Summary

An evaluation of the effect of meniscus treatment (repair vs. meniscectomy) on return-to-play assessment and functional outcomes at 6 months after anterior cruciate ligament reconstruction

Abstract

Background

Anterior cruciate ligament (ACL) tears are often associated with other intra-articular pathology, with meniscal injury among the most common. Meniscus tears are treated at the time of ACL reconstruction (ACLR) via repair or partial meniscectomy. Little is known about the effect weight bearing restrictions and range of motion limitations routinely involved with combined meniscus repair on short term ACLR recovery and return-to-play assessment. The Lower Extremity Assessment Protocol (LEAP) is a series of strength and functional testing developed to evaluate athletes post ACL reconstruction to quantify recovery and aid in decision making for return to physical activity and sports participation. Our expectation would be that the 6 weeks of weightbearing restrictions after ACLR with meniscal repair would lead to weakness and decreased functional scores on this objective testing protocol.

Purpose

to compare strength, jumping performance and patient reported outcomes between isolated ACLR patients and those undergoing meniscus treatment at the time of ACLR surgery.

Methods

ACLR patients at the time point of return to activity (5-7-month post-ACLR) and Healthy controls completed the IKDC and KOOS to assess subjective knee function, and underwent isokinetic testing of knee extensor and flexor strength. All isokinetic tests were performed at 90°/sec and mass normalized (Nm/kg). Limb symmetry (%) measures were also obtained. ACLR patients were stratified into Meniscal subgroups dependent on meniscal involvement at the time of ACLR: Isolated ACLR (ACLR), ACLR+Meniscectomy (ACLR-MS), ACLR+Meniscal Repair (ACLR-MR). One-way ANOVAs with post-hoc Tukey’s test for equal variances were used to assess differences in subjective knee function as well as quadriceps and hamstring strength between groups.

Results

A total of 306 participants, including 165 ACLR patients and 141 healthy controls were recruited for participation. Average time post-operatively was 5.96±0.47 months. Meniscal group stratification resulted in: ACLR: n=50, ACLR+MS: n=44, and ACLR+MR: n=71. Heathy controls demonstrated higher subjective knee function than all Meniscal subgroups (p<.001); however, there were no differences between any of the Meniscal subgroups on the IKDC or any KOOS subscales (all p-values >.05). Healthy controls demonstrated significantly higher unilateral (2.08 ±.56 Nm/kg) and limb symmetry (98±.12%) measures of extensor peak torque than all Meniscal subgroups (p<.001). There were no differences in unilateral or limb symmetry measures of peak knee extensor torque between ACLR (1.45±.46 Nm/kg, 68±19%), ACLR+MS (1.48±.48 Nm/kg, 68±19%), and ACLR+MR (1.58±.52 Nm/kg, 71±20%) patients (all p-values>.05). There were no differences in unilateral or limb symmetry measures of peak knee flexor torque between any subgroups (all p-values>.05).

Conclusion

At 6 months following ACLR, patients remain weaker and report more symptoms compared to healthy controls. Meniscus treatment – whether it was meniscus repair or meniscectomy – did not influence these outcomes. These findings suggest that weightbearing and range-of-motion restrictions associated with meniscus repair do not result in early functional differences in strength symmetry between ACLR and ACLR+MR patients at the time of return to sport. Such results may provide further insights for postoperative rehabilitation and guide return to play protocols.