During ACL reconstruction, small asymptomatic meniscal lesions can be left untreated: a systematic review

Abstract

Importance: Rupture of the anterior cruciate ligament (ACL) of the knee is a commonly occurring injury in the athletic population. Associated meniscal and chondral injury is well recognised. This occurs at both the time of index injury and secondarily over time in the ACL-deficient knee. There are different treatment options to manage meniscal tears during ACL reconstruction (repair, meniscectomy, lesion left in situ) and the place of the non-operative treatment of such meniscal lesions remains unclear., Objective: This article reviews the contemporary literature about the indications and results of leaving meniscal lesions without treatment during ACL reconstructions., Evidence review: PubMed was searched for eligible studies. 15 studies met the inclusion criteria, including 1485 untreated meniscal tears (843 lateral meniscus, 642 medial meniscus)., Findings: The outcomes of untreated meniscus lesions during ACL reconstruction demonstrated low rates of failures for lateral meniscus tears (between 0% and 7% if the lesion remains posterior to the popliteus tendon), whereas 12-15% of untreated medial meniscus tears underwent reoperation., Conclusions and relevance: This systematic review was in favour of leaving small lateral meniscus lesions during ACL reconstruction without additional risk of subsequent meniscectomy., For the medial meniscus, the risk might be still present, even for small lesions., (C) 2016 BMJ Publishing Group Ltd