Meniscal Repair
There is limited evidence in patients with combined ACL tears and reparable meniscus tears, but it supports that the practitioner might repair these meniscus tears when combined with ACL reconstruction because it improves patient outcomes.
Rationale
Nine low strength and two very low strength studies were included in this recommendation.6, 20, 45, 57, 68, 76, 102, 103, 106, 120, 121 One low strength study reported improved subjective knee function (Lysholm knee score and IKDC Score) and reduced activity related pain and swelling with repaired (51%)/stable (49%) menisci compared to meniscectomy at the time of ACL reconstruction.121 Objective functional outcomes as evidenced by single leg hops scores were also improved in the repaired/stable meniscus group. One low strength study and one very low strength study reported reduced radiographic abnormalities in knees with repaired/stable menisci and a reduced incidence of osteophytes following repair compared to medial meniscectomy.6, 121Likewise, a very low strength study reported a reduction in pain following lateral meniscus repair compared to lateral meniscectomy combined with ACL reconstruction.103 Several studies reported improved outcomes with ACL reconstruction and menisci repair, but the groups were not directly comparable.
Possible Harms of Implementation
As with all surgical procedures, there are patient risks including but not limited to infection, anesthetic complications, phlebitis, neurovascular injury, meniscal repair failure, and ACL reconstruction failure.
Future Research
Long-term, prospective studies comparing ACL reconstruction in patients with normal menisci to patients with torn menisci having either meniscectomy or meniscal repair. Further, we can investigate the pattern of meniscal tear, biology of meniscal healing, and repair techniques to increase the chance of successful repair. When meniscectomy is necessary additional research should be performed in the fields of meniscal transplantations and meniscal regeneration.
Possible Harms of Implementation
As with all surgical procedures, there are patient risks including but not limited to infection, anesthetic complications, phlebitis, neurovascular injury, meniscal repair failure, and ACL reconstruction failure.
Future Research
Long-term, prospective studies comparing ACL reconstruction in patients with normal menisci to patients with torn menisci having either meniscectomy or meniscal repair. Further, we can investigate the pattern of meniscal tear, biology of meniscal healing, and repair techniques to increase the chance of successful repair. When meniscectomy is necessary additional research should be performed in the fields of meniscal transplantations and meniscal regeneration.
- (102) Shelbourne KD, Benner RW. Correlation of joint line tenderness and meniscus pathology in patients with subacute and chronic anterior cruciate ligament injuries. J Knee Surg 2009;22:187-190.
- (103) Shelbourne KD, Dersam MD. Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees. Arthroscopy 2004;20:581-585.
- (106) Siebold R, Dehler C, Boes L, Ellermann A. Arthroscopic all-inside repair using the Meniscus Arrow: long-term clinical follow-up of 113 patients. Arthroscopy 2007;23:394-399.
- (120) Wirth CJ, Peters G, Milachowski KA, Weismeier KG, Kohn D. Long-term results of meniscal allograft transplantation. Am J Sports Med 2002;30:174-181.
- (121) Wu H, Hackett T, Richmond JC. Effects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: A long-term prospective study. Am J Sports Med 2002;30:845-850.
- (20) Chiang CW, Chang CH, Cheng CY et al. Clinical results of all-inside meniscal repair using the FasT-Fix meniscal repair system. Chang Gung Med J 2011;34:298-305.
- (45) Hart AJ, Buscombe J, Malone A, Dowd GS. Assessment of osteoarthritis after reconstruction of the anterior cruciate ligament: a study using single-photon emission computed tomography at ten years. J Bone Joint Surg Br 2005;87:1483-1487.
- (57) Jorgensen U, Bak K, Ekstrand J, Scavenius M. Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability. Knee Surg Sports Traumatol Arthrosc 2001;9:137-145.
- (6) Aglietti P, Zaccherotti G, De BP, Taddei I. A comparison between medial meniscus repair, partial meniscectomy, and normal meniscus in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res 1994;165-173.
- (68) McConville OR, Kipnis JM, Richmond JC, Rockett SE, Michaud MJ. The effect of meniscal status on knee stability and function after anterior cruciate ligament reconstruction. Arthroscopy 1993;9:431-439.
- (76) Noyes FR, Chen RC, Barber-Westin SD, Potter HG. Greater than 10-year results of red-white longitudinal meniscal repairs in patients 20 years of age or younger. Am J Sports Med 2011;39:1008-1017.