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.
 

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