Incidence and Healing Rates of Meniscal Tears in Patients Undergoing Repair During the First Stage of 2-Stage Revision Anterior Cruciate Ligament Reconstruction

Nicholas N DePhillipo, Travis J Dekker, Zachary S Aman, David Bernholt, W Jeffrey Grantham, Robert F LaPrade
American Journal of Sports Medicine 2019 November 6, : 363546519878421

BACKGROUND: Meniscal tears, including tears at the root attachment, have been associated with tears of the anterior cruciate ligament (ACL) in both primary and revision settings. However, there is a paucity of literature reporting the healing rates of meniscal repair during 2-stage revision ACL reconstruction (ACLR).

PURPOSE: To evaluate the healing rates of meniscal repairs performed during 2-stage revision ACLR in ACL-deficient knees and to report the incidence of meniscus root tears in patients undergoing primary ACLR as compared with revision ACLR.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Patients who underwent primary and revision ACLR by a single surgeon were retrospectively identified. Revision ACLRs were grouped according to 1- or 2-stage ACLR. Meniscal tears were grouped according to laterality (medial, lateral) and location of tears. Meniscal repair technique was recorded, including transtibial or inside-out. Meniscal repair healing was assessed via second-look arthroscopy at the time of second-stage revision ACLR.

RESULTS: There were 1168 patients identified who underwent ACLR: 851 primary and 317 revision procedures. Sixty-four patients underwent meniscal repair during first-stage bone grafting in ACL-deficient knees, with an overall healing rate of 86%. The healing rates were 82.3% for meniscus root tears via the transtibial repair technique and 92.4% for meniscal peripheral tears via the inside-out repair technique. Meniscus root tears had overall incidences of 15.5% and 26.2% in primary and revision ACLRs, respectively. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs.

CONCLUSION: A high incidence of meniscus root tears was found in patients undergoing revision ACLRs as compared with primary ACLRs. Meniscal repairs have a high rate of healing and success when performed during the first stage of revision ACLR in ACL-deficient knees.

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