Revision ACL reconstruction with meniscal repair had less than 10% failure rate at 2-years
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Published results did not show a high failure rate among patients who underwent meniscal repair with revision ACL reconstruction at 2-year follow-up, with failure rates of less than 10% for medial and lateral repairs.
Rick W. Wright, MD, and colleagues in the Multicenter ACL Revision Study (MARS) Group collected demographics, sports participation, injury mechanism, comorbidities and knee injury history among patients who underwent revision ACL reconstruction with concomitant meniscal repair between 2006 and 2011. Researchers also collected KOOS score, WOMAC Index, IKDC subjective form and the Marx Activity Rating Scale.
To determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction, researchers obtained 2-year follow-up by phone and email, as well as operative reports of patients who underwent subsequent surgery to verify the pathologic condition and subsequent treatment.
Of the 1,205 revision ACL reconstructions included in the study, 18% of patients underwent concurrent meniscal repairs, including 153 medial, 48 lateral and 17 medial and lateral, according to the results. Researchers noted 76% of the repairs were performed with all-inside techniques.
Researchers obtained 2-year surgical follow-up among 90% of patients. At 2 years, researchers found patients had a meniscal repair failure rate of 8.6%. Results showed 15 of the 17 failures were medial and two were lateral, with four medial failures treated in conjunction with a subsequent repeat revision ACL reconstruction.
“These results in the MARS Group are generalizable to the sports medicine community with its 52 sites across the country, and 50/50 mix of private and academic surgeons,” Wright told Healio Orthopedics. “Surgeons and patients should pursue meniscal repair when indicated in the revision setting with expectations of excellent results.”
Perspective
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Revision ACL reconstruction surgery can be challenging, as often there is more concomitant damage to the knee, such as articular cartilage wear and meniscus tears, compared to primary ACL reconstruction. In particular, the preservation of meniscus function is critical in this setting, as the meniscus not only acts as a shock absorber to prevent further articular cartilage loss, but is also an important secondary stabilizer in the knee to prevent increased loading of the revision ACL graft.
Therefore, knowing the results of meniscus repair in this setting is essential, and the current authors of the MARS group represent the largest known revision ACL reconstruction prospective cohort to date with over 1,200 patients. At minimum 2-year follow-up, they report a low failure rate of 8.6% for meniscus repair.
I find this data reassuring as it underscores that meniscus repair can and should be performed at the time of revision ACL reconstruction surgery, when indicated. Certainly, comparative data is lacking, but published results from our institution have clearly demonstrated better longer-term outcomes in knees that have preservation of the meniscus. In my opinion, skilled and experienced surgeons who can recognize and treat meniscus injury at the time of revision ACL reconstruction are mandatory to optimize patient outcome.
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