Lateral meniscus posterior root repair in the setting of anterior cruciate ligament reconstruction restores joint mechanics to the intact state and improves clinical function: a systematic review of biomechanical and clinical outcomes

Abstract

Purpose To perform a systematic review of biomechanical and clinical outcomes following lateral meniscus posterior root (LMPR) repair with concomitant anterior cruciate ligament reconstruction (ACLR). Methods A literature search was performed systematically using PubMed, Embase, and Medline databases in April 2022. The search included the following terms combined with Boolean operators: 'Meniscus repairs', 'Meniscal Repair', 'Posterior Horn', 'Root', 'Radial'. Inclusion criteria consisted of level I-IV human clinical and biomechanical studies reporting biomechanical data and/or outcomes following LMPR repair in the setting of ACLR. Results Three biomechanical studies, all utilizing a transtibial pullout technique, were identiied, all of which reported signiicant improvement in joint contact pressures and mechanics and 3/4 of which reported signiicant improvement in anterior or rotational stability with LMPR repair. Five clinical studies, consisting of 146 patients (mean age 28.5 ± 1.1 years) undergoing LMPR repair, were identiied with an average follow-up of 19.1 months (range 6.2-46 months). Across all clinical studies, Lysholm and International Knee Documentation Committee (IKDC) scores were found to improve postoperatively, with 3/4 reporting signiicant improvement in Lysholm (all, p ≤ 0.001) scores and 3/5 reporting signiicant improvement in IKDC scores when compared to preoperative values (all, p ≥ 0.004). Meniscal extrusion decreased signiicantly following repair in 2/4 studies (all, p ≤ 0.001). Conclusions Biomechanically, transtibial pullout repair of the LMPR restored joint contact pressures and joint mechanics to intact levels when performed with concomitant ACLR. Clinically, LMPR repair with concurrent ACLR resulted in improved Lysholm and IKDC scores. These indings enable surgeons to determine optimal treatment plans and discuss realistic outcomes with patients when encountering LMPR injuries. Level of evidence IV.

Medial meniscal lesions increase antero‐posterior laxity in knees with anterior cruciate ligament injury

“…This is a key aspect, since meniscal tears represent one of the most common injuries in orthopaedics, with a mean annual incidence of 60−70 per 100.000 [23], and since patients undergoing ACL reconstruction have been reported to have a meniscus tear incidence from 55% up to nearly 80% [24][25][26][27][28]. Meniscal lesions should therefore be carefully considered when performing ACL reconstruction surgery to restore knee stability [29][30][31][32]. In fact, while meniscectomy can increase the femoro-tibial contact stress and anterior tibial translation in ACL-deficient knees, meniscal repair showed to increase anteromedial knee laxity [8,33].…”