2015 ISAKOS Biennial Congress ePoster #1253

Outcome of Meniscus Treatment and Subsequent Meniscus Tears After Primary Anatomical Anterior Cruciate Ligament Reconstruction

Yuka Kimura, MD, Hirosaki, Aomori JAPAN
Eiichi Tsuda, Prof., Hirosaki, Aomori JAPAN
Yuji Yamamoto, MD, Hirosaki, Aomori JAPAN
Shugo Maeda, MD, Hachinohe, Aomori JAPAN
Takuya Naraoka, MD, Fujinomiya, Shizuoka JAPAN
Yasuyuki Ishibashi, MD, Hirosaki, Aomori JAPAN

Hirosaki University Graduate School of Medicine, Hirosaki, JAPAN

FDA Status Not Applicable

Summary: Most concurrent meniscus tears which were repaired or left in situ at anterior cruciate ligament reconstruction showed considerable healing and a high success rate. The failure rate of medial meniscus repair was 7.3%, and that of lateral meniscus was 3.7% at minimum 2 year follow-up. In medial meniscus, failure rate of all-inside suture was significantly high than that of inside-out suture.

Rate:

Abstract:

Purpose

Meniscal injury are frequently associated with Anterior cruciate ligament (ACL) injuries, and meniscal repair is commonly performed concurrently with ACL reconstruction (ACLR). Recently, anatomical ACLR has improved knee joint stability and provided good clinical outcomes. However, subsequent meniscal tears after ACLR remain a problem and are still unclear. The purpose of this study was to investigate the outcome of meniscal treatment with concurrent ACLR and subsequent meniscus tears after primary ACLR.

Methods

Patients who underwent primary ACLR with bone-patella-bone tendon graft or hamstring graft in our institute from 2003 to 2012 were involved in this study. Using medical records, age at the surgery, data of ACLR, state of meniscus at ACLR, meniscal treatment, and meniscus injury after ACLR including subsequent meniscus tear and re-tear of repaired meniscus at minimum 2 year follow-up were investigated. Subsequent meniscus tear and re-tear were defined by symptoms of joint line pain and/or locking or joint effusion requiring surgical treatment.

Results

There were 570 patients who underwent primary ACLR during the period. The mean age at ACLR was 24.6 (11-66) years. The prevalence of medial meniscus (MM) tear at the surgery was 244 (42.8%) and lateral meniscus (LM) tear was 323 (56.7%). MM tears were repaired in 150 (61.5%) of 244 menisci in which 36 were repaired with all-inside suture and 114 with inside-out suture, 41 (16.8%) underwent partial meniscectomy, and 53 (21.7%) were left in-situ. LM tears were repaired in 54 (16.7%) of 323 menisci in which 37 were repaired all-inside suture and 17 with inside-out suture, 84 (26.0%) underwent partial meniscectomy, 184 (57.0%) were left in-situ and 1 case underwent allograft transplantation. At mean of 841 days (range, 262-2725 days) after ACLR, 15 patients (12 MM tears and 5 LM tears) required meniscal surgery without ACL re-injury or instability. Six of 12 MM tears had been repaired using all-inside suture and 5 MM had been repaired using inside-out suture 1 MM had been partially resected at primary surgery. Two LM tears had been repaired and 1 LM tear were partially resected, 1 LM had been left in situ, and 1 LM had not seen at ACLR. Of these15 patients, mean age at primary ACLR was 17.9 (13-41) years. Eight of 15 patients had traumatic episode during sports activity. At meniscal surgery, 7 MM tears and 3 LM tears were repaired and 5 MM tears and 2 LM tears were partially resected.

Discussion

Most concurrent meniscus tears (94.1% MM and 98.8% LM) which were repaired or left in situ at ACLR showed considerable healing and a high success rate. However, younger patients were at risk of meniscus re-injury or subsequent meniscus tear after ACLR. The failure rate of MM repair was 11/150 (7.3%), and that of LM was 2/54 (3.7%). In MM, failure rate of all-inside suture of 6/36 (16.7%) was significantly high than that of inside-out suture of 5/114 (4.4%). Inside-out suture of MM repair was better than all-inside suture for young patients.