2015 ISAKOS Biennial Congress Paper #0

Prior Isolated Medial Bucket-Handle Meniscus Repair Significantly Increases Risk of Subsequent Ipsilateral Anterior Cruciate Ligament Reconstruction: An Analysis of 438 Patients

William M McLaughlin, MD, New Haven, CT UNITED STATES
Stephen M Gillinov, AB, New Haven, CT UNITED STATES
Peter Y Joo, MD, MPH, New Haven UNITED STATES
Jay Moran, BS, New Haven UNITED STATES
Jonathan Grauer, New Haven, CT UNITED STATES
Elizabeth Gardner, MD, New Haven, CT UNITED STATES
Yale School of Medicine, New Haven, Connecticut, UNITED STATES

FDA Status Not Applicable

Summary: Patients with prior surgically treated isolated meniscus tears are significantly more likely to require subsequent ipsilateral ACL-R surgery.

Abstract:

Background

Meniscus tears in a young population often occur from a traumatic, rotational mechanism of injury, which is similar to that of an ACL tear. However, there is limited evidence regarding the risk of subsequent ACL injury following a surgically treated isolated meniscus tears.

Purpose

(1) Define the incidence of surgically treated isolated bucket-handle meniscus tears. (2) Investigate the timing and risk of subsequent ipsilateral ACL reconstruction (ACL-R) in patients undergoing primary isolated bucket-handle meniscus repair compared to first-time ACL-R in the general population. We hypothesized that a prior meniscus tear, more specifically a bucket-handle tear, is indicative of a more severe injury occurred to the knee and thus increases the risk of subsequent ipsilateral ACL-R.

Methods

A retrospective review of a national database was conducted from 2015 to 2020 to identify patients, aged 10 to 40, who underwent primary isolated BH meniscus surgery. Patients were stratified by meniscal tear laterality and operative method. A control group of 500,000 age-matched patients was randomly selected to establish a benchmark rate of ACL-R. Kaplan-Meier analysis was performed to compare the timing and incidence of subsequent ipsilateral ACL-R after primary isolated BH meniscus repair to the control group within 2 and 5 years after index surgery.

Results

In total, 1,767 patients with isolated bucket handle meniscus tears (BHMT) treated with surgery were identified and met inclusion criteria. The incidence of isolated BHMT among all surgically treated meniscal injuries was 1.67%. Isolated BH repairs had significantly increased odds of ACL-R within 5 years compared to the control group (OR, 6.09; 95% CI, 2.86-12.99; P<0.001). Medial BH repairs had the highest odds of ACL-R within 5 years (OR, 9.15; 95% CI, 4.27-19.57; P<0.001). Lateral BH repair was not associated with subsequent ipsilateral ACL-R within 5 years (OR 2.63; CI 0.37-18.90; p=0.340).

Conclusion

Isolated BH tears comprised 1.67% of all surgically-treated meniscal injuries. Patients who underwent prior surgery for an isolated BH meniscal tear were at increased risk of undergoing subsequent ipsilateral ACL reconstruction compared to the general population. Isolated medial BHMT treated with repair had the highest risk for subsequent ipsilateral ACL-R. This study should raise awareness amongst physicians when treating isolated medial BHMT to perform careful examination of the ACL and examination under anesthesia for potential laxity or rotation instability.