Concomitant meniscal injury is frequently seen in the anterior cruciate ligament (ACL) deficient or injured knee. Higher rates of osteoarthritis have been demonstrated in ACL injured knees when concomitant meniscal injury is present and higher rates of ACL graft failure have been seen in meniscal deficient knees. In this context, there has been significant interest in meniscal repair at the time of ACL reconstruction.
To assess how meniscal repair and excision impact patient reported outcome measures (PROMs), knee stability, and early graft rupture rates following primary hamstring anterior cruciate ligament reconstruction (ACLR) in a group of young active patients where meniscal repair is commonly advocated.
Six hundred and eighteen patients under 25 years of age at high-risk of graft failure following ACLR were recruited to the Stability 1 study. Multivariable regression models were developed to identify surgical and demographic predictors of Knee Osteoarthritis Outcomes Survey (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC), ACL Quality of Life Questionnaire (ACL-QOL) and Marx Activity Rating Scale (MARS) scores. Chi Square tests of independence were used to explore the association between meniscal treatment, graft rupture, and rotatory knee laxity.
Medial meniscus repair was associated with worse outcomes on the KOOS (B = -1.32, 95% CI: -1.57 to -1.10, p = 0.003), IKDC (B = -1.66, 95% CI: -1.53 to -1.02, p = 0.031) and ACL-QOL (B = -1.25, 95% CI: -1.61 to 1.02, p = 0.087). Other important predictors of post-operative PROMs include age, sex, and baseline scores. The associations between medial meniscal treatment and outcome scores indicated small, clinically insignificant changes based on reported minimal important differences. There was no significant association between meniscal treatment and graft rupture or rotatory knee laxity.
While repairing the medial meniscus may result in a small reduction in PROM scores at two-year follow up, these differences are not likely to be important to patients or clinicians. Any surgical morbidity associated with meniscal repair appears negligible in terms of PROMs. Meniscal repair does not affect rotatory laxity or graft failure rates in the short term.