Summary

The aim is to examine clinical and arthroscopic evaluations after medial meniscal (MM) repair performed at the time of ACL reconstruction. Sixty one patients experienced the second-look arthroscopic examination after anatomic double bundle ACL reconstruction and MM repair. Repaired MM was evaluated as Complete healing in 63.9% of the knees, incomplete healing in 21.3%, and re-rupture in 14.8%.

Abstract

Introduction

The incidence of medial meniscal (MM) tears increases in patients with ACL-rupture knees and chronic ACL-deficient knees. When partial meniscectomy for meniscal tear is performed, it may lead to articular cartilage damage and osteoarthritis.
Therefore, our strategy for the treatment of meniscal tears has been meniscal repair at the timing of ACL reconstruction (ACLR), as possible.
However, the rate of meniscal repair failures of combined ACLR was reported with the range from0 to 29%, so that it is necessary to investigate the influence of re-rupture of meniscus on clinical outcomes with ACLR.

Purpose

The aim of this study is to evaluate the clinical outcomes with clinical evaluation of MM repair at the time of ACLR with the healing condition by arthroscopic findings.

Methods

(Patients) Sixty one patients (mean age, 24 year-old, 39 female and 22 male patients) had underwent both of primary anatomic double bundle ACLR and MM repair. They had also experienced the removal of the double spike plates (DSPs) and screws on the tibia and the second-look arthroscopic examination since more than 1 year after ACLR.
(Surgical Technique) Anatomic double bundle ACLR was performed in all patients. MM was repaired using FASTFIX360 in 55patients, and all-inside technique with suture-hook through posteromedial portal as working portal in 4 patients. 2 patients underwent combined these techniques.
Patients were divided into 3 groups (Complete healing: group A, incomplete healing: group B, and re-rupture: group C), and they were clinically evaluated concerning the side-to-side knee anterior translation, the Lysholm knee scoring scale, and the IKDC evaluation.

Results

Second-look arthroscopy showed that repaired MM was evaluated as group A in 63.9% (n=39) of the knees, group B in 21.3% (n=13), and group C in 14.8% (n=9). Regarding to the ICRS classification grade more than 1, 2 knees in group A were ranked as grade 2 and 1 knee in group C was ranked as grade 3. There was no significant difference in side-to-side anterior translation of the knee at 30 degrees among these groups. On the other hand, Lysholm score was less in group C (94.8pts) than in group A (98.8pts.).
Concerning with the IKDC evaluation, there was not significantly different in A+B among each group. Regarding pivot shift test, 3 knees were positive in each group, respectively.

Discussion

Our study evaluated the relevance between MM repair failure and postoperative clinical outcomes. There were not significant differences between each group in anterior laxity and the IKDC evaluation except for Lysholm knee scoring scale. Our study demonstrated the failure rate 14.8% of MM repair combined with ACLR at second-look arthroscopy. It was not worse although the follow-up was not longer. However, Lysholm knee scoring scale in the MM repair failure group was less than the complete healing group, and, occasionally, reoperation would be necessary for these patients in failure group. Therefore, we expect that further technique will be discovered to raise the successful rate of meniscal repair.