Meniscal Repair Outcomes in Revision ACL Reconstructions

摘要

Objectives: Meniscal preservation has been demonstrated to contribute to long term knee health. This has been a successful intervention in the isolated and ACL reconstructed patient. The results of meniscus repair in the setting of revision ACL reconstruction have never been documented to any significant extent. The MARS group offers with its large cohort of revision ACL reconstructions the opportunity to explore this issue. Methods: The MARS Group was assembled with the aim of determining what impacts outcome in an ACL revision setting, and to identify potentially modifiable factors that could improve these outcomes. This collaboration consists of a group of 83 sports medicine fellowship trained surgeons across 52 IRB approved sites. Surgeons are a near equal mix of academic and private practitioners. Surgeons document surgical technique and intraarticular findings including meniscal and chondral damage and their treatment.All revision ACL reconstruction with meniscal repair cases from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by both phone and email to determine whether any subsequent surgery had occurred to either knee since their initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify pathologic condition and treatment. Results: 1215 patients were enrolled. 235 repairs were performed in 218 patients (19.5% of the cohort): 170 were medial, 65 lateral and 17 medial and lateral. 178 (76%) were performed with all-inside techniques. 17 repairs failed by 2 year follow up: 15 medial (8.8%; 13 all inside, 2 outside in) and 2 lateral (3.1%; both all inside). 4 of the medial failures were treated in conjunction with a subsequent repeat revision reconstruction. Conclusion: Meniscus repair in the revision setting is a successful treatment choice when appropriate. Failure rates for medial and lateral tears were both less than 10% and consistent with primary ACL reconstruction meniscus repair success rates. Medial tears underwent reoperation for failure at a statistically significant higher rate than lateral tears.