Meniscal repair with ACL reconstruction

Abstract

Approximately 26-60 % of patients with ACL injury reportedly have meniscal tears. In acute ACL injuries, the lateral meniscus is more frequently torn, whereas the medial meniscus is more commonly damaged in chronic injuries. About 60 % of meniscus tears with ACL injuries were located at peripheral posterior portion, and in terms of tear patterns, most were longitudinal tears. For the longitudinal tears at peripheral posterior portion of meniscus, the inside-out repair was recommended, because this technique allows for the secure fixation to the capsule. Especially, we recommend an inside-out “double-stacked vertical divergent suture repair” technique. Regarding clinical outcomes, there are only a few studies that have specifically targeted cases of meniscal repair with concurrent ACL reconstruction (ACLR). At early follow-up, high success rates have been reported (90-96 %), whereas long-term studies show a decline in success rates with time. Long-term outcomes after meniscal repair in patients undergoing concurrent ACLR are limited to case series, with failure rates ranging from 0 % to 29 % at a minimum of 5 years of follow-up. In addition to these studies, those that have assessed prognostic factors affecting the outcomes of meniscal repair with concomitant ACL injury have been published. Yet, some negative prognostic factors exist for meniscal healing in cases of ACLR. For meniscal healing with ACLR, it is critical to reconstruct the ACL to avoid knee instability which can lead to failure of the meniscal repair.