Concomitant meniscal repair and resection are not associated with ACL reoperation, and successful meniscal repair preserves patient-reported outcomes: A 2-year retrospective cohort study.

PURPOSE: To compare 2-year anterior cruciate ligament reconstruction (ACLR) reoperation rates, subsequent meniscal procedures, patient-reported outcome measures (PROMs) between isolated ACLR and ACLR with concomitant meniscal repair or resection, including subgroup analyses of successful and failed repair, respectively, repair laterality. Higher subsequent meniscal procedure rates and inferior PROMs driven by failed repairs were hypothesised for concomitant repair, and inferior PROMs for combined versus medial or lateral repairs.

METHODS: Patients undergoing primary ACLR with or without concomitant meniscal procedure at Capio Artro Clinic, Stockholm, Sweden, (2015-2022) were included. ACL reoperations, subsequent meniscal procedures within 2 years were identified through medical records. The knee injury and osteoarthritis score (KOOS) was collected preoperatively and at 2 years. The PROMs minimal important change (MIC), patient-acceptable symptom state (PASS) and treatment failure (TF) were evaluated using KOOS4. Multivariable logistic regression was performed for subsequent meniscal procedure, ACL reoperation and PROMs. Subgroup analysis compared PROMs by repair success and repair laterality.

RESULTS: Among 5387 primary ACLRs, 1305 and 1097 underwent concomitant meniscal repair respectively resection. The mean age was 29.7 ± 12.1 years, 51.0% were male. Meniscal repair had more subsequent procedures (11.3%) than resection (4.8%) or isolated ACLR (5.4%, p = 0.02), and was associated with subsequent meniscal procedure (odds ratio [OR] = 1.58, 95% confidence interval [CI]: 1.16-2.16; p = 0.004). ACL reoperation rates were comparable across groups. Successful repair demonstrated MIC (40.0%), TF (8.9%), similar to isolated ACLR (31.4%, 5.4%). Failed repair was associated with TF (OR = 2.04, CI 1.06-4.31; p = 0.03). Lateral repair yielded superior MIC (45.2%, p = 0.04), PASS (58.2%, p < 0.001) than medial (37.1%, 45.2%), combined (32.4%, 36.6%) repair.

CONCLUSION: ACLR with concomitant meniscal repair showed higher rates of subsequent meniscal procedures and worse PROMs than isolated ACLR or concomitant meniscal resection, predominantly driven by failed repairs. Successful repairs achieved PROMs comparable to isolated ACLR. These findings support meniscal preservation, while emphasising the need to improve repair success.

LEVEL OF EVIDENCE: Level III.