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Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes

  • Mohamed Sarraj
  • Ryan P. Coughlin
  • Max Solow
  • Seper Ekhtiari
  • Nicole Simunovic
  • Aaron J. Krych
  • Peter MacDonald
  • Olufemi AyeniEmail author
KNEE

Abstract

Purpose

The aim of this review was to compare the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with either meniscal repair or meniscectomy for concomitant meniscal injury. The primary hypothesis was that short-term clinical outcomes (≤ 2-year follow-up) for ACLR concomitant with either meniscal repair or resection would be similar. The secondary hypothesis was that ACLR with meniscal repair would result in better longer term outcomes compared with meniscal resection.

Methods

The authors searched two online databases (EMBASE and MEDLINE) from inception until March 2018 for the literature on ACLR and concurrent meniscal surgery. Two reviewers systematically screened studies in duplicate, independently, and based on a priori criteria. Quality assessment was also performed in duplicate. The Knee injury and Osteoarthritis Outcome Score (KOOS) sub-scale scores at 2 years post-operatively were combined in a meta-analysis of proportions using a random-effects model.

Results

Of 2566 initial studies, 25 studies satisfied full-text inclusion criteria. Mean follow-up was 2.09 years, with a total sample of 37,087 subjects including controls. The meta-analysis demonstrated equivocal results at 2 years, except for KOOS symptom scores which favoured meniscal resection over repair. Mean KT-1000 side-to-side difference (SSD) scores were 1.51 ± 0.60 mm for meniscal repair, 1.96 ± 0.36 mm for meniscal resection, and 1.58 ± 0.20 for control patients (isolated ACLR). Medial meniscal repair showed decreased anterior knee joint laxity compared to medial meniscal resection (P < 0.001). Patients with meniscal repair had higher rates of re-operation (13.3% vs 0.8% for meniscal resection, P < 0.001).

Conclusion

Patients with ACLR combined with meniscal resection demonstrate better symptoms at 2-year follow-up compared to patients with ACLR combined with meniscal repair. ACLR combined with meniscal repair results in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term, but also higher re-operation rates.

Level of evidence

III.

Keywords

Anterior cruciate ligament reconstruction Meniscectomy Meniscal repair 

Abbreviations

AAOS

American Academy of Orthopaedic Surgeons

AAOSM

American Orthopaedic Society for Sports Medicine

ACL

Anterior cruciate ligament

ACLR

ACL reconstruction

CKRS

Cincinnati knee rating system

ESSKA

European Society for Sports Traumatology, Knee Surgery and Arthroscopy

EQ-5D

EuroQol-5D

GRADE

Grading of Recommendations Assessment, Development, and Evaluation

IKDC

International Knee Documentation Committee

ISAKOS

International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

KOOS

Knee injury and Osteoarthritis Outcome Score

MOON

Multicenter Orthopaedic Outcomes Network

MR

Meniscal repair

MM

Partial menisectomy

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-analyses

R-AMSTAR

Revised Assessment of Multiple Systematic Reviews

RCT

Randomized controlled trial

MINORS

Methodological Index for Non-randomized Studies

SSD

Side-to-side difference

VAS

Visual Analog Scale

WOMAC

Western Ontario and McMaster Universities Osteoarthritis Index

Notes

Author contributions

All authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; provided final approval of the version to be published; and agreed to act as guarantor of the work (ensuring that questions related to any part of the work are appropriately investigated and resolved).

Funding

No funding was received for the implementation of this study.

Compliance with ethical standards

Conflict of interest

ORA is a paid consultant for ConMed. PM receives fellowship support from Conmed Ossur and Arthrex. The authors have no other potential conflicts of interests to declare.

Ethical approval

 This review did not involve primary data collection from patients and as such research approval was not obtained.

Supplementary material

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.DeGroote School of MedicineMcMaster UniversityHamiltonCanada
  2. 2.Division of Orthopaedic Surgery, Department of SurgeryMcMaster UniversityHamiltonCanada
  3. 3.St. George’s University, University Centre GrenadaWest IndiesGrenada
  4. 4.Department of Orthopedic Surgery and the Sports Medicine CenterMayo Clinic and Mayo FoundationRochesterUSA
  5. 5.Department of SurgeryUniversity of ManitobaWinnipegCanada
  6. 6.Department of Health Research Methods, Evidence, and ImpactMcMaster University Medical CentreHamiltonCanada

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