Abstract
BackgroundThe Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries.MethodsWe retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus.ResultsThere were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the “successful healing” rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025).ConclusionsThere was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears.Level of studyLevel IV, retrospective case series.
Highlights
Meniscal tears occurring concurrently with anterior cruciate ligament (ACL) injuries are common and can affect treatment outcomes [1, 2]
At the time of second-look arthroscopy, the “successful healing” rate for tears following repair was higher in lateral meniscus (LM) tears (91.2%) compared to medial meniscus (MM) tears (80.0%), it was not statistically significant (p = 0.156)
The “successful healing” rate for tears left in situ was 85.7% for medial meniscal tears and 80.0% for lateral meniscal tears (p = 0.761)
Summary
Meniscal tears occurring concurrently with anterior cruciate ligament (ACL) injuries are common and can affect treatment outcomes [1, 2]. Success rates of meniscus repair performed concurrently with ACLR can be range in the range of 80–95% [2–4] Many factors, such as residual laxity, tear length, tear location, patient age, patient physical activity level, and repair integrity, can all affect the biologic healing of meniscal tears and clinical outcomes [5, 6]. Recent literature have reported the superior biologic healing potential of the lateral meniscus (LM) compared to the medial meniscus (MM) [1, 7–10] These studies compared the healing rate of repaired or left in situ meniscus between MM and LM. The purpose of this study was to compare the meniscal healing and the incidence of subsequent reoperation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries
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