meniscectomy concurrent anterior cruciate ligament reconstruction (ACLR), are known to increase the risk of osteoarthritis and lead to poorer outcomes, their effects on return to sport (RTS) have been little studied so far.
Purpose/Hypothesis: The aim of our study was to assess the effect of meniscal tears on RTS in the context of ACRL depending on the affected meniscus.
Methods
This was a retrospective, single-center study of prospectively collected data involving 504 patients who received the same post-operative follow-up for a minimum of 3 years between April 2015 and December 2019. Patient-Reported Outcomes Measures (PROMS) were collected pre-operatively for the Tegner Activity Scale, at 6 months for the Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI). At the last follow-up information was collected on RTS levels, return to the same sport and same athletic level, the Self Knee Value (SKV), the International Knee Documentation Committee (IKDC), the ACL-RSI, the Tegner Activity Scale as well as information on graft failure, contra-lateral rupture and re-intervention. Isolated ACLR was compared with ACLR involving medial meniscus (MM), lateral meniscus (LM) and bi-menisci (BM) injuries, then meniscal repair and meniscectomies were compared for MM and LM injuries.
Results
504 patients were included with a mean follow-up of 4,9 +/- 1.2 years and 6 patients lost of follow-up. The Tegner score was significatively lower for ACLR with MM injuries, than in isolated ACLR (5.4 ± 2.0 vs 6.0 ± 2.0, P < .01). The RTS rate was also significantly lower for MM injuries (82.1%), BM injuries (81.1%) compared to isolated ACLR (93.8%, P = .02). Outcomes were similar in ACLR with LM and in isolated ACLR. MM repairs significantly increased the Tegner score compared with MM meniscectomies (5.8 ± 1.9 vs 4.7 ± 2.1, P < .01). No other significant differences were found on RTS.
Conclusion
ACLR with MM Injuries are associated with a lower Tegner score and a lower RTS rate compared with isolated ACLR while LM injuries show similar outcomes than isolated ACLR. However, MM repair increases Tegner score compared to meniscectomy.