Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study

Abstract

III.

Outcomes After Anterior Cruciate Ligament Reconstruction Using the Norwegian Knee Ligament Registry of 4691 Patients

“…Previous studies have described lower postoperative rates of osteoarthritis and higher subjective patient outcomes scores for meniscal repair in comparison to meniscal resection, with and without ACLR. 11,19 The relatively few differences between meniscal repair and meniscal resection seen in our study may be because the benefit of preserving meniscal tissue, which is the goal of meniscal repair, may not be appreciated until the repetitive loading of the knee is performed over the course of many years. In addition, the decreased mobility of the MM in comparison to the LM 20 and the differing insertion geometries of the medial and lateral meniscal roots 9,10 may potentially explain the better outcomes for LM repairs in comparison to MM repairs at short-term follow-up.…”

“…As of today, the literature reports that patients who undergo a meniscal resection rather than a meniscal repair have higher postoperative rates of osteoarthritis and decreased function over the long term (.10 years). 2,4,11,12,18 Despite no clinical difference being found in this cohort at 2 years postoperatively, we still advocate that meniscal tears be repaired whenever possible and that patients who have meniscal resections be advised to follow up with their physicians at either a routine time postoperatively (between 5 and 10 years postoperatively) or at the first signs of pain or swelling with activities to determine if they are developing osteoarthritis. The subjective and objective clinical findings at that further follow-up could direct whether activity modifications or other treatment may be indicated depending on whether signs or symptoms of osteoarthritis were present.…”

“…Barenius et al 2 reported that MM and LM resections were significant risk factors for osteoarthritis at 14-year follow-up, while MM or LM repairs were not. In addition, Melton et al 11 reported that patients undergoing either meniscal repair or resection with ACLR had significantly lower International Knee Documentation Committee (IKDC) outcome scores than ACLRs with intact menisci at 10-year follow-up. 11 As noted above, concurrent meniscal injury, especially when treated with resection, may negatively influence the long-term outcomes after ACLR.…”

“…In addition, Melton et al 11 reported that patients undergoing either meniscal repair or resection with ACLR had significantly lower International Knee Documentation Committee (IKDC) outcome scores than ACLRs with intact menisci at 10-year follow-up. 11 As noted above, concurrent meniscal injury, especially when treated with resection, may negatively influence the long-term outcomes after ACLR. However, the prognosis for meniscal treatments on patient-reported outcomes is unknown at short-term follow-up, and this information would be important when educating patients on the expected short-versus long-term prognoses of treatment options.…”

Meniscal pathology - the evidence for treatment

“…Meniscal repair is most commonly performed in younger populations aged under 35 years [10,21-27] and aims to preserve the entire meniscus, without excision. The rationale for meniscal repair is that by preserving the structure of the meniscus, function is maintained and long-term changes in other joint structures will be ameliorated.…”