Tunnel Overlap Occurs 25% of the Time With Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Root Repair

Abstract

PurposeTo assess the risk of socket-tunnel overlap for posterior medial or lateral meniscal root repair combined with anterior cruciate ligament reconstruction (ACLR) using artificial tibias and computerized tomography (CT) scans for three-dimensional (3D) modeling. MethodsArtificial tibias (n=27; n=3/subgroup) were allocated to groups based on inclination of socket-tunnels (550, 600, 650) created for MMPR and LMPR repair, and ACLR. Three standardized socket-tunnels were created: one for the ACL and one for each posterior meniscal root insertion. CT scans were performed and sequentially processed using computer software to produce 3D models for assessment of socket-tunnel overlap. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U tests. Significance was set at p<0.05. ResultsThe present study found no significant risk of tunnel overlap when drilling for combined ACLR and MMPR repair, while seven cases of tunnel overlap occurred between ACL tunnels and LMPR (25.9% of cases). No subgroup or specific pattern of angulation consistently presented significantly safer distances than other subgroups for all distances measured. ConclusionThis study demonstrated 25.9% rate of overlap for combined LMPR repair and ACLR, compared to 0% for MMPR repair with ACLR. Lower ACL drilling angle (55 or 60 degrees) combined with higher lateral meniscus drilling angle (65 degrees) produced no socket-tunnel overlap. Clinical RelevanceSocket-tunnel overlap during meniscal root repair combined with ACLR may compromise graft integrity and lead to impaired fixation and treatment failure of either the ACL, the meniscus, or both. Despite this, risk for socket-tunnel overlap has not been well characterized.