Second-Look Arthroscopic Evaluations of Meniscal Repairs Associated With Anterior Cruciate Ligament Reconstruction

PURPOSE:

To examine the healing status of meniscal repair performed concomitantly with anterior cruciate ligament (ACL) reconstruction with our current indication and surgical procedure based on second-look arthroscopic results. Additionally, the significance of the demographic and clinical factors that can potentially influence the healing rate was statistically assessed.

METHODS:

Between January 2009 and January 2015, second-look was performed for patients who opted to have tibial screw removal and agreed to have concomitant arthroscopy. The healing status of the repaired meniscus was classified into 3 conditions: healed, incompletely healed, and not healed. In addition, clinical outcomes were evaluated at a minimal 1-year follow-up. The effects of patient factors on the meniscal healing rate were statistically assessed.

RESULTS:

A total of 217 knees underwent arthroscopic meniscal repair concomitant with ACL reconstruction, while second-look was performed for 105 knees. The average period from index surgery to second-look was 15.0 months. Clinical evaluation was conducted at a mean of 17 months (12-50 months). Based on the second-look arthroscopic findings, 64 menisci, 22 menisci, and 29 menisci were categorized as healed, incompletely healed, and not healed, respectively. When the not healed condition was defined as failed repair, a Tegner activity score of 8 or more, recurrent instability, tears in the red-white to white-white zones, and time from injury to surgery of 4 months or longer were identified as clinical factors significantly correlated with failure (P < .01).

CONCLUSIONS:

Meniscal repair in ACL reconstructed knees with expanded indications achieved a healing rate (including incomplete healing) of 75%. Clinical factors such as high sports activity level, recurrent ACL instability, poor vascularity of the repaired site, and long duration from injury to surgery were shown to impair the healing status.

LEVEL OF EVIDENCE:

Level Ⅳ, therapeutic study, case series.

 2019 Aug 19. pii: S0749-8063(19)30327-5. doi: 10.1016/j.arthro.2019.04.009. [Epub ahead of print]