Abstract
PurposeTo compare patient reported outcome measures (PROMs) during the first postoperative year between isolated anterior cruciate ligament (ACL) reconstruction and ACL reconstruction with concomitant meniscal intervention.MethodsPatients who underwent primary ACL reconstruction at Capio Artro Clinic, Stockholm, Sweden, between 1st Jan 2001 and 31st Dec 2014 without concomitant injuries others than meniscal and/or cartilage lesions were included. Five groups of meniscal treatment simultaneously to ACL reconstruction were established; medial meniscal (MM) resection, MM repair, lateral meniscal (LM) resection, LM repair, and MM + LM resection. Patients treated with isolated ACL reconstruction formed a separate group. Preoperative, 6-month and 1-year Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm knee score and Tegner Activity scale were collected. Differences in the change over time were analyzed with an ANOVA for repeated measurements with age at surgery, gender, and cartilage injury as covariates. A univariate ANOVA was applied to analyze PROMs between groups at the final follow-up.ResultsA total of 6398 patients were included (56.8% males, mean age 28.5 ± 10.2 years). The KOOS improved across all subscales for all treatment groups. The mean change over time differed significantly between groups for the subscales symptoms (p = 0.017) and activities in daily living (ADL) (p < 0.001). Symptoms was least improved in the MM repair group, while the MM + LM resection group showed the largest improvement. For the ADL subscale, the isolated ACL reconstruction group showed the least improvement and the MM + LM resection group showed the major improvement. At 1-year follow-up, a significant difference between the groups was found for the subscale symptoms (p = 0.019), where the MM repair group reported the lowest score [mean 78.4 (95% CI 76.3–80.5)]. No significant differences were found between groups in change of the Lysholm score over time; however, at 6 months, the difference between groups was significant (p = 0.006) with the meniscal repair groups reporting the lowest scores.ConclusionPatients with concomitant meniscal resection are able to reach the same subjective knee function as isolated ACL reconstructions as early as 6 months postoperatively. However, patients with meniscal repair may have slightly worse subjective knee function at both 6- and 12-month follow-up. These findings could help clinicians to set realistic short-term expectations for patients undergoing ACL reconstruction with simultaneous meniscal intervention.Level of evidence3.
Highlights
The risk for simultaneous injury to the menisci in the occurrence of an anterior cruciate ligament (ACL) injury is substantial [1, 2]
This study revealed that all meniscal treatment groups, except the lateral meniscal (LM) resection, reported significantly lower preoperative scores compared to isolated ACL reconstruction and that these differences were equalized for all treatment groups except for the medial meniscal (MM) repair group, at 2-year follow-up [15]
Six groups were generated depending on meniscal treatment; Isolated ACL reconstruction, MM resection, MM repair, LM resection, LM repair, and combined MM + LM resection (Fig. 1)
Summary
The risk for simultaneous injury to the menisci in the occurrence of an anterior cruciate ligament (ACL) injury is substantial [1, 2]. The radiographic findings of OA are not always accompanied by symptomatic OA [13, 14], a resection of the meniscus seems to result in worse patient reported outcome compared to repair at long-term follow-up [11, 12]. This study revealed that all meniscal treatment groups, except the LM resection, reported significantly lower preoperative scores compared to isolated ACL reconstruction and that these differences were equalized for all treatment groups except for the MM repair group, at 2-year follow-up [15]. The purpose of this study was to compare patient reported outcome measures (PROMs) during the first postoperative year between isolated ACL reconstruction and combined ACL reconstruction and meniscal intervention in order to increase the awareness of the outcome during the time of rehabilitation. It was hypothesized that presence of meniscal injury would influence preoperative PROMs negatively; the short-term outcome would be comparable to patients with an isolated ACL reconstruction
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