Meniscal Repair with Concurrent Anterior Cruciate Ligament Reconstruction: Operative Success and Patient Outcomes at 6-Year Follow-up

OBJECTIVES: Meniscus repairs are commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. Properly functioning menisci coupled with knee stability are thought to be critical factors in achieving optimal outcomes. While meniscal repair in conjunction with ACLR has demonstrated good success at 2 years, no large-scale, prospective, multicenter studies have evaluated long-term patient-oriented outcomes after combined ACLR and meniscus repair. We hypothesize that patient-centered outcome scores will deteriorate and ipsilateral reoperations will increase at 6 years following combined ACLR and meniscus repair. METHODS: All unilateral primary ACL reconstructions from the Multicenter Orthopaedic Outcomes Network (MOON) between 2002 and 2004 were evaluated, and patients who underwent concurrent meniscus repair were selected. Validated patient-oriented outcome data [Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities (WOMAC) scores, Marx activity scores and International Knee Documentation Committee (IKDC) scores] was gathered at 2 and 6 years following the index procedure. Subsequent ipsilateral knee re-operation was confirmed by operative reports to evaluate for failure of meniscal repairs. RESULTS: In total, 1440 primary ACLR’s were performed between 2002 and 2004 as part of the study cohort. Of these, 286 subjects underwent concurrent meniscus repair (298 meniscal repairs). 235/286 (82.2%) were available for follow up at 6 years (154 medial meniscus repairs, 72 lateral meniscal repairs, and 9 patients who underwent both lateral and medial meniscal repairs). Overall, the success rate of meniscal repair at the time of ACLR was 86% (202/235) at 6 years. We found an 86.4% six year success rate with combined ACLR and medial meniscal repair, 86.1% for lateral meniscal repairs and 77.8% when both medial and lateral menisci were repaired. 27.3% (9/33) of the failures were associated revision ACL surgery. Medial meniscal repairs failed earlier (mean 2.1 years) than lateral meniscal repairs (mean 3.7 years) (p=0.01). All-inside techniques were performed in 88.5% of cases. There were 31 failures with this technique representing a 14.9% failure rate. There was one failure in the inside-out technique group (1/19, 5.2%), and one failure noted in the outside-in technique group (1/6, 16.6%). Significant improvements were observed in patient reported outcomes [KOOS Symptoms, KOOS Pain, KOOS KRQOL, WOMAC Pain, and IKDC scores] when baseline scores were compared to 6-year follow-up. No significant clinical differences were observed between 2 and 6 year follow up indicating there was no clinical deterioration over this time period. Marx Activity levels gradually declined from time of injury to 6-year follow-up. CONCLUSION: Concurrent meniscal repair with ACLR is associated with success rates approximating 86% at 6-year follow-up. Patient-oriented outcome measures were generally similar between 2 and 6 years follow up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscus repairs.