Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success?

Abstract

Background: When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear. Hypothesis: The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up. Results: A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P = .02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P = .17). The odds of failure were 68% higher with medial versus lateral repairs ( P < .001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk ( P = .004). Conclusion: Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts. Registration: NCT00463099 (ClinicalTrials.gov identifier).

Anterior Cruciate Ligament Rupture Combined with Complete Radial Tear of the Posterior Horn of the Lateral Meniscus: Suture or Resection?

“…Several biomechanical studies have reported that the load of the medial and lateral menisci increases in the ACLdeficient knee, and secondary meniscus lesions in the ACLdeficient knee can result from this increased load on the menisci due to increased anterior tibial translation. [37][38][39] Moreover, it has been reported that there is a significant increase in meniscal injuries after ACL rupture before the incidence of cartilage lesions rises; this corroborates previous reports stating that the integrity of the meniscus is important for preventing early degeneration of the articular cartilage. 40 Therefore, the IKDC and Lysholm scores of the study group were superior to those of the control group after the operation; our analysis was based on the stability of the joint being restored after meniscus suture and healing, and the damage to the cartilage was reduced.…”

Higher healing rate after meniscal repair with concomitant ACL reconstruction for tears located in vascular zone 1 compared to zone 2: a systematic review and meta-analysis

“…Patients included in this review received different ACL grafts, thereby introducing possible bias. Salem et al report different failure rates of meniscal repair with concomitant ACLR for different types of ACL grafts [ 29 ]. To further identify the influence of the meniscal tear zone on the actual healing of meniscal tears, a large-scale study should be conducted in a more homogenous patient group with a considerable number of tears in all meniscal vascular regions.…”

Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations

“…The elected surgical technique for ACLR appears to influence return to the pre-injury level of sport outcomes. Certain surgical factors, including graft choice for ACLR [42], augmentation of the ACLR to include a lateral extra-articular procedure (LEAP) [43], and concomitant meniscal repair/ligamentous reconstruction at the time of ACLR have all been observed to impact outcomes related to an athlete's return to their pre-injury level of sport [44]. Of these factors, graft selection appears particularly important, because higher RTS rates have been observed after ACLR with a BPTB autograft than with HT autografts or an all-soft tissue allograft [10,42,45].…”

“…Compared to an isolated ACLR, meniscal repair and/or other knee ligament reconstructions at the time of ACLR are known to reduce RTS rates [15,44,45,54], and the number of reconstructed ligaments (i. e., 2 or more ligaments reconstructed at the time of ACLR) appears to influence RTS rates more than if the meniscus was intact versus repaired or resected [45,54,55]. A cohort study by Bakshi et al [55] reported that 43.5 % of National Football League players were able to return to their pre-injury level of sport the next season after an ACL + medial collateral ligament (MCL) injury/surgery compared to only 18.5 % after an ACL, posterior cruciate ligament, and fibular collateral ligament injury/surgery.…”

“…Regarding the impact of ACL graft selection on meniscal repair survivorship, Salem et al [44] reported a 13.9 % meniscal repair failure rate after ACLR with a BPTB autograft at two-and six-year follow-up, compared to a respective 17.4 % and 19.4 % failure rate with an HT autograft or allograft. Although RTS rates were not reported, patients in the BPTB group appeared to be the youngest and still experienced the lowest rate of meniscal repair failure [44].…”