Incidence and Risk Factors of Subsequent Meniscal Surgery After Successful Anterior Cruciate Ligament Reconstruction: A Retrospective Study With a Minimum 2-Year Follow-up

Abstract

Background: One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear. Purpose: To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation. Study Design: Case series; Level of evidence, 4. Methods: Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up). Results: The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection ( P = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; P = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; P = .032), and follow-up period after ACL reconstruction (OR, 1.02; P = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction. Conclusion: Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.

Early ACLR and Risk and Timing of Secondary Meniscal Injury Compared With Delayed ACLR or Nonoperative Treatment: A Time-to-Event Analysis Using Machine Learning

“…Although several previous studies have evaluated the presence of meniscal injury in patients undergoing ACLR compared with those undergoing nonoperative management, 9,16,23,29,42 few investigations have addressed the risk factors for secondary meniscal injury and compared the natural history of patients stratified by treatment method. Furthermore, the available evidence is challenging to interpret given the potential confounding by significant baseline differences in the comparative analysis.…”

Early Return to Sports to Continue the Season after Anterior Cruciate Ligament Injury Is Not Recommended for Student Athletes

“…12) Moreover, early surgical intervention also reduces the risk of subsequent meniscal surgery after ACLR. 11) LM tears are predominantly observed in acute ACL injury. 25,26) In the current study, LM tears did not increase in the ERS group, compared with the non-ERS group, similar to the findings of previous studies.…”

“… 12 ) Moreover, early surgical intervention also reduces the risk of subsequent meniscal surgery after ACLR. 11 )…”

“… 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ) Furthermore, delayed ACLR is considered a risk factor for subsequent meniscal surgery. 11 ) Early ACLR prevents future meniscus tears and cartilage injuries and may reduce consequent osteoarthritis. 12 , 13 ) Therefore, the standard treatment for ACL injury is reconstruction in conjunction with a recommendation to temporarily suspend sports activity until after ACLR.…”

Risk Factors Associated with Cartilage Defects after Anterior Cruciate Ligament Rupture in Military Draftees

“…The sequelae of graft failure, especially OA, are still clinically challenging problems [ 3 , 23 , 24 , 25 , 26 ]. However, the cause of OA is multifactorial and long-term outcomes after ACL injury and post-ACLR are influenced by many associated factors, such as the status of the articular cartilage, meniscus, BMI, state of the quadriceps muscles, and knee joint laxity [ 5 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”