2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Return to Sport Following ACL Reconstruction With Meniscus Allograft Transplantation Versus Isolated ACL Reconstruction: A Matched-Cohort Study

Walter Richard Lowe, MD, Houston, TX UNITED STATES
Victoria Rigsby, DPT, Houston UNITED STATES
Jacquelyn Kleihege, PT, MPT, Houston, Tx UNITED STATES
William Brooks, Houston, TX UNITED STATES
Steven Higbie, DPT, Houston, TX UNITED STATES
Lane Bailey, PT, PhD, DPT, CSCS, Houston, TX UNITED STATES

McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, UNITED STATES

FDA Status Not Applicable

Summary

This study provides clinicians with subjective and objective outcomes to aid them in counseling patients undergoing ACL with concomitant MAT.

Abstract

Background

Meniscus allograft transplantation (MAT) is indicated in the setting of ACL reconstruction to restore proper arthrokinematics and load distribution for the meniscus deficient knee. Objective outcomes following ACL reconstruction with concomitant MAT in athletic populations are scarcely reported and highly variable.

PURPOSE/HYPOTHESIS: To compare patient outcomes using an objective functional performance battery, self-reported outcomes, and return to sport rates between individuals undergoing an ACL reconstruction with concomitant MAT and those of a matched group undergoing isolated ACL reconstruction.

STUDY DESIGN: Level II, matched case-control study

Methods

A single surgeon ACL database (n = 1,431) was utilized to identify patients undergoing ACL reconstruction with concomitant MAT from 2014-2019. Patients were age, gender, and revision-matched to a group undergoing isolated ACL reconstruction. Baseline patient and surgical demographics data were obtained. Patients completed an objective functional performance battery at the time of return to sport which included range of motion (ROM), single leg squat performance, single leg hop test performance, self-reported function (International Knee Documentation Committee score (IKDC)), and psychological readiness (ACL Return to Sports After Injury scale (ACL-RSI)). Between limb comparisons were assessed using limb symmetry indices (LSI). Injury surveillance was conducted for two-years and included the Single Assessment Numeric Evaluation (SANE), re-injury rates, complications, and current level of sports participation. Between group comparisons at time of return to sport and two-years were analyzed using generalized linear models for parametric and non-parametric equivalents with an a-priori alpha level of .05.

Results

Forty-six patients were included in the ACL reconstruction with concomitant MAT group along with 46 in the isolated ACL reconstruction group. Allograft transplantation was as follows; isolated medial (43.5%), isolated lateral (10.9%), and both at (45.7%). Baseline differences existed between groups with the MAT group exhibiting lower bodyweight (P = .036) and MARX scores (P = .024). At the time of return to sport, the MAT group reported lower IKDC scores (83.2 ±12.6 vs 91.1 ±11.3, P = .037), however no other functional performance or self-reported differences were observed. At two-year, no significant differences existed between groups for SANE score, ACL graft re-injury rates, or level of return to sport (P > .05). The MAT group did demonstrate a significantly lower rate of return to prior level of sport (69.5% vs 78.3%, P = .026).

Conclusion

The majority of patients (87%) undergoing ACL reconstruction with concomitant MAT are able to return to some level of sports participation at two-years with a low risk of ACL or meniscal transplant failure. Patients receiving a concomitant MAT may exhibit lower self-reported function at return to sport compared to matched controls undergoing isolated ACL reconstruction, however these differences are not present at two-years. Clinicians should consider patient demographics, self-reported function, and return to sport rates when counseling patients for ACL reconstruction with MAT.