Low Failure Rates and Favorable Outcomes of Meniscal Repair With Concomitant Anterior Cruciate Ligament Primary...

Arthroscopic anterior cruciate ligament (ACL) primary repair (ACLPR) has reemerged as a treatment option for select proximal ACL tears. However, concerns persist regarding its ability to restore knee stability adequately to support meniscal healing after concurrent meniscal repair.

To evaluate the clinical outcomes after medial and/or lateral meniscus repair in patients undergoing ACLPR, compared with isolated ACLPR (ACLPR-only) and ACLPR with partial meniscectomy (ACLPR-PME).

Cohort study; Level of evidence, 3.

Consecutive patients with complete, proximal modified Sherman type 1 and 2 ACL tears who underwent ACLPR between 2008 and 2021 with a minimum 2-year follow-up were included. Patients were categorized into 3 groups: ACLPR-only, ACLPR with meniscal repair (ACLPR-MR), and ACLPR-PME. The primary outcome was the International Knee Documentation Committee (IKDC) Subjective Knee Form score. Secondary outcomes consisted of meniscal repair and ACLPR failure, overall reoperation rates, anterior tibial translation side-to-side difference (ATT SSD), clinical outcomes (Lachman test and pivot-shift test results), and patient-reported outcome measures (PROMs) including the Lysholm score, Forgotten Joint Score-12, Anterior Cruciate Ligament Return to Sport after Injury score, and Tegner activity scale score.

A total of 276 patients (ACLPR-only: n = 131; ACLPR-MR: n = 76; ACLPR-PME: n = 69) with a mean age of 39.7 ± 10.7 years (50.4% female) and mean follow-up of 2.9 ± 1.0 years were included (7.4% lost to follow-up). The mean IKDC scores demonstrated no significant difference between groups (ACLPR-only: 89.4 ± 10.3 [95% CI, 87.2-91.6]; ACLPR-MR: 86.7 ± 12.9 [95% CI, 83.6-89.8]; ACLPR-PME: 89.2 ± 9.9 [95% CI, 86.6-91.9]; P = .27). Eight patients (10.5%) in the ACLPR-MR group experienced recurrent meniscal injury. ACLPR failure occurred in 28 patients (10.1%), with no significant difference between groups (P = .62). Younger age was a significant predictor of ACLPR failure (P < .01), but not meniscal repair failure (P = .77). No group differences were observed in ATT SSD (ACLPR-only: 0.8 ± 1.3 mm; ACLPR-MR: 1.1 ± 1.2 mm; ACLPR-PME: 1.2 ± 1.4 mm; P = .34), overall reoperations, Lachman test results, pivot-shift test results, and PROMs (all P > .05).

Meniscal repair with ACLPR is not associated with inferior clinical and patient-reported outcomes at the 2-year follow-up when compared with ACLPR-only and ACLPR-PME, with ACLPR-MR demonstrating a meniscal reinjury rate of 10.5%. These findings suggest that ACLPR provides sufficient knee stability to support clinically successful meniscal healing.