Résultats cliniques après réparation méniscale itérative à distance d’une reconstruction du LCA : 32 patients avec un suivi moyen de 89 mois

Abstract

Meniscus preservation is protective against long-term osteoarthritis. High failure rates for isolated meniscus repair are reported. Low is known about meniscus repair after anterior cruciate ligament reconstruction (ACLR). This study aimed to report clinical outcomes and failure rate for isolated meniscal repairs in patients with a prior history of ACLR. A retrospective analysis of prospectively collected data from (blinded) database was performed. Patients who underwent isolated meniscal repair in a stable knee with a prior history of ACLR with a minimum follow-up of 2 years were included. Preoperative evaluation of knee stability was performed with instrumented differential laxity. Tegner activity scale, ACL-RSI scale, Lysholm knee score, WOMET score, subjective IKDC and KOOS score were reported at the final follow-up. Clinical Failure was defined as recurrence of lesion in the previously sutured meniscus by clinical or radiological evaluation, or as reoperation for secondary meniscectomy. Failure risk factor analysis was performed. Thirty-two isolated meniscal repairs in 32 patients with a mean follow-up of 89.39 ± 29.50 months (range 29–150) were included. Preoperative knee stability was confirmed with mean side-to-side laxity of 1.53 ± 1.01 millimeter (range 0–4). The lateral meniscus (LM) was involved in 20 tears (62.5%) and the medial meniscus (MM) in 12 (37.5%). The overall failure rate was 46.87% (n = 15). No significant difference was found (P = 0.784) between MM (n = 6, 50%) and LM (n = 9, 45%) failure rate, as for patient-reported outcomes at final follow-up (P > 0.05). Good to excellent clinical outcomes were reported in the overall cohort. Failed meniscal repairs reported lower ACL-RSI (P = 0.047), subjective IKDC (P = 0.019), Lysholm (P = 0.023) and KOOS Sport (P = 0.038) scores compared to succeed ones. No failure risk factor was identified with multivariate analysis. This study demonstrated high failure rate of meniscus repair after ACLR in stable knees. Repair of new meniscal tears should nevertheless be considered as good clinical outcomes were achieved in case of success, especially for the LM regarding the risk of rapid chondrolysis.